Young Adult With Treatment-Resistant Depression
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Clinical diagnosis:
Major depressive disorder, SSRI-resistant subtype
Clinical recommendation
L-methylfolate 15 mg qd (± SAMe);
switch from SSRI to vortioxetine
introduce high-CFU B. longum 1714 psychobiotic
anti-inflammatory, high-prebiotic diet
Microbiome findings:
Low Bifidobacterium and Akkermansia abundance; high gut-derived LPS gene counts indicating systemic inflammation
Molecular findings:
Plasma homocysteine 17 µmol/L (↑); RBC folate 350 ng/mL (low-normal); CSF 5-HIAA below age norms
Genome findings:
Homozygous MTHFR C677T (TT) → impaired methyl-folate recycling; SLC6A4 5-HTTLPR S/S → poor SSRI response