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Schulz et al., 2012

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Gut microbiota regulates maturation of the adult enteric nervous system via enteric serotonin networks

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Additional factors in the assessment of severe depression include thoughts of suicidality and inpatient status.3,8,11 Severe depression is associated with a greater number of comorbidities, a longer time to treatment response, greater risk of recurrence, and greater likelihood of suicide.3,8 Chronic depression, defined as depression in which patients are symptomatic more days than not over a 2-year period, is associated with a high rate of treatment resistance.3,11 Patients with MDD are often affected by anxiety symptoms