Adrenal fatigue: Best methods to increase cortisol naturally

thingsvarious

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Oct 11, 2020
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69
Hey, I am a final year medical student. For years I had incredibly fatigue and other low-cortisol issues.

After doing a LOT of research, I collected a list of methods we can try to raise our cortisol naturally and therefore to help get rid of HPA-dysfunction. I share this here because I am sure that I am not the only one struggling with low cortisol.

I hope you find value in this list. The following list is not like the many bull****-lists circulating everywhere around the Internet intended for nudging you towards buying someone´s shitty product. Each single point on this list works. However, keep in mind that while many points on this list are incredibly simple, they are easier said than done.

Here is a list of things we can do to improve cortisol naturally:

  • Make sure we get blue light in the morning and avoid (excessive) amounts of blue light at night.

  • Make sure we are not taking too much melatonin.

  • Eliminate any chronic stressor as much as possible (e.g. caloric restriction, infection, regular fasting, allergies, excessive exercise, bouts of hypoglycemia).

  • Make sure we are not sleep-deprived. At first, sleep deprivation increases HPA-activity but over time it can lead to HPA-dysfunction, adrenal fatigue and burnout in the same way other chronic stressors do.

  • We should make sure our general levels of stress are not too extreme for too long. (Although as vertebrates who evolved to live in the wild, we should naturally be quite resilient and able to tolerate a fair amount of stress.).

  • Maintaining too low levels of body fat, prolonged caloric restriction, intermittent fasting, a ketogenic diet, excessive exercise can all lead to “adrenal” fatigue and burnout. All via the same mechanism. → Burnout

  • Bouts of hypoglycemia. One of the main functions of gluco-corticoids is to maintain adequate levels of blood glucose. Consequently, hypoglycemia (low blood sugar) stimulates the HPA-axis from within the brain stem and hypothalamus. Recurrent bouts of hypoglycemia over time (e.g. with intermittent fasting) can cause HPA-dysfunction, the same way it occurs with other things causing “adrenal” fatigue/ burnout.

  • Having a healthy amount of physical activity in our life. Any physical activity naturally stimulates HPA-activity, which (might) adapt to a higher setpoint over time.

  • Make sure we have no night-time stress. This increases cortisol secretion at night, which, firstly, impairs sleep quality and architecture, and secondly, night-time cortisol leads to negative feedback, reducing the HPA-activation in the morning impairing the cortisol awakening response (CAR).

  • Make sure we get enough sleep. Sleep deprivation disrupts hypothalamic signaling to peripheral glands.

  • Make sure we do not exercise excessively.

  • Make sure we have no vitamin or mineral deficiency. (e.g. vitamin B12, vitamin D, iron, zink, magnesium)

  • Forget about all the lists of “super-foods” and “super-supplements” to improve cortisol “naturally.” Most of them are a scam. Others, at most, will give a gain in the single-digit % range. (But there is a list of supplements I do recommend. See here.)

  • Make sure we are not taking any molecules that interfere with hormone signaling or production. (e.g. opioids, weed, alcohol, some prescription drugs).

  • Make sure that we did not have any major (or minor) head trauma. Head trauma (e.g. football, military, boxing, etc.) is a common, but neglected cause for hormonal problems. During a major (or minor) blow to the head, the axons making up the pituitary stalk often break, sometimes causing permanent hormonal deficiencies (or a slight reduction in one or more hormones, which often remains subclinical for the rest of the individual’s life without anyone ever getting to know.) If this is the case, there is not much “natural” stuff we can do other than going down the replacement route.

  • Make sure our caloric intake and insulin levels are not too low. This point is incredibly important (and common). Read Section 5 here.

  • Two supplements that might help slightly are ashwagandha and Rhodiola. Both seem to have serotonergic properties and the 5HT2A-receptor stimulates hormone production throughout the hypothalamus. What is more, anything serotonergic decreases (perceived) stress, therefore they facilitate recovery from stress-induced hormonal decline.

  • Licorice root is another option to “naturally” bring up cortisol levels (Glycyrrhizic acid inhibits HSD-II, an enzyme that mediates cortisols breakdown into cortisone).

