ained by an allelic frequency difference in rs7997012 of HTR2A between the two population samples. Three recent genome-wide association studies failed to identify gene associations with response to antidepressant drugs in depression. These failures underscore the heterogeneity of the clinical depression phenotype, and the complex gene-environment nature of the disorder. In addition, these large, multi-site studies risk incurring methodological problems such as heterogeneity of case material, ethnic heterogeneity, measurement error, and variable recruitment practices. By comparison, strengths of our study design include single site performance by an experienced research team, strictly blinded quality control, ethnic homogeneity, inclusion of only clinically referred cases, clinical diagnoses by experienced psychiatrists in advance of confirmatory research diagnostic interviews, outcome MedChemExpress G5555 assessments in person rather than by telephone, and verification of adequate antidepressant blood levels. We also required that all cases were unexposed to antidepressant drugs in the current episode of depression before enrolment in this study. By these means, heterogeneity and confounding of the case material were controlled, and we succeeded in identifying and validating significant genetic predictors of response with manageable sample sizes. The prediction model examined observed response and nonresponse: without a placebo control group we have no basis to predict specific drug response. The PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/19672994 gain of information from the predictive model is substantial, especially in the prediction of nonresponse. For the 16% of completer cases that our HAP-SNP PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/1967325 model predicts will be nonresponders in the derivation sample, the relative risk of observed nonresponse is 3.3 in comparison to all other cases, and 6.9 in comparison to the cases whom 
the model predicts will be responders. In the validation sample, these relative risks are 3.2 and 5.6, respectively. For comparison, the relative risk of a poor outcome is 1.5 in the 27% of patients receiving clopidogrel who have loss of function polymorphisms in CYP2C19. The genetic determinants of observed response to SSRI drugs were not associated with response to non-SSRI antidepressant drugs. Thus, these results are consistent with the previous reports that pharmacologically different antidepressants are associated with different genetic determinants of response. A further, indirect, inference is that the significant markers for observed response to SSRI drugs may be unrelated to nonspecific response factors in our patients. However, we should mention that previous antidepressant treatment history in prior episodes of depression might have influenced the clinicians’ choice of non-SSRI treatment in the cross-validation sample. We cannot positively rule out this possible confound in this naturalistic study, even though the crossvalidation sample closely resembled the SSRI-treated samples on relevant clinical variables. Genetic Prediction of SSRI Response The convergent data from the validation and cross-validation samples suggest that for approximately half the total cases who adhere to treatment, a gene-based recommendation of SSRI or non-SSRI agent as first-line treatment may be possible with 85% confidence, and that this represents a significant improvement over base rates of response and nonresponse in the absence of genotype information for those cases. The ethnic homogeneity of our sample may be viewed as either a strengt
