Despite a proliferation of pharmaceutical options for the treatment of major depression over the past 20 years, reported remission rates among patients given antidepressants have remained stubbornly low. Clinicians confronted with an inadequate antidepressant response have four options open to them—a dose adjustment, a switch to an alternative antidepressant, the introduction of another drug not considered itself an antidepressant (augmentation), or the addition of another antidepressant. Unfortunately, controlled trials have yielded very limited support for the first, second, and last of these options, and evidence for augmentation strategies concerns chiefly the use of lithium or T3 with tricyclic antidepressants, rather than with the antidepressants now in wide use (1). Indeed, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project revealed discouraging response rates when either of these was used in the face of inadequate response to a selective serotonin reuptake inhibitor (SSRI) (2). There do now exist a number of large, industry-sponsored trials that have shown the addition of atypical antipsychotics to be helpful in the face of inadequate responses to SSRIs or to serotonin-norepinephrine reuptake inhibitors (SNRIs) (1). Their use, though, often entails adverse metabolic consequences and/or considerable added expense.