Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant. It is an effective anti- depressant in MDD and has fewer side effects than tricyclic antidepressants (TCAs)(5-7). Although most patients with depression respond to fluoxetine, some do not, warranting consideration of alternative or combined treatments. Fluoxetine augmentation by other medication, especially tricyclics, may be effective for these patients. However, some patients prefer psychotherapy augmentation because of adverse events or other reasons. Hence, fluoxetine augmented by psychological treatment may be a positive second step.