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Exercise and fluoxetine can both activate the CREB/BDNF axis, with the 5-HT system as a key mediator (221), enhancing BDNF expression through multiple pathways, such as the PI3K/AKT and calcium/calmodulin-dependent protein kinase IV/MAPK pathways (222,223), thereby improving synaptic plasticity and neurogenesis (191,224,225)
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