Essentials: The Science & Treatment of Bipolar Disorder

Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance.

欢迎来到 Huberman Lab Essentials，在这里我们回顾过去的剧集，寻找针对心理健康、身体健康和表现的最有效、最可操作的基于科学的工具。

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。

Today, we are going to be discussing bipolar disorder, often called bipolar depression.

今天，我们将讨论双相情感障碍，通常称为双相抑郁症。

Bipolar depression is a condition in which people undergo massive shifts in their energy, their perception, and their mood.

双相抑郁症是一种人们的能量、感知和情绪发生巨大变化的疾病。

However, it is very important to note that these shifts in mood, energy, and perception are all maladaptive.

然而，值得注意的是，这些情绪、能量和感知的变化都是适应不良的。

They can often cause tremendous damage to the person suffering from bipolar disorder and tremendous damage to the people in their lives.

它们常常会给双相情感障碍患者以及他们生活中的人造成巨大的伤害。

In fact, people suffering from bipolar disorder are at 20 to 30 times greater risk of suicide.

事实上，患有双相情感障碍的人自杀的风险要高出 20 到 30 倍。

So today is a serious discussion, and it's certainly one in which people who are suffering from manic bipolar disorder or who know people that are suffering from manic bipolar disorder can benefit from.

因此，今天是一场严肃的讨论，而患有躁狂双相情感障碍的人或认识患有躁狂双相情感障碍的人无疑可以从中受益。

So bipolar disorder impacts about 1% of people.

因此，双相情感障碍影响了大约 1% 的人。

That might seem like a small percentage, but if you think about a room of 100 people, that means that at least one of them is very likely to have bipolar disorder.

这个比例看起来可能很小，但如果你考虑一个有 100 个人的房间，这意味着其中至少有一个人很可能患有双相情感障碍。

The typical age of onset is anywhere from 20 to 25 years old, although it can be much earlier.

典型的发病年龄为 20 至 25 岁，但也可能更早。

There are basically two kinds of bipolar disorder, referred to as Bipolar I and Bipolar II.

双相情感障碍基本上有两种，称为双相 I 型和双相 II 型。

Bipolar I is characterized by a fairly extended period of mania.

I型双相情感障碍的特点是相当长的一段时间的躁狂。

What is mania?

什么是躁狂症？

Mania is a period of very elevated mood, energy, distractibility, impulsivity, and some other symptomology that we'll talk about going forward.

躁狂症是一段情绪非常高涨、精力充沛、注意力不集中、冲动以及我们将在接下来讨论的其他症状的时期。

But this manic episode is extreme.

但这次狂躁的发作是极端的。

One of the key clinical criteria or diagnostic criteria for Bipolar I is that a person suffer from these manic episodes or display these manic episodes for seven days or more.

I 型双相情感障碍的关键临床标准或诊断标准之一是一个人患有这些躁狂发作或表现出这些躁狂发作持续 7 天或更长时间。

Typically, a person will be brought into a clinic, or a person would bring themselves to a clinic or meet with a psychiatrist, and the psychiatrist is going to start to evaluate for a couple of different things.

通常，一个人会被带到诊所，或者一个人会自己去诊所或会见精神科医生，精神科医生将开始评估一些不同的事情。

But first of all, what they're going to try and figure out is whether or not the person has at least three of the following symptoms.

但首先，他们要尝试弄清楚该人是否至少有以下三种症状。

The first symptom is distractibility.

第一个症状是注意力分散。

People who are in a manic episode will be talking about a pen, and then they'll be talking about something they saw the other day, and then something they want to purchase, and then a place they're going to travel to, et cetera.

处于躁狂期的人会谈论一支钢笔，然后他们会谈论他们前几天看到的东西，然后是他们想要购买的东西，然后是他们要去旅行的地方，等等。

But they are also very prone to any stimulus within the room.

但他们也很容易受到房间内的任何刺激。

So highly distractible, highly impulsive.

非常容易分心，非常容易冲动。

Impulsivity relates to actions.

冲动与行动有关。

So the person might be fidgeting with something, and then they might try and leave the room.

所以这个人可能正在烦躁地做某件事，然后他们可能会尝试离开房间。

The other is grandiosity.

另一个是宏大。

People who have manic bipolar disorder who are in a manic episode will often display words of or actions of grandiosity.

患有躁狂双相情感障碍的人在躁狂发作时经常会表现出夸张的言语或行为。

These are actual beliefs that the person comes to have about their grandiose position in the world or grandiose opportunities or potential in the world.

这些是人们对自己在世界上的宏伟地位或在世界上的宏伟机会或潜力的真实信念。

Flight of ideas are also typical of manic episodes.

想法的飞扬也是躁狂发作的典型特征。

So this is a little bit like distractibility, but this would be people talking extensively about one thing and then switching and talking extensively about something else.

所以这有点像分散注意力，但这就是人们广泛谈论一件事，然后又广泛谈论另一件事。

The other aspect of manic bipolar disorder that often presents itself in the manic episodes are agitation.

躁狂躁郁症的另一个方面经常出现在躁狂发作中，那就是躁动。

People feeling extremely physically agitated, so a lot of shaking and moving about.

人们感觉身体极度烦躁，因此经常摇晃和移动。

This can venture into the realm of paranoia, but a lot of agitation, a difficulty sitting down and being still, a difficulty in just looking, feeling, and acting calm.

