 5. All patients will complete a disease specific assessment tool QIDS-SR16 at every office visit at a minimum assessments at baseline, 3 months into treatment, and 6 months into treatment. Patients choosing to withdraw from the study or from treatment will also be offered the assessment at participation endpoint. COTA will score each patient based on the standardized tools as either improved, stable, or worsened. The primary endpoint for this study is QIDS-SR16 percent mean change from baseline, with response being defined as a reduction of 50 from baseline. Physicians may know the results of these tests and may alter therapy per their usual practice. 