  • Cutting out caffeine. Firstly, caffeine stimulates the HPA-axis, which just adds fuel to the fire if the HPA is already “stressed out”. Secondly, caffeine specifically interferes with sleep architecture and suppresses the cortisol awakening response. (In fact, caffeine-addicted people are often useless and “zombies” before they get their first cup of coffee in the morning, simply because without it, cortisol does not rise adequately.)

  • Supplementation with small doses of pregnenolone, a precursor to other steroid hormones, theoretically should elevate adrenal hormones slightly (At the end of the day 1$ is 1$.) because with its supplementation more substrate for cortisol, DHEA, and aldosterone synthesis is available (and other 60 or so expendable steroids synthesized by the adrenal glands). Thus, theoretically, this should “support” the adrenals in their effort to meet the cortisol demands and thus should help with recovery from adrenal fatigue/burnout. However, in most people, the benefit is very modest at best…but worth a try. For a more detailed discussion on pregnenolone and how to best supplement with it, see see How To Replace Non-Major Hormones: An Ultimate Guide”.


Replacing cortisol is hard, and very few doctors know about it. Because there is just SOOOO much misinformation about cortisol, I wrote a guide about how to check for low cortisol and replace it in a safe and effective way. The points listed above are an excerpt about the guide I wrote on how to cure burnout/adrenal fatigue and also -if need be- how to replace cortisol in the best/safest way. Had I known then what I know now it would have saved me lots of time, money, effort, suffering.

I hope some of you find value in it. Enjoy.

How to replace cortisol. The Ultimate Guide.


So, in case you have been or are suffering from adrenal fatigue, which of the points listed do you found most useful? I´d be interested to hear about the experience of others.
 

Vinero

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I have used corticosteroids for my eczema in the past, and was suprised they caused the effects you describe. I felt energetic, alive, euphoric almost for months while I was using the steroids on my skin. Unfortunately these positive effects turned into over-stimulation, depression and anxiety after about a half year of using it. When I stopped the steroids cold turkey my eczema flared back up like never before. I believe you when you say cortisol is a very important hormone. Not too high, not too low is probably best.
Do you think its possible that having an auto-immune disease or inflammatory condition in your body like eczema "uses up" your cortisol? I wouldn't mess with taking any external hormones, like DHEA, cortisol, or thyroid. I want my body to produce the adequate amount by itself. Not relying on supplementation. Minimizing inflammation by choosing foods which do not cause auto-immunity and inflammation is key for this. For example, my eczema got worse when eating milk and cheese.
 

Elize

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Joined
Jan 25, 2016
Messages
751
Vinero have you tried to see if salycilates in food and medications could be an issues for you or even histamine liberating foods and medications. Asprin is high in salicylates
 

Elize

Member
Joined
Jan 25, 2016
Messages
751
Hey, I am a final year medical student. For years I had incredibly fatigue and other low-cortisol issues.

After doing a LOT of research, I collected a list of methods we can try to raise our cortisol naturally and therefore to help get rid of HPA-dysfunction. I share this here because I am sure that I am not the only one struggling with low cortisol.

I hope you find value in this list. The following list is not like the many bull****-lists circulating everywhere around the Internet intended for nudging you towards buying someone´s shitty product. Each single point on this list works. However, keep in mind that while many points on this list are incredibly simple, they are easier said than done.

Here is a list of things we can do to improve cortisol naturally:

  • Make sure we get blue light in the morning and avoid (excessive) amounts of blue light at night.

  • Make sure we are not taking too much melatonin.

  • Eliminate any chronic stressor as much as possible (e.g. caloric restriction, infection, regular fasting, allergies, excessive exercise, bouts of hypoglycemia).

  • Make sure we are not sleep-deprived. At first, sleep deprivation increases HPA-activity but over time it can lead to HPA-dysfunction, adrenal fatigue and burnout in the same way other chronic stressors do.

  • We should make sure our general levels of stress are not too extreme for too long. (Although as vertebrates who evolved to live in the wild, we should naturally be quite resilient and able to tolerate a fair amount of stress.).