这可能会进入偏执狂的境界，但会很烦躁，很难坐下来保持静止，很难只是看起来、感觉和表现得平静。

And then another condition is no sleep.

还有一个条件就是不睡觉。

And when I say no sleep, I mean no sleep or very minimal sleep.

当我说不睡觉时，我的意思是不睡觉或睡眠很少。

As incredible as it sounds, people who are in a manic episode can often go seven days or more with zero sleep.

听起来令人难以置信，躁狂发作的人通常可以连续 7 天或更长时间处于零睡眠状态。

And a key feature of this zero sleep is that they're not troubled by it.

这种零睡眠的一个关键特征是他们不会因此而烦恼。

You can only imagine how pulled apart most of us would feel under those conditions, and yet they are just going and going and going with no sleep, up all hours, shopping, talking, running, doing all sorts of different things in the categories of other symptoms that we talked about before, and it doesn't bother them that they're not sleeping.

你只能想象我们大多数人在这种情况下会感到多么分裂，但他们只是不停地走啊走啊，不睡觉，整点时间，购物，说话，跑步，做我们之前讨论过的其他症状类别中的各种不同的事情，而且他们不睡觉并不困扰他们。

And then the last sort of category of symptoms that the psychiatrist is evaluating for and seeing if they present is rapid, pressured speech.

精神科医生正在评估并查看它们是否出现的最后一类症状是快速、有压力的言语。

It's coming at you, coming at you, coming at you, and there's really no room for conversation.

它向你袭来，向你袭来，向你袭来，实在没有说话的余地。

So we've got distractibility, impulsivity, grandiosity, flight of ideas, agitation, no sleep, and rapid, pressured speech.

因此，我们会出现注意力不集中、冲动、浮夸、想法飞扬、焦躁不安、失眠、语速过快、压力过大等问题。

For someone to be diagnosed as in a manic episode, they do not have to be engaging in or displaying all of those symptoms.

对于被诊断为躁狂发作的人来说，他们不必表现出所有这些症状。

They do, however, need to present at least three of those symptoms, and then in order to meet the condition of Bipolar I, they have to be presenting those three symptoms for at least seven days.

然而，他们确实需要至少出现其中三种症状，并且为了满足 I 型双相情感障碍的条件，他们必须出现这三种症状至少 7 天。

It could be longer, but at least seven days.

可以更长，但至少七天。

Now, Bipolar I disorder means they're having these extended manic episodes, seven days or more, but it does not necessarily mean that they are dropping into a depressive episode as well.

现在，I型双相情感障碍意味着他们有持续的躁狂发作，7天或更长时间，但这并不一定意味着他们也会陷入抑郁发作。

This is a common misconception about bipolar disorder because, as it's often called, bipolar disorder is referred to as bipolar depression, and yet many people with bipolar disorder don't necessarily experience the deep depressive episodes.

这是对双相情感障碍的常见误解，因为双相情感障碍通常被称为双相抑郁，但许多双相情感障碍患者不一定会经历深度抑郁发作。

The second category of bipolar disorder is Bipolar II.

双相情感障碍的第二类是双相情感障碍II。

So BPII, or Bipolar Disorder II, is somewhat different than Bipolar Disorder I.

因此，BPII 或双相情感障碍 II 与双相情感障碍 I 有所不同。

First of all, it's characterized most often by the presence of both manic episodes, mania, and depressive episodes, or what's referred to as hypomania.

首先，其最常见的特征是同时存在躁狂发作、躁狂和抑郁发作，或所谓的轻躁狂。

Bipolar II is often diagnosed on the basis of the presence of manic episodes that are lasting four days Or even less.

II型双相情感障碍通常是根据持续四天甚至更短的躁狂发作来诊断的。

So someone with BP2 might have four days of this increased energy, goal-directed activity.

因此，患有 BP2 的人可能会进行四天的这种精力充沛、目标导向的活动。

They're irritable, they're euphoric, they're not sleeping, et cetera, but it's only lasting for about four days.

他们烦躁、欣快、睡不着等等，但这种情况只持续大约四天。

Or they could be having longer extended periods of mania, but they are hypomanic episodes.

或者他们可能有更长的躁狂期，但它们是轻躁狂发作。

They're not quite as intense, so the pressured speech isn't quite as pressured, the impulsivity isn't quite as severe, et cetera.

它们没有那么强烈，所以受压力的言语没有那么有压力，冲动也没有那么严重，等等。

The other aspect of bipolar II is one that I had mentioned briefly a moment ago, which is that it's often associated with the drops into the depressive episodes.

双相情感障碍 II 的另一个方面是我刚才简单提到的，那就是它通常与抑郁发作有关。

One person might go from very high highs that last seven days or more to very low lows, bouts of depression, major depression that could last two weeks or more.

一个人可能会从持续 7 天或更长时间的非常高的高点到非常低的低点，抑郁症发作，重度抑郁症可能会持续两周或更长时间。

Other people are rapid cycling by way of three days manic, three days normal, three days manic, and then dropping into three days depression.

其他人则快速循环三天躁狂，三天正常，三天躁狂，然后陷入三天抑郁。

So you want to erase that picture in your mind that manic bipolar disorder is this sine wave, this cycling up and down between mania and depression.

所以你想抹去你脑海中的图像，即躁狂双相情感障碍是正弦波，在躁狂和抑郁之间循环。

It can take a lot of different forms.

