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): 21.0-85.0,  Major Depressive Disorder to 85 Years of age Diagnosis of Stage I, II or III cancer Histologically-proven malignancy Receiving or within one year of having received cancer treatment with radiation and/or chemotherapy Montgomery and Åsberg Depression Rating Scale (MADRS) ≥ 20 (moderate to severe depressive symptoms) Duration of depressive symptoms ≥ 2 weeks by patient report No active/acute suicidality requiring immediate care or psychiatric hospitalization Sufficient English language proficiency to complete all assessments without assistance Able to swallow pills No severe anemia, defined as hemoglobin < 10 g/dL  Have a current or previous diagnosis of or history consistent with obsessive-compulsive disorder, posttraumatic stress disorder, bipolar I or II, manic or hypomanic episodes, schizophrenia, major Axis II disorders which might compromise the study, or major depression with psychotic symptoms, as assessed using the MINI International Neuropsychiatric Interview (MINI Plus) Have a documented history of an intellectual disability Use of any antidepressant medication in the last 2 weeks before visit 1 (4 weeks for fluoxetine) Currently being treated with tamoxifen Subjects who were non-responsive to two or more courses of antidepressant medications given at an adequate dosage* for symptom treatment within four weeks, or by the judgment of the investigator considered to have treatment resistant depression (TRD), or a history of electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) or psychosurgery within the last year Have a history of any seizure disorder Any clinically significant abnormal vital sign, ECG, or laboratory values as determined by the investigator which might interfere with the study Have a high suicidal risk as assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS). High suicidal risk is indicated by: 1. A positive response to question 4 or 5, indicating endorsement of suicidal ideation with at least some intent to act in the past month; and/or 2. A positive response to part two of question 6, indicating the presence of any suicidal behavior in the past 3 months Have a history of substance dependence/abuse** within the past 6 months or a positive drug screen result during the screening period Have a history of severe allergies to more than 1 class of medication or multiple adverse drug reactions