Patient description: A 46-year-old Asian woman with MDD complains of persistent feelings of sadness and loss of interest in daily activities. She states that her mood is still depressed most of the days. She complains of loss of energy and feelings of worthlessness nearly every day. She is on anti-depressants for the past 6 months, but the symptoms are still present. She does not drink alcohol or smoke. She used to exercise every day for at least 30 min., but she doesn't have enough energy to do so for the past 3 weeks. She also has some digestive issues recently. She is married and has 4 children. She is menopausal. Her husband was diagnosed with colon cancer a year ago and is undergoing chemotherapy. Her past medical history is unremarkable. Her family history is negative for any psychologic problems. Her HAM-D score is 20.

Clinical trial eligibility criteria: eligible ages (years): 18.0-70.0,  Major Depressive Disorder Primary diagnosis by DSM-IV for Major Depressive Episode, single or recurrent episode as confirmed by the Structured Clinical Interview for the DSM-IV (SCID-IV), with the additional stipulation of a duration for this episode of greater than or equal to 4 weeks and CGI-S greater than or equal to 4 Duration of current episode of depression less than 3 years (the definition of an episode is demarcated by a period of greater than or equal to 2 months when the patient did not meet full for the DSM-IV definition of major depressive episode) Total HAM-D17 score of greater than or equal to 20 and Item 1 score greater than or equal to 2 at screening visit Medication resistance to at least two different antidepressant treatments, defined as resistance to a minimum of 1 and a maximum of 4 antidepressant drug trials of adequate dose and duration in the current episode with adequate dose and duration defined as minimum level 3 on the Antidepressant Treatment History Form (ATHF); or, if patient has not received a sufficient number of antidepressant treatments to assess their medication resistance in the current episode, then the patient must meet level 3 medication resistance by ATHF to at least 1 and no more than 4 drug trials in a previous episode Patients who have not completed antidepressant trials of adequate dose and duration due to intolerance to therapy may be included if they have demonstrated intolerance to greater than or equal to 4 anti-depressant medications in the current or a previous episode, and did not meet ATHF for a single adequate treatment trial in the current episode Capable and willing to provide informed consent Signed HIPAA authorization Able to adhere with the treatment schedule, and withdrawal of ongoing pharmacotherapy If currently taking antidepressant pharmacotherapy, must be clinically appropriate to discontinue treatment with those agents  Investigators, site personnel directly affiliated with this study, and their immediate families (immediate family is defined as a spouse, parent, child or sibling, whether by birth or legal adoption) Individuals diagnosed by the Investigator with the following conditions (current unless otherwise stated) Depression secondary to a general medical condition, or substance-induced Seasonal pattern of depression as defined by DSM-IV History of substance abuse or dependence within the past year (except nicotine and caffeine) Any psychotic disorder (lifetime), including schizoaffective disorder, or major depression with psychotic features in this or previous episodes Bipolar disorder Eating disorder (current or within the past year) Obsessive compulsive disorder (lifetime) Post-traumatic stress disorder (current or within the past year)