  • Maintaining too low levels of body fat, prolonged caloric restriction, intermittent fasting, a ketogenic diet, excessive exercise can all lead to “adrenal” fatigue and burnout. All via the same mechanism. → Burnout

  • Bouts of hypoglycemia. One of the main functions of gluco-corticoids is to maintain adequate levels of blood glucose. Consequently, hypoglycemia (low blood sugar) stimulates the HPA-axis from within the brain stem and hypothalamus. Recurrent bouts of hypoglycemia over time (e.g. with intermittent fasting) can cause HPA-dysfunction, the same way it occurs with other things causing “adrenal” fatigue/ burnout.

  • Having a healthy amount of physical activity in our life. Any physical activity naturally stimulates HPA-activity, which (might) adapt to a higher setpoint over time.

  • Make sure we have no night-time stress. This increases cortisol secretion at night, which, firstly, impairs sleep quality and architecture, and secondly, night-time cortisol leads to negative feedback, reducing the HPA-activation in the morning impairing the cortisol awakening response (CAR).

  • Make sure we get enough sleep. Sleep deprivation disrupts hypothalamic signaling to peripheral glands.

  • Make sure we do not exercise excessively.

  • Make sure we have no vitamin or mineral deficiency. (e.g. vitamin B12, vitamin D, iron, zink, magnesium)

  • Forget about all the lists of “super-foods” and “super-supplements” to improve cortisol “naturally.” Most of them are a scam. Others, at most, will give a gain in the single-digit % range. (But there is a list of supplements I do recommend. See here.)

  • Make sure we are not taking any molecules that interfere with hormone signaling or production. (e.g. opioids, weed, alcohol, some prescription drugs).

  • Make sure that we did not have any major (or minor) head trauma. Head trauma (e.g. football, military, boxing, etc.) is a common, but neglected cause for hormonal problems. During a major (or minor) blow to the head, the axons making up the pituitary stalk often break, sometimes causing permanent hormonal deficiencies (or a slight reduction in one or more hormones, which often remains subclinical for the rest of the individual’s life without anyone ever getting to know.) If this is the case, there is not much “natural” stuff we can do other than going down the replacement route.

  • Make sure our caloric intake and insulin levels are not too low. This point is incredibly important (and common). Read Section 5 here.

  • Two supplements that might help slightly are ashwagandha and Rhodiola. Both seem to have serotonergic properties and the 5HT2A-receptor stimulates hormone production throughout the hypothalamus. What is more, anything serotonergic decreases (perceived) stress, therefore they facilitate recovery from stress-induced hormonal decline.

  • Licorice root is another option to “naturally” bring up cortisol levels (Glycyrrhizic acid inhibits HSD-II, an enzyme that mediates cortisols breakdown into cortisone).

  • Cutting out caffeine. Firstly, caffeine stimulates the HPA-axis, which just adds fuel to the fire if the HPA is already “stressed out”. Secondly, caffeine specifically interferes with sleep architecture and suppresses the cortisol awakening response. (In fact, caffeine-addicted people are often useless and “zombies” before they get their first cup of coffee in the morning, simply because without it, cortisol does not rise adequately.)

  • Supplementation with small doses of pregnenolone, a precursor to other steroid hormones, theoretically should elevate adrenal hormones slightly (At the end of the day 1$ is 1$.) because with its supplementation more substrate for cortisol, DHEA, and aldosterone synthesis is available (and other 60 or so expendable steroids synthesized by the adrenal glands). Thus, theoretically, this should “support” the adrenals in their effort to meet the cortisol demands and thus should help with recovery from adrenal fatigue/burnout. However, in most people, the benefit is very modest at best…but worth a try. For a more detailed discussion on pregnenolone and how to best supplement with it, see see How To Replace Non-Major Hormones: An Ultimate Guide”.


Replacing cortisol is hard, and very few doctors know about it. Because there is just SOOOO much misinformation about cortisol, I wrote a guide about how to check for low cortisol and replace it in a safe and effective way. The points listed above are an excerpt about the guide I wrote on how to cure burnout/adrenal fatigue and also -if need be- how to replace cortisol in the best/safest way. Had I known then what I know now it would have saved me lots of time, money, effort, suffering.

I hope some of you find value in it. Enjoy.

How to replace cortisol. The Ultimate Guide.


