Precision Depression Adalimumab Trial

The goal of this clinical trial is to learn if the anti-inflammatory medication adalimumab improves depressive symptoms in adults with Major Depressive Disorder (MDD) who are already taking the anti-depressant medication Lexapro (escitalopram). The main questions it aims to answer are: 1. Does adalimumab improve the symptoms of some patients with MDD who are already taking an anti-depressant? 2. What characteristics predict for whom adalimumab has anti-depressant properties. Researchers will compare adalimumab to a placebo (a look-alike substance that contains no drug) to see if adalimumab works to improve depressive symptoms as an add-on drug to the anti-depressant Lexapro (escitalopram). For these primary aims the participants will: 1. Visit the clinic once every 2 weeks for a checkups and injection of adalimumab or placebo from the study psychiatrist (Day 1, 15, 29, and 43 for injections) 2. Complete short (\

Inclusion Criteria: * Provision of signed and dated informed consent form * Stated willingness to comply with all study procedures and availability for the duration of the study * Male or female, aged 18+ years * Meet DSM-5 criteria for Major Depressive Disorder * baseline serum TNF-alpha (average of two samples in the same week) greater than 1.5 pg/mL * Taking a steady dose of Lexapro (escitalopram) for at least 4 weeks * Ability to take oral medication and physician-administered subcutaneous injection and be willing to adhere to the study protocol * For females of reproductive potential: use of highly effective contraception for at least 1 month * Access to a phone or computer with a camera Exclusion Criteria: 1. Pregnant or breastfeeding 2. Active, chronic or recurrent infection 3. Known malignancy 4. Current use of immune modulating medications 5. Immunocompromised, current autoimmune condition or history of severe immune condition (e.g., history of cancer, HIV/AIDS) 6. History of, or positive test for, Hepatitis B surface antigen or core antibody positivity or tuberculosis (TB) 7. Congestive heart failure 8. History of demyelinating disease (multiple sclerosis (MS), optic neuritis, Guillain-Barre syndrome) 9. History of seizure disorder 10. Symptomatic hyponatremia 11. Monoamine oxidase inhibitors (MAOI) use within 14 days 12. Recent use of Rituxan (rituximab) 13. Concomitant use of: 1. Immunosuppressants 2. Kineret (anakinra) 3. Orencia (abatacept) 4. Remicade (infliximab) 5. Enbrel (etanercept) 6. Cimzia (certolizumab pegol) 7. Simponi (golimumab) 8. Imuran (azathioprine) 9. Purinethol (6-mercaptopurine) 10. Linezolid 11. IV methylene blue 12. Pimozide 13. Antiplatelet agents 14. Strong anticoagulants (e.g. warfarin, large doses of NSAIDs) 15. Other SSRIs, SNRIs, tryptophan 14. Clinically relevant substance use disorder 15. Known allergic reactions to components of adalimumab and/or escitalopram 16. Treatment with another investigational drug or other intervention while participating in the study