Brain Changes During Social Reward Psychotherapy for Mid- and Late-Life Suicidality

This study is testing a type of psychotherapy called Social Reward Psychotherapy — which focuses on increasing positive social connections and meaningful rewards in life — for older and middle-aged adults (ages 50–80) who are experiencing suicidal thoughts alongside major depression. Researchers are also using brain imaging to understand how this therapy changes brain activity. **You may be eligible if:** - You are 50–80 years old (with half the spots reserved for those over 65) - You have major depressive disorder diagnosed by a structured clinical interview - You have expressed suicidal thoughts at a significant level (as measured by a standard interview) - Your depression score is 16 or higher on the MADRS scale - You are not currently receiving individual psychotherapy, and your antidepressant dose (if any) has been stable for at least 8 weeks - Your cognitive function is intact (MMSE score of 23 or higher) **You may NOT be eligible if:** - You have an intent or specific plan to attempt suicide in the near future (requiring immediate intervention) - You have another psychiatric diagnosis beyond depression, generalized anxiety, or specific phobia - You have a neurological condition such as dementia, Parkinson's disease, or epilepsy - You have had a serious medical event in the past 3 months (such as a stroke, heart failure, or major surgery) - You are taking psychotropic medications other than a low dose of lorazepam or a stable antidepressant Talk to your doctor to see if this trial is right for you.