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MADD was previously considered solely a genetic disorder caused by recessive pathogenic variants mainly in the\n                      <jats:italic>ETFDH<\/jats:italic>\n                      gene.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A nationwide population\u2010based registry search was conducted to identify adult patients with sertraline\u2010associated MADD in Sweden 2014\u20132024. Patients with muscle biopsy reports of lipid storage myopathy or biochemical investigations showing acylcarnitine profile suggesting MADD were included. Medical records were retrospectively reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 40 (30\/10 female\/male)\n                      <jats:styled-content>patients using sertraline when diagnosed with MADD<\/jats:styled-content>\n                      . Median age at symptom onset was 42\u2009years and muscle weakness was the most common first symptom. All patients reported muscle symptoms during the disease course. Extra\u2010muscular symptoms, including sensory disturbance (29 patients) and fatigue (18 patients), were common. Most had lipid accumulation in muscle fibers, an abnormal acylcarnitine profile, a myopathic electromyography pattern, and elevated creatine kinase. Cyanocobalamin, folic acid, and proton\u2010pump inhibitors were the most frequent other medications at diagnosis. Five patients carried a heterozygous\n                      <jats:italic>ETFDH<\/jats:italic>\n                      variant. All patients were treated with riboflavin. Almost all (38\/39) experienced clinical improvement. Acylcarnitine profile improved in all patients (31\/31) with available data. The mean incidence was 1.24 patients per 100,000 adults receiving sertraline treatment per year.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Acquired MADD associated with sertraline is the most common type of adult\u2010onset MADD in Sweden. The disease is generally responsive to riboflavin treatment. Patients presenting with muscle symptoms during sertraline therapy should undergo adequate evaluation to exclude MADD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70555","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:01:27Z","timestamp":1773219687000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Acquired Multiple Acyl\u2010Coenzyme A Dehydrogenase Deficiency Associated With Sertraline in Sweden\u2014A Nationwide Population\u2010Based Study"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7884-4380","authenticated-orcid":false,"given":"Sofie","family":"Sunebo","sequence":"first","affiliation":[{"name":"Department of Biomedical and Clinical Sciences Link\u00f6ping University  Link\u00f6ping Sweden"},{"name":"Clinical Department of Neurology in Link\u00f6ping Region \u00d6sterg\u00f6tland  Link\u00f6ping 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