Genecept Assay™ vs. Treatment-as-Usual to Evaluate Efficacy of Assay-Guided Treatment in Adults With MDD

Inclusion Criteria:

1. Age 18-75 years; Sub-Group Age =/> 65 years

2. Ability to understand and provide informed consent

3. Ability to understand, read and speak English

4. Primary diagnosis of Major Depressive Disorder (without psychosis) based on DSM-5
criteria and MINI 7.0

5. SIGH-D-17 score >18 (i.e., moderate depression) at Screening and Baseline

6. Failure of at least 1 prior adequate trial of standard antidepressant in the current
major depressive episode (using ATRQ criteria - i.e., 6 weeks at adequate dose) due
to inefficacy, side effects or intolerability

7. Subject is willing to follow study instructions, complete study assessments and
likely to complete all required visits

Exclusion Criteria:

1. Severe personality traits (based on DSM-5 criteria) that in the opinion of the
investigator may interfere with the participation in the study or the evaluation of
efficacy and safety and all diagnosed Personality Disorders

2. Current DSM-5 diagnosis of Neurocognitive Disorders, Schizophrenia Spectrum (lifetime
diagnosis) and other Psychotic Disorders, Bipolar and Related disorders (lifetime
diagnosis*), Trauma and Stress related Disorders, Obsessive Compulsive Disorder and
Related Disorders. Other DSM-5 disorders that in the opinion of the investigator may
interfere with the participation in the study or the evaluation of efficacy and
safety.

3. DSM-5 diagnosis of Substance Related and Addictive Disorders diagnosed in the last 12
months (other than tobacco and caffeine)

4. History of Suicidal Behavior within 12 months of screening or presence of Active
Suicidal Ideation with Intent in the past 12 months (Items 4 or 5) at Screening or
Baseline, as determined by the Columbia Suicide Severity Rating Scale (C-SSRS), or
subject is considered to be an acute suicide risk in the clinical judgment of the
investigator

5. Previous homicidal behavior or acute homicidal risk at Screening or Baseline, in the
clinical judgment of the investigator

6. Four (4) or more failed pharmacologic interventions for depression in the current
major depressive episode (One of the four failed interventions must meet ATRQ
criteria - i.e., 6 weeks at adequate dose).

7. Subjects who are not willing to take psychotropic medications for treatment of MDD.

8. Electroconvulsive therapy (ECT) or transcranial magnetic stimulation therapy (TMS)
started within 90 days of screening or planned during the study.

9. Subjects with a vagus nerve or deep brain stimulator are prohibited from the trial.

10. Psychotherapy including cognitive behavioral therapy (CBT), or dialectical behavioral
therapy (DBT) started within 90 days of screening or planned during the study.

11. Unstable or active medical condition(s) which in the opinion of the investigator
would jeopardize the subject's safety or interfere with participation of the study or
confound evaluation of efficacy or safety.

12. Current diagnosis of unstable hypothyroidism.

13. Females who are pregnant, nursing, or planning a pregnancy during the study or
believe they may be pregnant at Screening or Baseline.

14. Participation in another investigative trial within 30 days of screening

15. Subject previously treated with the use of a similar psychotropic genetic testing
assay.

16. Subject tests positive for illicit drug use on the urine drug screen (UDS) at the
screen visit (including Marijuana where legal).