它可以采取多种不同的形式。

And again, this is a serious challenge for the psychiatrist to diagnose people because of that fact that they're only getting a snapshot of the person, unless they'd known them for some time and are working with them for some time.

再说一遍，这对精神科医生来说是一个严峻的挑战，因为他们只能得到一个人的快照，除非他们已经认识他们一段时间并与他们一起工作了一段时间。

But this is also especially important for those of you that either have bipolar depression or suspect that you might, or that know someone with bipolar depression or suspect somebody might have bipolar depression, AKA bipolar disorder.

但这对于那些患有双相抑郁症或怀疑自己可能患有双相抑郁症的人，或者认识患有双相抑郁症的人或怀疑某人可能患有双相抑郁症（又称双相情感障碍）的人来说也尤其重要。

Because if you're noticing that somebody is very manic and then normal, well, that's a very different picture than somebody who's going from very manic to very deep bouts of depression.

因为如果你注意到某人非常躁狂，然后又变得正常，那么，这与一个从非常躁狂转变为非常严重的抑郁症的人是完全不同的情况。

The very manic to deep bouts of depression is easier to recognize because of the extremes of those highs and lows.

由于这些极端的高潮和低谷，从非常狂躁到深度的抑郁发作更容易识别。

Now, this might seem somewhat obvious to all of you as I describe it, and yet it's very important as a, frankly, a citizen of the planet who knows other human beings, to keep an eye out for these manic episodes, because again, whether or not it's four days or less or whether or not it's seven days or more, these manic episodes really are the defining criteria of bipolar disorder, AKA bipolar depression.

现在，正如我所描述的那样，这对你们所有人来说似乎是显而易见的，但坦率地说，作为一个了解其他人类的地球公民，密切关注这些躁狂发作是非常重要的，因为同样，无论是四天或更短时间，还是7天或更长时间，这些躁狂发作确实是双相情感障碍（又称双相抑郁症）的定义标准。

I'd like to take a quick break and acknowledge our sponsor, BetterHelp.

我想稍微休息一下并感谢我们的赞助商 BetterHelp。

BetterHelp offers professional therapy with a licensed therapist carried out entirely online.

BetterHelp 提供由持证治疗师完全在线进行的专业治疗。

Now, I've been doing therapy for a very long time, and I can tell you that it's a lot like physical workouts.

现在，我已经进行治疗很长时间了，我可以告诉你，这很像体育锻炼。

There are days when I want to do it, and there are days when I don't want to do it.

有想做的日子，也有不想做的日子。

But when I finish a therapy session, every single time, I come away feeling better and knowing that the time was well spent.

但当我完成一次治疗后，每一次，我都会感觉好多了，并且知道我的时间花得很值。

And typically, when I finish a session, I come away with a valuable insight or several, or a new perspective on something that I'm trying to work through, whether it's with work, relationships, my relationship with myself, or some other aspect of life.

通常，当我完成一次课程时，我会对我正在努力解决的事情产生一个或多个有价值的见解，或者一个新的视角，无论是工作、人际关系、我与自己的关系，还是生活的其他方面。

There's just so many benefits that come through effective therapy.

通过有效的治疗可以带来很多好处。

Now, with BetterHelp, they make it very easy to find an expert therapist who can help provide the benefits that come from effective therapy, and it works.

现在，有了 BetterHelp，他们可以很容易地找到一位专家治疗师，他可以帮助提供有效治疗带来的好处，而且它很有效。

BetterHelp has an average rating of 4.9 out of five for its live sessions based on over 1.7 million client reviews.

根据超过 170 万条客户评论，BetterHelp 的现场会议平均评分为 4.9 分（满分 5 分）。

Also, because BetterHelp is entirely online, it's very time efficient.

此外，由于 BetterHelp 完全在线，因此非常省时。

There's no driving to a therapist's office, looking for parking, dealing with traffic, et cetera.

无需开车去治疗师办公室、寻找停车位、处理交通等等。

If you would like to try BetterHelp, go to betterhelp.com/huberman to get 10% off your first month.

如果您想尝试 BetterHelp，请访问 betterhelp.com/huberman，第一个月可享受 10% 的折扣。

Again, that's betterhelp.com/huberman.

再说一次，这是 betterhelp.com/huberman。

Now I'd like to talk about some of the treatments for bipolar disorder.

现在我想谈谈双相情感障碍的一些治疗方法。

And in the discussion of those treatments, there's an absolutely incredible history of the discovery of one particular treatment that still shows great success in many patients, although some people can't take it for reasons that we'll talk about.

在对这些治疗方法的讨论中，有一种绝对令人难以置信的特定治疗方法的发现历史，这种治疗方法仍然在许多患者中取得了巨大的成功，尽管有些人由于我们将要讨论的原因而无法接受它。

The key player in this story is a physician by the last name Cade.

这个故事的关键人物是一位姓凯德的医生。

Cade was an Australian psychiatrist who also was a soldier.

凯德是一位澳大利亚精神病学家，同时也是一名士兵。

And during World War II, after the fall of Singapore to Japan, he became a prisoner of war, and he was a prisoner of war from 1942 until 1945.

而二战期间，新加坡被日本占领后，他成为了战俘，从1942年到1945年都是战俘。

So he had some time for observation.

所以他有时间观察。

And during his imprisonment, he observed some of his fellow inmates as going through pretty wild vacillations in mood and energy, essentially going from manic episodes to depressed episodes or from manic to normal episodes.

