VA Augmentation and Switching Treatments for Improving Depression Outcomes

Inclusion Criteria:

   - DSM-IV diagnosis of single or recurrent, non-psychotic, major depressive disorder

   - Currently taking a selective serotonin reuptake inhibitor (SSRI) or
   serotonin-norepinephrine reuptake inhibitor (SNRI) or mirtazapine for major depressive
   disorder

   - Need for "next-step" treatment based on documented suboptimal outcome from current
   antidepressant treatment for major depressive episode (at least 6 weeks treatment with
   a QIDS-C16 >= 16 or at least 8 weeks with a QIDS-C16 >= 11; and at least 3 weeks at a
   stable "optimal" dose

   - Age: 18 years of age or older

Exclusion Criteria:

   - Prior inadequate response after an adequate treatment trial or clear cut intolerance
   to either of the study medications (aripiprazole or bupropion)

   - Current treatment with bupropion, aripiprazole or any other antipsychotic agent

   - Lifetime history of bipolar disorder, schizophrenia, schizoaffective disorder, or
   psychosis not otherwise specified

   - Current diagnosis of Dementia

   - Current diagnosis of an eating disorder or a seizure disorder

   - High suicide risk currently requiring acute intervention (other than outpatient
   treatment of depression)

   - Unstable, serious medical condition or one requiring acute medical treatment, or
   anticipation of hospitalization for extended care

   - Requiring immediate hospitalization for psychiatric disorders

   - Physiologic substance dependence requiring detoxification (excluding nicotine) in the
   past 30 days (substance abuse is not an exclusion criteria)

   - Taking any concomitant medication that contraindicates any of treatment options or
   augmenting agents known to have an antidepressant effect

   - Concurrent or recent participation (within the last 30 days) in another conflicting
   clinical trial with a mental health, investigational drug, or medical device
   intervention

   - Female - pregnant or lactating or planning to become pregnant

   - Patient was not able or willing to provide informed consent; or changed mind about
   participating prior to randomization

   - Patient was not referred to the study