 The study will be conducted at Mayo Clinic Jacksonville Department of Psychiatry recruit up to 10 patients and 10 controls with paired data and Mayo Clinic Depression Center in Rochester recruit up to 30 patients and 30 controls with paired data. Patients with major depression, Bipolar Disorder I or Bipolar Disorder II confirmed by structured diagnostic interview SCID and moderate symptom severity Quick Inventory of Depressive Symptomatology or S-C16 will be enrolled in the 12 week study. We will explore the gut microbiome and its genetic material and gut-brain markers of inflammation cortisol, cytokines from stool specimens and serum samples, respectively. Collections will be at baseline, week 2, and week 12 of the study. Healthy controls matched for age, sex including menopausal status of female subjects, and body-mass index BMI will have only baseline stool and serum collections. Statistical t-tests will be used to assess baseline differences between patient and controls in microbiome and inflammatory markers. Treatment response 50 reduction in QIDS, treatment remission QIDS-C16 6 will be analyzed with change in microbiome and inflammation markers. Correlational analysis with multiple testing corrections will be conducted between depression symptom severity and measures of cortisol, cytokines, and gut microbiome composition. 