 Because no randomized, controlled trials exist to suggest that current medical treatment is effective in these patients, and because a substantial placebo effect is a known reality, the design of this study citalopram vs. placebo is appropriate. Patients are commonly referred to the DVBIC with mild-moderate mood and anxiety symptoms. We have cared for several clinically anxious patients who refused medications. We worked with them in a supportive educational framework, and in some cases, their anxiety remitted. Thus, the best treatment for these patients is far from established. It is likely that this and other future research will help clarify which treatments are best for which patients. 