Inclusion Criteria:  patients 18-65, patients with diagnosis of MDD, PHQ-9 score > 10 at screening and baseline  Exclusion Criteria:  history of mania, hypomania, or psychosis as defined in DSM V current substance abuse, including abuse within the previous 6 months patients with a cognitive disorder or dementia patients with other axis I diagnosis (anxiety disorders, dissociative disorders, etc.) that was primary in the past 6 months receiving other forms of manual therapy during study authors belief that there was significant suicidal risk changes in medication or psychotherapy within 6 weeks of starting study or during study period history of migraines presence of any other significant organic disease (infectious, cardiac, pulmonary, gastrointestinal, renal, etc.) other absolute contraindications to OMT (malignancy, infection, myelopathy, severe osteoporosis, increased ICP, intracranial bleeding, fractures, etc.)