在监禁期间，他观察到一些狱友在情绪和精力上经历了相当剧烈的波动，基本上是从躁狂发作到抑郁发作，或者从躁狂发作到正常发作。

And for one reason or another, we don't know why, because I couldn't find any report as to why he hypothesized this, but he hypothesized that there was some buildup of some chemical in these people's brains that then they would urinate out, and that urinating out of whatever chemical was in there would allow them to be more relaxed and not manic.

出于某种原因，我们不知道为什么，因为我找不到任何关于他为什么做出这种假设的报告，但他假设这些人的大脑中积聚了某种化学物质，然后他们会小便，而小便中的任何化学物质都会让他们更加放松而不是躁狂。

Eventually, he got out of this prison as we mentioned, in 1945, and he started doing experiments in addition to seeing patients in his clinic.

最终，正如我们提到的，他于 1945 年离开了这所监狱，除了在诊所看病之外，他还开始做实验。

And what he did is he started to take urine from people who exhibited mania and urine from people who were not manic, and he took that urine, and he would inject it into guinea pigs as an experimental model.

他所做的是，他开始采集表现出躁狂症的人和没有躁狂症的人的尿液，然后他将这些尿液注射到豚鼠体内作为实验模型。

And his general observation was that there was something in the urine that was indeed making the guinea pigs more manic if they were injected with urine from a manic patient.

他的总体观察是，如果给豚鼠注射躁狂症患者的尿液，尿液中的某些物质确实会让它们变得更加躁狂。

Right?

正确的？

The exact measures that he was taking in these guinea pigs wasn't exactly clear.

他对这些豚鼠采取的具体措施尚不清楚。

This is at a time or an era in science when you could just sort of report things a little bit more subjectively, although there were still numbers and statistics.

在科学的一个时代或一个时代，你可以更主观地报告一些事情，尽管仍然有数字和统计数据。

What Cade figured out was that the urine from manic patients seemed to be more toxic for these guinea pigs.

凯德发现，躁狂症患者的尿液似乎对这些豚鼠的毒性更大。

And he also knew that there are two toxic substances in urine, urea and uric acid.

而且他还知道，尿液中有两种有毒物质，尿素和尿酸。

So he was able to separate the urea and uric acid from people with mania and patients that did not have mania, and he figured out that the urea was the same in both These mentally ill manic patients and the non-manic patients.

因此，他能够将患有躁狂症的人和没有躁狂症的患者的尿素和尿酸分开，并且他发现这些精神病患者的躁狂症患者和非躁狂症患者的尿素是相同的。

So instead he focused on the uric acid.

因此，他转而关注尿酸。

Now, in order to put the uric acid into solution so that he could inject it into these guinea pigs, he had to try a number of different compounds in order to dilute it.

现在，为了将尿酸放入溶液中以便将其注射到这些豚鼠体内，他必须尝试多种不同的化合物来稀释它。

It just so happens that, and you chemists will be familiar with this, but there's certain things that just don't go into solution easily.

碰巧的是，你们化学家会熟悉这一点，但有些事情并不容易解决。

You put the powder in a vial, you add some water or a saline or another solution, you mix it up, and the powder stays suspended in there.

将粉末放入小瓶中，加入一些水或盐水或其他溶液，将其混合，粉末就会悬浮在其中。

It just doesn't actually ever become a clear liquid that you can inject.

它实际上永远不会成为可以注射的透明液体。

So in order to try injecting different strengths of uric acid, he ended up using lithium to assist in the dilution, and lithium worked.

因此为了尝试注射不同浓度的尿酸，他最终使用锂来辅助稀释，锂起了作用。

So what he basically was doing, again, for you chemists, is he was taking uric acid, he was adding lithium and making a solution of lithium urate.

所以他基本上所做的，对于你们化学家来说，他正在服用尿酸，他正在添加锂并制成尿酸锂溶液。

Okay?

好的？

This is a lot of details, but this is important because what he eventually found is that when he diluted the uric acid with lithium and created lithium urate, lithium urate could actually calm down these guinea pigs that were injected with the toxic urea.

这是很多细节，但这很重要，因为他最终发现，当他用锂稀释尿酸并产生尿酸锂时，尿酸锂实际上可以让这些被注射有毒尿素的豚鼠平静下来。

He also found that lithium urate had a generally calming effect on these guinea pigs.

他还发现尿酸锂对这些豚鼠具有总体镇静作用。

So now we're really off in crazy territory.

所以现在我们真的陷入了疯狂的境地。

Right?

正确的？

We're talking about urine from patients that's separating out urea and uric acid.

我们谈论的是分离出尿素和尿酸的患者尿液。

We're adding lithium to the uric acid.

我们在尿酸中添加锂。

We're injecting this into guinea pigs.

我们正在将其注射到豚鼠体内。

This is getting pretty wild and pretty weird, but this is medicine, and from time to time, this is medicine and science.

这变得非常疯狂和奇怪，但这就是医学，有时，这是医学和科学。

Cade was a good scientist in addition to being a good physician, and by good scientist, I mean that he did control experiments.

凯德除了是一名优秀的医生之外，还是一名优秀的科学家，我所说的优秀科学家是指他做了对照实验。

Here he was injecting lithium urate into animals and seeing an effect, but he knew that that solution of lithium urate contained not just the uric acid, but it also contained lithium.

