is associated with type 2 diabetes and depression, which may be related to prenatal stress and insulin resistance as a result of chronic hypothalamic-pituitary-adrenal (HPA) axis hyperactivity. We examined whether treatment with a selective serotonin reuptake inhibitor [escitalopram (ESC)] could downregulate HPA axis activity and restore insulin sensitivity in LBW rats. After 4 -5 wk of treatment, ESC-exposed LBW (SSRI-LBW) and saline-treated control and LBW rats (Cx and LBW) underwent an oral glucose tolerance test or a hyperinsulinemic euglycemic clamp to assess whole body insulin sensitivity. Hepatic phosphoenolpyruvate carboxykinase (PEPCK) mRNA expression and red skeletal muscle PKB Ser 473 phosphorylation were used to assess tissue-specific insulin sensitivity. mRNA expression of the hypothalamic mineralocorticoid receptor was fivefold upregulated in LBW (P Ͻ 0.05 vs. Cx), accompanied by increased corticosterone release during restraint stress and total 24-h urinary excretion (P Ͻ 0.05 vs. Cx), whole body insulin resistance (P Ͻ 0.001 vs. Cx), and impaired insulin suppression of hepatic PEPCK mRNA expression (P Ͻ 0.05 vs. Cx). Additionally, there was a tendency for reduced red muscle PKB Ser 473 phosphorylation. The ESC treatment normalized corticosterone secretion (P Ͻ 0.05 vs. LBW), whole body insulin sensitivity (P Ͻ 0.01) as well as postprandial suppression of hepatic mRNA PEPCK expression (P Ͻ 0.05), and red muscle PKB Ser 473 phosphorylation (P Ͻ 0.01 vs. LBW). We conclude that these data suggest that the insulin resistance and chronic HPA axis hyperactivity in LBW rats can be reversed by treatment with an ESC, which downregulates HPA axis activity, lowers glucocorticoid exposure, and restores insulin sensitivity in LBW rats.selective serotonin reuptake inhibitors STRESS MAY BE INVOLVED IN THE DEVELOPMENT of major Western lifestyle disorders such as cardiovascular disease and the metabolic syndrome (53,59,61). Particularly in humans born with low birth weight (LBW) (e.g., birth weight Ͻ2,500 g), stressrelated psychiatric illness and metabolic disturbances seem to coexist, and the prevalence of conditions associated with psychological stress, such as melancholic depression, is increased in subjects born with LBW (35). In addition, these individuals also have a higher prevalence of type 2 diabetes (23, 57, 80) that is potentially due to early development of insulin resistance. Hence, the LBW condition can be considered as both a predepressive and a prediabetic state. However, the exact mechanisms responsible for these changes and whether they are associated are still debated.Recently, impairments in hippocampal structure and function have been proposed to account for some of the phenotypic characteristics of LBW (21,40,63). Hippocampus regulates the overall circadian tonus of the hypothalamic-pituitary-adrenal (HPA) axis, and accordingly, the processes involved in corticosteroid regulation in LBW have been studied extensively. At this point the HPA axis in LBW has been studied at various developmental ...