So, in case you have been or are suffering from adrenal fatigue, which of the points listed do you found most useful? I´d be interested to hear about the experience of others.
Thanks so much for the information
 

mostlylurking

Member
Joined
May 13, 2015
Messages
310
So, in case you have been or are suffering from adrenal fatigue, which of the points listed do you found most useful? I´d be interested to hear about the experience of others.
Well....since you asked.... I think that my life experiences are a lot different from yours. Maybe if you are in your early 20's, you can tolerate cortisol. I'm 71. I've been through some fairly rough health issues, including 45 years of hypothyroidism, years of chronic fatigue syndrome/fibromyalgia brought on by organo-phosphate poisoning, heavy metal poisoning, and more recently, rheumatoid arthritis.

After studying Ray Peat's work for 6 years and managing to pull myself back from the brink, I can honestly say that I would never intentionally attempt to increase cortisol ever. In fact one of my main goals health-wise is to keep cortisol as low as possible. But then I'm battling to keep rheumatoid arthritis in remission and maintain my muscles as best I can. Cortisol is a complex topic, however I do not believe that it is a safe solution for fatigue. We have different perspectives.

Ray Peat has written a number of articles that touch on cortisol. Here's a list: Programmable Search Engine

Here's a quote from Ray Peat from this article: Multiple sclerosis, protein, fats, and progesterone
"Reduction of the mediators of inflammation is better than augmenting a single antiinflammatory agent such as cortisol. Although immunosuppressive drugs, including the "essential fatty acids," do alleviate inflammatory symptoms temporarily, they probably contribute to the underlying pathology.

"People with MS have chronically increased production of cortisol. This creates a distortion of protein assimilation, resembling a nutritional protein deficiency. Excessive serotonin and estrogen cause a relatively uncontrolled production of cortisol. A vicious circle of inflammatory mediators and amino acid imbalance can result."​
 

Korven

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Joined
May 4, 2019
Messages
262
Vinero have you tried to see if salycilates in food and medications could be an issues for you or even histamine liberating foods and medications. Asprin is high in salicylates

Just recently discovered that salicylates really aggravate my ezcema/pustular rosacea. Aspirin - which is supposed to be anti-inflammatory - makes my skin itch and burn and it takes days for the rash to calm down.

From what I understand salicylates by blocking COX-1, and reducing PGE2, removes the inhibition on leukotriene production which then go on to degranulate histamine from mast cells and basophils. Also aspirin can chelate iron and promote staph aureus (bacteria usually involved in ezcema) biofilms (The Active Component of Aspirin, Salicylic Acid, Promotes Staphylococcus aureus Biofilm Formation in a PIA-dependent Manner).

Explains why I seem to do so poorly with ANY fruit or vegetable, particularly oranges which are also supposed to be histamine liberating. A "colorless diet" of meat, refined starch and dairy products keeps my skin nice and happy.
 

thingsvarious

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Thread starter
Joined
Oct 11, 2020
Messages
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Just recently discovered that salicylates really aggravate my ezcema/pustular rosacea. Aspirin - which is supposed to be anti-inflammatory - makes my skin itch and burn and it takes days for the rash to calm down.

From what I understand salicylates by blocking COX-1, and reducing PGE2, removes the inhibition on leukotriene production which then go on to degranulate histamine from mast cells and basophils. Also aspirin can chelate iron and promote staph aureus (bacteria usually involved in ezcema) biofilms (The Active Component of Aspirin, Salicylic Acid, Promotes Staphylococcus aureus Biofilm Formation in a PIA-dependent Manner).

Explains why I seem to do so poorly with ANY fruit or vegetable, particularly oranges which are also supposed to be histamine liberating. A "colorless diet" of meat, refined starch and dairy products keeps my skin nice and happy.
Very interesting! Thank you for sharing.
 

