Inclusion Criteria | |
• Outpatients 18 to 60 years of age. | |
• DSM-IV-TR criteria for MDE in MDD, as confirmed by the MINI. | |
• Depressive episode duration ≥3 months. | |
• Free of psychotropic medications for at least 5 half-lives (i.e. 1 week for most antidepressants, 5 weeks for fluoxetine) before baseline. | |
• Score ≥24 on the MADRS. | |
• Fluent in English, sufficient to complete the interviews and self-report questionnaires. | |
Exclusion Criteria | |
• Diagnosis of Bipolar I or Bipolar II disorder. | |
• Any other psychiatric diagnosis that is considered the primary diagnosis. | |
• Any significant personality disorder diagnosis (e.g., borderline, antisocial) that might interfere with participation in the protocol, defined by clinician judgment. | |
• High suicidal risk, defined by clinician judgment. | |
• Substance dependence/abuse in the past 6 months. | |
• Significant neurological disorders, head trauma, or other unstable medical conditions. | |
• Pregnant or breastfeeding. | |
• Psychosis in the current episode. | |
• High risk for hypomanic switch (i.e., history of antidepressant-induced hypomania). | |
• Failed 4 or more adequate pharmacologic interventions (as determined by the ATHF). | |
• Previously failed or showed intolerance to escitalopram or aripiprazole. | |
• Started psychological treatment within the past 3 months with the intent of continuing treatment. | |
• Contraindications to MRI. |