{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:55:08Z","timestamp":1789192508969,"version":"build-2803163510"},"reference-count":57,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec id=\"ab-yoi250074-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Antidepressant treatment remains a trial-and-error process: one-third of people with major depressive disorder (MDD) report inefficacy of first-line medications. Predictors of prescription patterns are needed to improve prescribing precision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250074-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate phenotypic and genetic heterogeneity of MDD subgroups defined by antidepressant prescription patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250074-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This was a retrospective cohort study of Australian Genetics of Depression Study (2017-2018) adult participants (aged \u226518 years) with lifetime MDD who filled 1 or more prescriptions of the 10 most commonly used antidepressants across 4.5 years (2013-2017). Data were analyzed from August 2024 to October 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250074-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Treatment complexity was assessed as number of different antidepressant classes in prescriptions filled in 4.5 years. Sustained-use 360 groups were defined as 360 or more cumulative days (in 4.5 years) of a single antidepressant. Participants with genome-wide genotypes were contrasted across mutually exclusive sustained-use 360 groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250074-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Associations of 44 self-reported phenotypes and polygenic scores (PGSs) for 15 traits with sustained-use 360 subgroups. Genome-wide association studies (GWASs) were conducted for selective serotonin reuptake inhibitor (SSRI) or SSRI\/serotonin-norepinephrine reuptake inhibitor sustained use contrasted to other participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250074-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 12\u202f074 participants (9041 [75%] female with a mean [SD] age of 41.8 [14.6] years; 3022 [25%] male with a mean [SD] age of 47.7 [14.6] years) with 1 or more prescriptions and lifetime MDD, 8898 had genotyping data. High treatment complexity was significantly associated with 37 of 44 self-reported phenotypes (eg, higher rates of smoking, recurrent MDD, suicidal ideation, chronic pain, and circadian and atypical depression subtypes) and higher PGSs for psychiatric traits (MDD PGS: \u03b2, 0.04; 95% CI, 0.03-0.06;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20091.2\u2009\u00d7\u200910\n                      <jats:sup>\u22128<\/jats:sup>\n                      ; ADHD PGS: \u03b2, 0.03; 95% CI, 0.02-0.05;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20092.1\u2009\u00d7\u200910\n                      <jats:sup>\u22125<\/jats:sup>\n                      ; bipolar disorder PGS: \u03b2, 0.03; 95% CI, 0.01-0.04.\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20091.2\u2009\u00d7\u200910\n                      <jats:sup>\u22124<\/jats:sup>\n                      ; neuroticism PGS: \u03b2, 0.02; 95% CI, 0.01-0.04;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20091.3\u2009\u00d7\u200910\n                      <jats:sup>\u22123<\/jats:sup>\n                      ). A total of 5453 (61%) met criteria for an exclusive antidepressant sustained-use 360 group. These groups had distinct phenotypic profiles, including associations with body mass index, suicidal ideation, and co-occurring conditions. GWASs identified novel loci, including an immune-related gene\n                      <jats:italic toggle=\"yes\">SLAMF3<\/jats:italic>\n                      \/\n                      <jats:italic toggle=\"yes\">LY9<\/jats:italic>\n                      , for which single-nucleotide variant rs4656934 was associated with reduced odds of sustained SSRI use (G allele; odds ratio, 0.81; 95% CI, 0.75-0.87;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20093.5\u2009\u00d7\u200910\n                      <jats:sup>\u22128<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250074-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This study found that phenotypic factors were associated with sustained antidepressant use and treatment complexity. PGSs for traits studied were associated with treatment complexity but showed little association with sustained-use 360 groups. These findings support further research to guide treatment selection and to identify patients at risk of difficult-to-treat depression, informing precision psychiatry and early intervention in MDD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2025.4372","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T16:31:13Z","timestamp":1769617873000},"page":"247","source":"Crossref","is-referenced-by-count":3,"title":["Genetic and Phenotypic Associations With Sustained Antidepressant Use in Major Depressive Disorder"],"prefix":"10.1001","volume":"83","author":[{"given":"Alicia","family":"Walker","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany L.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Brain and Mental Health Program, QIMR Berghofer Medical 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