Elize

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Joined
Jan 25, 2016
Messages
751
Vitamin c triggers histamine liberating reactions with me. Any form of Acid too. Rashes from it can take days to clear
 

Fexxx

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Jun 1, 2017
Messages
126
Maybe not so Peat but my Adrenal Fatigue resulted from permanent episodes of Hypoglycemia. A (very) Low Carb without Starving or Fasting approach fixed that completely for me. Also my Energy increased, anxiety decreased and my Sleep became a lot better. So a positive spin for me. At the End every Invention has its Time and is a kind of Tradeoff.
 

thingsvarious

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Maybe not so Peat but my Adrenal Fatigue resulted from permanent episodes of Hypoglycemia. A (very) Low Carb without Starving or Fasting approach fixed that completely for me. Also my Energy increased, anxiety decreased and my Sleep became a lot better. So a positive spin for me. At the End every Invention has its Time and is a kind of Tradeoff.
By inducing CRH, recurrent bouts of hypoglycemia can certainly stress the HPA. Glad it worked for you! However, I´d be interested in whether it will work long-term.
 
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Why would you want to raise cortisol? If your cortisol is actually low, you have much bigger problems to worry about.
 
Joined
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Because many people have low levels of cortisol, which is not good either. With hormones it is all about balance.
Define "low". Cortisol is a stress hormone, ideally you want low levels of stress - I don't know of any benefits that cortisol has to the body, apart from acute effects in survival situations. Many people feel better when they take exogenous cortisol but that doesn't mean their problem was 'low cortisol', it's like how giving SSRI's to depressed people doesn't mean their problem was 'low serotonin'.

Also, why would someone have "low" cortisol? I can think of two reasons: a very healthy person who isn't stressed, or a person who is so sick that they aren't even making pregnenolone. Cortisol, estrogen, aldosterone and other end-pathway steroid hormones are (almost) always elevated in those with health problems.
 

Quelsatron

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Supposedly adequate vitamin D will increase your cortisol sensitivity (in a positive way) , i think haidut made a thread on it
 

thingsvarious

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Define "low". Cortisol is a stress hormone, ideally you want low levels of stress - I don't know of any benefits that cortisol has to the body, apart from acute effects in survival situations. Many people feel better when they take exogenous cortisol but that doesn't mean their problem was 'low cortisol', it's like how giving SSRI's to depressed people doesn't mean their problem was 'low serotonin'.

Also, why would someone have "low" cortisol? I can think of two reasons: a very healthy person who isn't stressed, or a person who is so sick that they aren't even making pregnenolone. Cortisol, estrogen, aldosterone and other end-pathway steroid hormones are (almost) always elevated in those with health problems.
There are many people with low levels of cortisol for a variety of reasons.
 

Quelsatron

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I have never heard of vitamin D increasing cortisol sensitivity.
A great study for a number of reasons. First, it discussed openly that in animal research circles cortisol administration is considered an official and reliable method of causing major depression. As the article states, for some reason human medical circles have been unwilling to accept the stress-depression causal link and continue to argue that stress is just a risk factors that ultimately depends on genetic predispositions to actually cause depression.
More importantly, the study also demonstrated that oral vitamin D (D3, a.k.a. cholecalciferol) administration for just 7 days concurrently with the cortisol administration (which was given to cause the depression) was able to fully prevent the depressive symptoms. Another finding was that vitamin D administration was also able to upregulate the expression of the glucocorticoid receptors (GR), which were downregulated as a result of the chronic administration of cortisol. These findings suggest, yet again, that vitamin D acts as a direct glucocorticoid antagonist and corroborates it not only as a rapidly-acting antidepressant (which GR antagonists are known to be), but also as an anti-catabolic / anabolic substance. Let's just hope that FDA won't take action and either ban vitamin D3 (cholecalciferol) as an "unapproved drug", or put it in the category of prescription chemicals such as vitamin D2. The latter is know known to have only about 30% of the effects of vitamin D in equivalent doses and has a much higher risk of side effects such as kidney disease, hypercalcemia, etc.
But what's up with the contradictory title? Isn't cortisol a powerful anti-inflammatory steroid/treatment, as our doctors keep telling us? Well, as they say in the movies - "life is stranger than fiction", and so it seems to be in medicine as well. As the study explains, cortisol, while directly anti-inflammatory itself, sets the stage for a pro-inflammatory systemic response that starts even while cortisol is still being administered. So, at best cortisol is an inflammatory symptom "masker" with the trade-off of drastically higher inflammation down the road, even if cortisol administration continues! One of the likely mechanisms for cortisol's pro-inflammatory effects is that being a highly catabolic hormone, cortisol administration floods the blood stream with cellular / tissue debris and those are known to trigger potent inflammatory reactions that persist for as long as there is a sufficient amount of debris left in the bloodstream. In a sense, the systemic inflammatory response can never stop as long as cortisol is being administered, and the longer cortisol is administered the worse systemic health becomes.