在这里，他将尿酸锂注射到动物体内并看到了效果，但他知道尿酸锂溶液不仅含有尿酸，还含有锂。

And so he quite appropriately asked, maybe the lithium alone is having this calming effect on these guinea pigs.

因此，他非常恰当地问道，也许锂本身就能对这些豚鼠产生镇静作用。

And indeed, that was the case.

事实确实如此。

When he did the proper control experiment and injected only lithium solution into these guinea pigs, they calmed down.

当他做了适当的对照实验并只给这些豚鼠注射锂溶液时，它们平静了下来。

From there, he in sort of 1940s style medicine, this would not happen now, he very quickly moved from that animal model into human patients and started injecting human patients with lithium or providing lithium orally to those patients.

从那时起，他采用了 20 世纪 40 年代风格的医学，现在这种情况不会发生，他很快从动物模型转移到人类患者身上，并开始给人类患者注射锂或为这些患者口服锂。

And lo and behold, found an absolutely profound and positive effect of lithium in reducing symptoms of mania.

你瞧，我们发现锂在减轻躁狂症状方面具有绝对深远和积极的作用。

And as all good physician scientists do, he wrote up his results and he wrote it up in a paper entitled "Lithium Salts in the Treatment of Psychotic Excitement." Okay, back then they didn't call it mania, they called it psychotic excitement.

正如所有优秀的医学科学家所做的那样，他写下了自己的结果，并将其写在一篇题为“锂盐治疗精神兴奋”的论文中。好吧，当时他们不称之为躁狂，他们称之为精神病性兴奋。

This is a paper that was published September 3rd, 1949 in the Medical Journal of Australia, a classic study in the field of psychiatry.

这是1949年9月3日发表在《澳大利亚医学杂志》上的一篇论文，是精神病学领域的经典研究。

Lithium, I should mention, has a number of important features, but it also a number of important side effects that need to be considered.

我应该提到，锂具有许多重要的特性，但它也有一些需要考虑的重要副作用。

First of all, it does have a certain toxicity, and so levels of lithium in the blood need to be monitored extremely carefully.

首先，它确实具有一定的毒性，因此需要非常仔细地监测血液中锂的含量。

So it's not the sort of thing that people can just take at a given dose and every patient responds the same.

因此，这并不是那种人们只要服用给定剂量就能让每个患者产生相同反应的药物。

There's a lot of oversight and a lot of blood tests that have to be done, especially in the first three months of lithium treatment.

需要进行大量的监督和大量的血液检查，尤其是在锂治疗的前三个月。

Now with that said, scientists and clinicians have been quite rigorous in trying to understand why and how lithium works in order to understand the why and how of bipolar disorder.

话虽如此，科学家和临床医生一直在非常严格地试图了解锂为何以及如何发挥作用，以便了解双相情感障碍的原因和方式。

Scientists and physicians understand that just because we have one treatment that works, if it has any side effects at all, there is the possibility for better treatments.

科学家和医生明白，仅仅因为我们有一种有效的治疗方法，即使它有任何副作用，也有可能找到更好的治疗方法。

And only by understanding how lithium works at the cellular level, at the neural circuit level, et cetera, do we really stand to find those new discoveries.

只有了解锂在细胞水平、神经回路水平等方面的工作原理，我们才能真正找到这些新发现。

Lithium seems to be able to suppress inflammation, and importantly, it can suppress inflammation in neural tissues and within the brain in particular.

锂似乎能够抑制炎症，重要的是，它可以抑制神经组织，特别是大脑内的炎症。

The other thing about lithium is that lithium is neuroprotective.

关于锂的另一件事是锂具有神经保护作用。

Neuroprotection is an ability for neurons to be better able to handle stress of different kinds, in particular excitotoxicity.

神经保护是神经元更好地处理不同类型的压力，特别是兴奋性毒性的能力。

There's a phenomenon in bipolar disorder and a lot of other psychiatric conditions in which hyperactivity of certain brain areas actually starts to kill off neurons.

在双相情感障碍和许多其他精神疾病中存在一种现象，其中某些大脑区域的过度活跃实际上开始杀死神经元。

Hyperactivity doesn't always do this, but it turns out that if certain brain circuits are too active for too long, some of the chemicals associated with neuronal activity, things like calcium and neurotransmitters like glutamate, can actually kill the very neurons that are active.

过度活跃并不总是会造成这种情况，但事实证明，如果某些大脑回路过于活跃太长时间，一些与神经元活动相关的化学物质，如钙和谷氨酸等神经递质，实际上可以杀死活跃的神经元。

So it seems that lithium can prevent some of that neurotoxicity.

因此，锂似乎可以预防某些神经毒性。

I've talked about this a little bit on the Huberman Lab podcast before, but there are two modes of perception.

我之前在 Huberman 实验室播客上谈过这个问题，但有两种感知模式。

Exteroception is literally an attention to things that are happening beyond the confines of our skin.

外感受实际上是对我们皮肤范围之外发生的事情的关注。

Then there's interoception, which is perception of things that are happening internally.

然后是内感受，即对内部发生的事情的感知。

So we are always existing in a balance between exteroception and interoception.

所以我们总是处于外感受和内感受之间的平衡。

But as it turns out, people with bipolar disorder over time, and especially into the second and third decade of having bipolar disorder, seem to have progressively diminished levels of interoception.

