The purpose of this study is to compare treatment outcomes between measurement based Algorithm Guided Treatment and Treatment As Usual strategies in a Chinese population with major depressive disorder.
Inclusion Criteria: * Meets Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for single or recurrent nonpsychotic major depressive disorder * Age 18-75 * Written informed consent completed * Scores 14 or higher on the 17-item Hamilton Depression Rating Scale * Initial treatment with escitalopram or mirtazapine or other antidepressants is clinically appropriate Exclusion Criteria: * History of bipolar disorder * Concurring psychotic disorders * Scores 3 or higher on item 3 (suicidal) of HRSD-17 * History of nonresponse to an adequate trial of escitalopram and/or mirtazapine * Has general medical condition, which contraindicates any leve 1 or 2 treatment option * Is on concomitant medication, which contraindicates any leve 1 or 2 treatment option * Any contraindication for mECT or rTMS * Is pregnant or breast feeding or is planning to get pregnant