 If a patient has severe depression not responding to test articleplacebo, and the treating physician deems antidepressant medication necessary, a non-SSRI medication, nortriptyline, will be used as the first line medication. Nortriptyline has been shown effective in post stroke depression 18, and may be monitored by plasma levels, thus being a good medication to combine with either placebo or sertraline. If nortriptyline is not effective or if nortriptyline is not appropriate for that particular patient, the treating physician will chose whatever antidepressant is clinically indicated. Appropriate clinical care of the patient is the first priority. 