但事实证明，随着时间的推移，患有双相情感障碍的人，尤其是进入双相情感障碍的第二个和第三个十年，内感受水平似乎逐渐下降。

And that very likely is important in their inability to register, for instance, that, wow, they are talking at an excessive rate, or they haven't slept in five days, or they haven't eaten in a long period of time.

这很可能很重要，因为他们无法记录，例如，哇，他们说话的速度太快了，或者他们已经五天没有睡觉了，或者他们已经很长一段时间没有吃东西了。

This atrophy of neural circuits for interoception is starting to emerge as one of the defining neural circuit characteristics or underpinnings of bipolar.

这种内感受神经回路的萎缩开始成为双相情感障碍的神经回路特征或基础之一。

Now I bridge to this conversation about neural circuits from the statement that lithium can protect against some of the neurotoxic effects of neural circuits being very active.

现在，我从锂可以防止神经回路非常活跃而产生的一些神经毒性作用的陈述中过渡到有关神经回路的对话。

The reality is that people with bipolar depression very likely have a hyperactivity, that is an increased level of activity in certain circuits within the brain early in the expression of their disease, and that typically, as I mentioned earlier, sets in around the early 20s, although sometimes that can be even earlier in the teens and so forth.

现实情况是，患有双相抑郁症的人很可能患有多动症，即在疾病表达的早期，大脑内某些回路的活动水平增加，并且正如我之前提到的，通常在 20 岁出头左右开始，尽管有时甚至可能在青少年等更早的时候出现。

But that hyperactivity, we think, leads to a toxicity An excitotoxicity of certain elements of the neural circuits that are responsible for interoception, and it appears that lithium very likely protects us against some of that atrophy of those circuits for interoception.

但我们认为，这种过度活跃会导致负责内感受的神经回路某些元件的毒性，并且锂很可能可以保护我们免受内感受回路的某些萎缩。

I'd like to take a quick break and acknowledge our sponsor, AG1.

我想稍微休息一下并感谢我们的赞助商 AG1。

AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens.

AG1 是一种维生素矿物质益生菌饮料，还包含益生元和适应原。

I discovered AG1 way back in 2012, long before I ever had a podcast, and I've been taking it every day since.

我早在 2012 年就发现了 AG1，那时我还没有播客，从那时起我就每天都在服用它。

The reason I started taking AG1, and the reason I still take it every day, is because AG1 is, to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the market.

我开始服用 AG1 的原因，以及我仍然每天服用的原因，是因为据我所知，AG1 是市场上质量最高、最全面的基础营养补充剂。

AG1 is designed to support things like gut health, immune health, and overall energy, and it does so by helping to fill any gaps that you might have in your daily nutrition.

AG1 旨在支持肠道健康、免疫健康和整体能量等方面，它通过帮助填补您日常营养中可能存在的任何缺口来实现这一目标。

I get asked pretty much all the time, if I could only take one supplement, what should that supplement be?

我经常被问到，如果我只能服用一种补充剂，那么该补充剂应该是什么？

And my answer is always AG1.

我的答案始终是AG1。

It has just been so helpful for supporting all aspects of physical health, mental health, and performance.

它对于支持身体健康、心理健康和表现的各个方面都非常有帮助。

If you would like to try AG1, you can go to drinkag1.com/huberman to get a special offer.

如果您想尝试 AG1，可以访问 Drinkag1.com/huberman 以获得特别优惠。

For a limited time, AG1 is giving away a free bottle of their new omega-3 coenzyme Q10 product.

AG1 限时免费赠送一瓶新的 omega-3 辅酶 Q10 产品。

Omega-3 and coenzyme Q10 are known to support cardiovascular health, cellular health, and energy generally, brain health, and much more.

众所周知，Omega-3 和辅酶 Q10 可支持心血管健康、细胞健康、能量、大脑健康等。

I personally take them both every day.

我个人每天都会服用它们。

Again, go to drinkag1.com/huberman to get a free bottle of the new omega-3 coenzyme Q10 with your first AG1 subscription.

同样，请访问 Drinkag1.com/huberman，首次订阅 AG1 即可免费获得一瓶新型 omega-3 辅酶 Q10。

Now I would like to also talk about some of the not-so-typical therapeutics for bipolar disorder and also point to the things that have been tried and failed for successful treatment of bipolar disorder, because some of those things are often talked about and suggested, especially in online communities.

现在我还想谈谈一些不那么典型的双相情感障碍治疗方法，并指出一些为成功治疗双相情感障碍而尝试过但失败的方法，因为其中一些方法经常被谈论和建议，尤其是在在线社区中。

And while it's not clear that any of them are particularly hazardous on their own, although some of them do carry some hazards, I do think it's important because of the critical time-sensitive nature of bipolar disorder and the urgency of getting treatments early to try and prevent some of the longer-lasting neural circuit changes, that if people can avoid some of the less effective or demonstrated to be ineffective treatments, that they stand to combat bipolar disorder much more successfully.

虽然尚不清楚它们中的任何一个本身是否特别危险，尽管其中一些确实具有一定的危害，但我确实认为这一点很重要，因为双相情感障碍具有关键的时间敏感性，并且迫切需要尽早接受治疗以尝试预防一些长期持续的神经回路变化，如果人们能够避免一些效果较差或被证明无效的治疗方法，那么他们就能更成功地对抗双相情感障碍。

First of all, a key point about drug therapies versus non-drug therapies or talk therapies.

