Start Your Journey Here!

1

Full Name* This field is required.

First Name

Last Name

2

Email Address* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Age* This field is required.

5

Gender (at birth)* This field is required.

Male

Female

Prefer not to say

6

Date of Birth* This field is required.

7

Diagnosis of Major Depressive Disorder (MDD) (please specify)* This field is required.

8

Current episode (Duration in weeks)* This field is required.

9

Baseline MADRS score* This field is required.

10

CGI-S score* This field is required.

11

Current Treatment Status* This field is required.Select all that apply

Receiving antidepressant monotherapy

Therapy

Electro-Convulsive Therapy

Other

12

Contraception agreement (for female of childbearing potential)* This field is required.

You agree to use highly effective contraception

13

Height* This field is required.In Inches

14

WeightIn lbs

15

History Of Health (please select any that apply)* This field is required.

Lifetime history of bipolar disorder, schizophrenia, or schizoaffective disorder

Current diagnosis of obsessive-compulsive disorder or eating disorder

History of treatment-resistant depression (failure of ≥2 adequate antidepressant trials in current episode)

Suicide ideation

Current use of antipsychotics, mood stabilizers, or other prohibited medications

Known or potential substance use disorder within the past 6 months

Significant medical illness or unstable condition that may interfere with study

Known hypersensitivity to study drugs or formulation components

16

Additional medical history or notes