LYMPHOCYTE GLUCOCORTICOID RECEPTOR - PREDICTOR OF SERTRALINE RESPONSEIN ADOLESCENT MAJOR DEPRESSIVE DISORDER (MDD)

Major depressive disorder (MDD) in adolescents demonstrates resistance to tricyclic antidepressants and absence of hypercortisolemia, The ef ficacy of serotonin reuptake inhibitors (SRIs) is uncertain, and respo nse predictors are unavailable, Abnormal fast feedback and negative fe edback of the hypothalamic-pituitary-adrenal axis implicates a dampene d limbic-hippocampal glucocorticoid type II receptor (GC(II)), We hypo thesized that lymphocyte GC(II) is altered in adolescent MDD and could serve as a marker for response to SRIs, In an open-label study, adole scents (n=20) meeting DSM-III-R criteria for MDD showed baseline lymph ocyte GC(II) sites per cell (sites/cell) values of 793+/-106 versus 2, 563+/-499 (+/-SEM) for matched controls (n=18) (t=3.5; df =36; p<.001) , GC(II) was bimodally distributed, with SRI responders differing from nonresponders (t=3.9; df=14; p<.001), GC(II) accurately classified 90 percent of sertraline responders and 80 percent of nonresponders. Onl y SRI responders showed GC(II) sites/cell upregulated after 6 weeks of treatment (t=2.1, df=10; p<.05).