首先，关于药物疗法与非药物疗法或谈话疗法的一个要点。

Without question, drug therapies are going to be most effective when done also with talk therapies, and we'll talk about which talk therapies have been demonstrated to be most effective.

毫无疑问，药物疗法与谈话疗法一起使用时将是最有效的，我们将讨论哪些谈话疗法已被证明是最有效的。

There is some argument about what I'm about to say next, but in general, most psychiatrists will tell you, or certainly the ones I've spoken to have told me, that talk therapy on its own is rarely if ever effective for bipolar depression and bipolar disorder, whether or not it's BP1 or BP2.

关于我接下来要说的话，存在一些争议，但总的来说，大多数精神科医生都会告诉你，或者肯定是我交谈过的那些人告诉我，谈话疗法本身对于双相抑郁和双相情感障碍很少有效，无论是 BP1 还是 BP2。

That's just the reality of it.

这就是现实。

There are both established and more novel forms of talk therapy being used, again, in concert with drug treatments for bipolar disorder.

再次，与双相情感障碍的药物治疗相结合，使用了既定的和更新颖的谈话疗法。

Cognitive behavioral therapy is the one that seems to be best, at least by way of the statistics and papers that exist.

认知行为疗法似乎是最好的一种疗法，至少从现有的统计数据和论文来看是这样。

It's also the one that's been explored the most.

这也是人们探索最多的一种。

So one of the reasons why it's often considered the most popular or effective is because it's also been around longer, and it's been explored the most.

因此，它通常被认为是最受欢迎或最有效的原因之一是因为它存在的时间更长，并且被探索得最多。

Cognitive behavioral therapy, in general, is a progressive exposure of the patient in a very controlled way, in a clinical setting, to some of the triggers or the conditions that would exacerbate bipolar disorder.

一般来说，认知行为疗法是在临床环境中以非常受控的方式使患者逐渐暴露于一些会加剧双相情感障碍的触发因素或条件。

And then there's a category of therapy called interpersonal and social rhythm therapy.

还有一类疗法称为人际关系和社会节奏疗法。

This is deserving of its own entire episode, really.

这真的值得拥有自己的整个情节。

Interpersonal and social rhythm therapy is sort of an expansion on family-focused therapy, although it's distinct in certain ways as well, and really focuses on how people are relating to others in their life and in the workplace and in the school environment and also within the family, et cetera.

人际和社会节奏疗法是对以家庭为中心的疗法的扩展，尽管它在某些方面也有所不同，并且真正关注人们如何在生活中、工作场所、学校环境以及家庭内部等中与他人建立关系。

And I should say that an overall theme that's emerging in psychiatry and psychology is to start wherever possible to incorporate more of the social aspects and the interpersonal aspects.

我应该说，精神病学和心理学中出现的一个总体主题是尽可能地纳入更多的社会方面和人际方面。

In other words, not just talking to and examining a patient as one biological system, one nervous system, one set of chemicals, and one life, but rather a set of chemicals, neural circuits, and a life that's embedded in the chemicals and neural circuits and lives of other people.

换句话说，不仅仅是将患者视为一个生物系统、一个神经系统、一组化学物质和一个生命来与患者交谈和检查，而是将其视为一组化学物质、神经回路以及嵌入化学物质和神经回路以及其他人的生活中的生命。

One very exciting and emerging treatment that does show great promise, and in some cases, great outcomes for bipolar disorder is, believe it or not, electric shock therapy.

不管你相信与否，一种非常令人兴奋的新兴治疗方法确实显示出巨大的希望，并且在某些情况下，双相情感障碍的效果很好，那就是电击疗法。

Generally used for treatment-resistant depression, so these are people that have no positive response or ongoing positive response to drug therapies or other therapies.

通常用于难治性抑郁症，因此这些人对药物疗法或其他疗法没有积极反应或持续积极反应。

The problem with ECT is that it's really only useful for treatment-resistant depression.

ECT 的问题在于它实际上只对难治性抑郁症有用。

It doesn't actually target the manic aspects of bipolar depression and bipolar disorder, but nonetheless is used when drug treatments don't work.

它实际上并不针对躁郁症和躁郁症的躁狂方面，但在药物治疗不起作用时仍会使用。

Some of the negatives of electric shock therapy, or electric convulsive therapy, ECT is the proper acronym and way it's described, is that it's quite invasive, right?

电击疗法或电惊厥疗法的一些负面影响，ECT 是正确的缩写词和描述方式，它具有相当的侵入性，对吧？

This is something that you need to go to the hospital for, and oftentimes there's some inpatient care required after the electric convulsive therapy.

这是您需要去医院的事情，并且通常在电惊厥治疗后需要一些住院护理。

It's a fairly high cost, especially for those that don't have insurance.

这是一个相当高的成本，特别是对于那些没有保险的人来说。

And of course, it requires anesthesia.

当然，这需要麻醉。

For most people, that's not going to be a problem, but for many people, that could be a problem.

对于大多数人来说，这不会是一个问题，但对于许多人来说，这可能是一个问题。

And there's often some associated memory loss.

而且经常会出现一些相关的记忆丧失。

And so the memory loss, the invasive nature of ECT, and the cost oftentimes rule out ECT for most patients, and that's why it's sort of a late stage or kind of last resort type thing for treatment-resistant depression.

