Drug Therapy to Treat Minor Depression

Inclusion Criteria: Minor Depression symptoms for at least 6 months Endorse one of the DSM-IV "A" criteria for MDD and at least one other symptom of MDD or endorse both of the "A" criteria for MDD Global Assessment of Functioning (GAF) score < 70 Short form health survey (SF-36) social functioning score <= 75% or an emotional role functioning score <= 67% HAM-D-17 score 10-17, inclusive Minor depression symptoms for at least 6 months Exclusion Criteria: Major depressive disorder (MDD) or dysthymia within the past year or in partial remission of MDD At least a 12-week course of either citalopram at a minimum or 40 mg/day or St. John's Wort at a minimum of 900 mg/day during the current episode of depression Previous intolerance to either citalopram or St. John's Wort or history of nonresponse to either citalopram at a minimum of 40 mg/day or St. John's Wort at a minimum of 900 mg/day for at least 12 weeks Unstable medical illness, including cardiovascular, hepatic, renal, respiratory, endocrine, neurologic, or hematologic disease Uncontrolled seizure disorder The following DSM-IV diagnoses: organic mental disorders; substance use disorders, including alcohol, active within the last year or patients with a positive urine drug screen; schizophrenia; delusional disorder; psychotic disorders not elsewhere classified; bipolar disorder; bereavement; adjustment disorder; antisocial personality disorder; panic disorder, social phobia, generalized anxiety disorder (GAD), or obsessive compulsive disorder (OCD). Patients may have a lifetime diagnosis of an anxiety disorder as long as it is not current. Mood-congruent or mood-incongruent psychotic features Psychotropic drugs Hypothyroidism Investigational psychotropic drugs within the last year Positive toxicology screen Medications metabolized by the CYP3A4 system, where induction of this system poses a risk to the medical stability of the patient Pregnancy or refusal to use a medically accepted method of contraception Serious suicide or homicide risk Psychotherapy beginning less than 3 months ago