Clinical Research Directory

Inclusion Criteria: 1. male or female, 18-65 years old; 2. able to provide written informed consent voluntarily; 3. had a diagnosis of major depression disorder (MDD) (recurrent episodes) without psychotic features in compliance with the Diagnostic and Statistical Manual of Mental Disorders -Fourth Edition -Text Revised (DSM-IV-TR) and confirmed by the Mini-International Neuropsychiatric Interview Chinese version 5.0; 4. failure of response to at least two antidepressant medication trials based on the Massachusetts General Hospital antidepressant treatment response questionnaire (MGH-ATRQ); 5. ongoing antidepressant(s) at a fixed dose for at least four weeks before baseline assessment; 6. had a score of ≥201 on the Hamilton Depression Scale- item 17 (HAMD-17) at baseline. Exclusion Criteria: 1. presence of other psychotic disorders; 2. have a treatment history that includes electroconvulsive therapy (ECT), modified electroconvulsive therapy (MECT), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), DBS, and transcranial magnetic stimulation (TMS); 3. presents a suicide risk (defined as a HAMD-17 score of ≥3 on suicide-related items); 4. experience difficulty in effectively communicating with investigators; 5. with a history of traumatic brain injury (TBI); 6. with intracranial or cardiovascular stents; 7. substance abuse within the past six months; 8. unstable neurological or coagulation disorders; 9. women who are pregnant, lactating, or of childbearing potential who refuse the use of reliable contraception during the study; 10. have been involved in other clinical studies within three months before enrollment in this study; 11. any conditions considered by the study group.