Vitamin D Supplementation Ameliorates Severity of Major Depressive Disorder - PubMed
Effects of cholecalciferol on behavior and production of reactive oxygen species in female mice subjected to corticosterone-induced model of depression - PubMed
Cholecalciferol abolishes depressive-like behavior and hippocampal glucocorticoid receptor impairment induced by chronic corticosterone administration in mice - PubMed

"...Major depressive disorder (MDD) is a highly prevalent and disabling psychiatric disorder that affects > 350 million people, causing a high personal and socioeconomic burden (World Health Organization, 2017). It is well reported that chronic stress and hypothalamic-pituitary-adrenal (HPA) axis dysfunction are risk factors for MDD (Goodyer et al., 2000; Nowacki et al., 2020). Chronic stress can induce increased levels of glucocorticoids, namely cortisol in humans and corticosterone in rodents, which may damage the hippocampus, a region that presents a high density of glucocorticoids receptor (GR) crucial for HPA axis autoregulation and mood modulation (Anacker et al., 2011; Lee et al., 2002)."

"...In keeping with these premises, exogenous corticosterone (CORT) administration in rodents has been proposed as a pharmacological stress model of depression that mimics the behavioral and neurochemical alterations associated with HPA dysfunction in the depressive state (Pazini et al., 2016; Rosa et al., 2014; Zhao et al., 2008). Despite the numerous studies reporting that chronic stress underlies the genesis of MDD, the mechanisms by which glucocorticoids contribute to the depressive symptoms have not been entirely established. Compelling evidence indicates that glucocorticoids may induce a peripheral and central pro-inflammatory state that involves the stimulation of the nod-like receptor pyrin domain containing 3 (NLRP3), an intracellular multiprotein complex responsible for the inflammatory response (Busillo et al., 2011; Kaufmann et al., 2017). Importantly, NLRP3-driven pro-inflammatory response culminates in neuronal damage and death remarkably in brain regions involved with mood modulation, and these events are thought to underlie depressive symptoms (Miller et al., 2009)."

"...In the present study, we showed that a low dose of cholecalciferol abrogates the depressive- and anhedonic-like behavior induced by chronic corticosterone administration, confirming a previous study from our group (Camargo et al., 2018). We extend these findings providing evidence that these behavioral effects were accompanied by the reestablishment of GR immunocontent impaired by corticosterone. Additionally, the ability of cholecalciferol in reducing NLRP3 inflammasome-related proteins ASC, TXNIP, and caspase-1 in the hippocampus of mice was also demonstrated."

"... In the present study, we reinforced the notion that repeated administration of cholecalciferol (2.5 μg/kg, p.o.) for 7 days is effective to reduce the immobility time, in a way similar to fluoxetine, in vehicle-treated mice submitted to the TST (Camargo et al., 2018; Souza et al., 2020). We also showed the cholecalciferol's ability to prevent corticosterone-induced depressivelike behavior evaluated in the TST, when administered in the last 7 days of corticosterone protocol. This result agrees with previous reports of our research group carried out in male Swiss mice (Camargo et al., 2018) and female Swiss mice (Souza et al., 2020). Of note, previous studies showed that administration of cholecalciferol (5 mg/kg, s.c.) or α-calcidiol (1 μg/kg, p.o.) caused an antidepressant-like effect in the forced swim test in rodents (Fedotova et al., 2016; Kawaura et al., 2017), in agreement with our results."

"...Collectively, our results show that repeated administration of cholecalciferol has an antidepressant-like effect, confirming previous findings (Camargo et al., 2018; Fedotova et al., 2016; Kawaura et al., 2017; Souza et al., 2020), an effect associated with the reestablishment of hippocampal GR immunocontent impaired by chronic corticosterone administration. Although we did not ascertain the causal relationship between GR and behavioral outcomes, further experiments could be carried out in future studies to shed light on this issue."
 
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