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): 18.0-999.0,  Major Depressive Disorder (MDD) Be able to understand the requirements of the study and provide written informed consent to participate in this study; a signed and dated ICF will be obtained from each patient before participation in the study Have provided written authorization for the use and disclosure of their protected health information Be ≥18 years of age Suffer from a Major Depressive Episode meeting DSM-IV-TR criteria Have had an inadequate response within the current episode to at least 1 psychotropic treatment. Inadequate response is defined as inadequate efficacy after 6 weeks of a psychotropic treatment or discontinuation of a psychotropic treatment due to AEs or intolerability Have a total baseline score on the QIDS-C16 and QIDS-SR16 rating scale ≥11 Agree to abide by the study protocol and its restrictions and be able to complete all aspects of the study, including all visits and tests  Patients posing a serious suicidal risk and/or in need of immediate hospitalization as judged by the investigator Patients with a diagnosis of Bipolar I or II disorder Patients with a current Axis I diagnosis of: 1. Delirium 2. Dementia 3. Amnestic and other cognitive disorder 4. Schizophrenia or other psychotic disorder Patients having experienced hallucinations, delusions, or any psychotic symptomatology within the current depressive episode or during prior depressive episodes Patient is currently in an inpatient facility Patients with a history of hypothyroidism unless taking a stable dose of thyroid medication and asymptomatic or euthyroid for 6 months Patients who meet DSM-IV-TR for any significant current substance use disorder Patients with significant unstable medical condition; life threatening disease; hepatic insufficiency (3X ULN for AST and/or ALT); liver transplant recipient; cirrhosis of the liver; need for therapies that may obscure the results of treatment and/or of the study; malignancy (except basal cell carcinoma) and/or chemotherapy within 1 year prior to screening; malignancy more than 1 year prior to screening must have been local and without metastasis and/or recurrence, and if treated with chemotherapy, without nervous system complications Participation in another clinical trial within 30 days of the screening visit Anticipated inability to attend scheduled study visits