Eligibility Criteria:
Inclusion Criteria:
* Adults 40 to 65 years of age at time of screening visit.
* Women only: Must be post-menopausal at time of screening visit (i.e., defined by NO menstruation for at least the past 12-months).
* Diagnosis of T2D, as defined by a diagnosis of T2D (for at least 12 months) in the medical record made by a physician (i.e., denoted as 250.XX according to ICD-9/ICD-10 billing codes) OR
* current use of oral hypoglycemic medications or insulin OR
* having a fasting plasma glucose ≥126 mg/dL in the medical record OR
* having a 2-hour oral glucose tolerance test ≥200 mg/dL in the medical record
* Patients who meet criteria for current MDD without significant co-morbid psychiatric diagnoses, as determined by study PI from screening visit:
* Clinical Psychiatric Interview to determine DSM-V criteria for current MDD AND
* A minimum score of 18 on the Hamilton Depression Scale (HAM-D)
* Patients with T2D and current MDD that would benefit from antidepressant therapy, which may include:
* Patients with current MDD who were NOT prescribed an antidepressant medication in the past;
* Patients with current MDD who are NOT responding to their current prescribed antidepressant;
* Patients with current MDD who are experiencing breakthrough depressive symptoms despite being maintained on another antidepressant.
* Must have the ability to provide informed consent to participate in the study.
Exclusion Criteria:
* Patients with any form of contraindication to Vortioxetine treatment, as outlined in the medication packet insert, (e.g., presence of a known hypersensitivity to the study drug or hypersensitivity to MAO-I use, etc.).
MRI-Related Exclusion Criteria
* Participants weighing \>550 lbs (per MRI weight restrictions set by Loyola University Medical Center);
* Patients with a pacemaker, AICD, ossicular prosthesis, nerve stimulator, or another contraindication to MRI;
* Pregnant patients;
* Patients with an inability to tolerate being in enclosed places/spaces such as MRI;
* Patients with a history of neurosurgery, brain irradiation, or cerebral endovascular treatment.;
* Patients with history of epilepsy, stroke, neurodegenerative disorder, severe traumatic brain injury, hydrocephalus or demyelinating disorder;
* Patients with a history of malignant neoplasm
Exclusion Criteria to Reduce False Positive Rates of Inflammation
* Specific pre-existing chronic pain conditions such as rheumatoid arthritis or fibromyalgia. However, this will NOT include more localized pain-related conditions such as low-back pain or complications associated with T2D (e.g., diabetic neuropathy).
* History of peptic ulcer complicated by perforation, hemorrhage, or obstruction; symptoms of peptic ulcer within 4 weeks of enrollment date that has not been treated.
* Current diagnosis of substance abuse/dependence during the 6 months prior to study enrollment.
* Current diagnosis of uncontrolled hypertension, anemia, liver disease, kidney disease, stroke, and autoimmune disease. Based on the clinical judgment of the study PI, a risk assessment will be conducted if a participant endorses any of these diagnoses but would be otherwise a suitable participant to enroll in the study.
* Current acute infection/infectious disease (i.e., a cold or the flu). Based on the clinical judgement of the study PI, a risk assessment will be conducted if a participant endorses some acute infection/infectious disease, but would be otherwise suitable to enroll in the study following a brief wait period for full symptom remission.
* Pre- and peri-menopausal women (i.e., defined as the presence of ANY menstruation within the past 12 months).
* Certain steroids (e.g., use of hormonal birth control) and any systemic corticosteroids. Please note that hormone replacement therapy will be allowed along with any topical corticosteroid creams.
* Patients currently enrolled in any other clinical trial for treatment of MDD (e.g., patients receiving experimental vitamin D supplementation).