Zisook S, et al. - Remission could not be attained in nearly two-thirds of patients with major depressive disorder with initial treatments, so researchers assessed patient baseline features for clues to help clinicians choose next-step treatments. They analyzed data of 1,522 Veterans Health Administration patients who had an inadequate response to at least one course of antidepressant treatment meeting minimal standards for dosage and duration from the US Department of Veterans Affairs (VA) Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study. Individuals who were employed, less severely and chronically depressed, less anxious, not experiencing complicated grief symptoms, did not experience childhood adversity, and had a better quality of life and positive mental health were more likely to achieve remission. Specific next-step treatment selections were informed by the following two features: age ≥65 years (augmentation with aripiprazole was noted more effective than switch to bupropion) and severe mixed hypomanic symptoms (augmentation with aripiprazole and combination with bupropion were identified more effective than switch to bupropion). These preliminary findings may help clinicians to identify the next-step treatment that will most benefit these patients.