rEEG Guided Pharmacotherapy of Subjects With Depression Treatment Failure

This study is testing a process (rEEG)for selecting the most appropriate medication(s) to treat a patient's depression versus a control group being treated according to a standardized method, the modified Star\*D Algorithm. Qualified subjects will be randomized to the experimental (rEEG guided) group, or the control group and treated for 10 weeks. Medications utilized in this study are currently marketed. All visits, physical exam, rEEG, labs, rating scales and medications are provided at no cost to the patient. To qualify for entry into the study, patients must be: 1. 18 years of age or older. 2. Diagnosis of Major Depressive Disorder. Subjects may meet criteria for both melancholic and atypical depression. 3. Have failed 1 or more SSRIs, or have failed 2 or more antidepressants in at least 2 drug classes. And patients must not have: 1. History of: closed head injury with unconsciousness, craniotomy, cerebral metastases, cerebrovascular accident; no current diagnosis of seizure disorder, bipolar disorder, schizophrenia, dementia, mental retardation, substance abuse, or major depression with psychotic features; or use of depot neuroleptics in last 12 months. 2. Known pregnancy and/or lactation, or intent to become pregnant during this study. Medications that can be used in this study are: Anti-depressants: fluoxetine, sertraline, paroxetine, desipramine, imipramine, nortriptyline,amitriptyline, clomipramine, bupropion, venlafaxine Stimulants \& MAO Inhibitors: moclobemide, tranylcypromine, selegiline, methylphenidate, dextroamphetamine, dexlevoamphetamine, pemoline, lamotrigine, topiramate Benzodiazepines: lorazepam, clonazepam, alprazolam Anti-convulsants: carbamazepine, lithium, divalproex, gabapentin Beta Blockers: metoprolol, propranolol, atenolol