因此，对于大多数患者来说，记忆丧失、ECT 的侵入性以及费用通常会排除 ECT，这就是为什么它是难治性抑郁症的晚期或最后手段。

There are two naturopathic, or I should say, nutrition supplement-based approaches to bipolar disorder.

有两种自然疗法，或者我应该说，基于营养补充剂的双相情感障碍方法。

They get talked about a lot, and one of them shows some interesting promise or effectiveness even in a limited context Before marching into this description of these two compounds, in fact, before even mentioning these two compounds, I do want to emphasize what's been said and written about over and over again, and what was relayed to me from expert psychiatrists.

它们被谈论了很多，其中一种即使在有限的背景下也显示出一些有趣的前景或有效性在开始描述这两种化合物之前，事实上，在提到这两种化合物之前，我确实想强调一遍又一遍地说过和写过的内容，以及专家精神病学家向我转述的内容。

It is not wise to rely purely on talk therapy or on natural approaches to the treatment of bipolar disorder, given the intensity of the disorder and the high propensity for suicide risk in people with bipolar disorder.

考虑到双相情感障碍的严重程度以及双相情感障碍患者自杀风险的高倾向，单纯依靠谈话疗法或自然方法来治疗双相情感障碍并不明智。

It is a chemical and neural circuit disruption, and it needs to be dealt with head-on through the appropriate chemistry and prescription drug approaches from a board-certified psychiatrist.

这是一种化学和神经回路中断，需要由经过委员会认证的精神科医生通过适当的化学和处方药方法来正面处理。

I don't say this to protect me.

我这么说并不是为了保护我。

I say this truly to protect those who either suffer from or think they may suffer from bipolar disorder, or if you know someone who you think might suffer from bipolar disorder.

我这样说确实是为了保护那些患有或认为自己可能患有双相情感障碍的人，或者如果你认识一个你认为可能患有双相情感障碍的人。

Now, all that is not to say that there aren't useful lifestyle interventions that can support people with bipolar disorder.

现在，这并不是说没有有用的生活方式干预措施可以支持躁郁症患者。

So I just briefly want to mention those.

所以我只想简单地提一下这些。

And again, I'm lifting the statements I'm about to make from some excellent online lectures from psychiatrists at Stanford and elsewhere, which essentially say that of course, getting better sleep, getting adequate exercise, getting proper nutrition, having quality, healthy social interactions, even getting regular sunlight in the day and avoiding bright light at night, all of those things are going to braid together to support the nervous system and the psyche of somebody with bipolar disorder.

再次，我引用了斯坦福大学和其他地方的精神病学家的一些优秀在线讲座的内容，这些讲座本质上是说，当然，获得更好的睡眠，进行充分的锻炼，获得适当的营养，进行高质量、健康的社交互动，甚至白天定期接受阳光，晚上避免强光，所有这些都将结合在一起，以支持双相情感障碍患者的神经系统和心理。

But they braid together to support the psyche and the neurochemistry and the neural circuits of anybody and everybody.

但它们编织在一起以支持任何人和每个人的心理、神经化学和神经回路。

With that said, there are two substances generally found as supplements, although there are other sources of them as well, including within nutritional sources, that have been shown, at least in some studies, to be pretty effective in adjusting the symptoms of bipolar disorder.

话虽如此，有两种物质通常被认为是补充剂，尽管它们还有其他来源，包括营养来源，至少在一些研究中已被证明，它们在调整双相情感障碍的症状方面非常有效。

And those two things are inositol and omega-3 fatty acids.

这两种物质就是肌醇和 omega-3 脂肪酸。

Now, inositol is a compound that is taken for a variety of reasons.

现在，肌醇是一种因多种原因而被服用的化合物。

It's something we've talked about on the podcast before.

这是我们之前在播客上讨论过的事情。

I personally take inositol, not because I have bipolar disorder.

我个人服用肌醇，并不是因为我患有双相情感障碍。

In fact, I am quite lucky that I don't have bipolar disorder.

事实上，我很幸运，我没有躁郁症。

But I take inositol at 900 milligrams of myo-inositol every third night or so in order to improve my sleep.

但我每三天左右服用 900 毫克肌醇，以改善睡眠。

It also seems to have a fairly potent anti-anxiety effect during the day.

它在白天似乎也具有相当有效的抗焦虑作用。

So the ability for fish oil, and in particular the omega-3 fatty acids, which come in varieties like EPA and DHA, have been explored at relatively high dosages for their ability to offset some of the effects of mania and to offset the effects of depressive episodes in bipolar disorder.

因此，人们对鱼油，特别是 omega-3 脂肪酸（如 EPA 和 DHA）的能力进行了探索，以相对较高的剂量来抵消躁狂症的一些影响，并抵消双相情感障碍中抑郁发作的影响。

There are several studies that have shown that supplementing with fish oil or omega-3 fatty acids at levels of, for instance, 9.6 grams of fish oil per day for four months greatly reduced symptoms of bipolar depression compared to the control group, which received olive oil.

有几项研究表明，与接受橄榄油的对照组相比，连续四个月每天补充鱼油或 omega-3 脂肪酸（例如 9.6 克鱼油）可大大减轻双相抑郁症的症状。

Olive oil is a different form of fat, monounsaturated fat, but doesn't contain as much of the omega-3 fatty acids and so forth.

橄榄油是一种不同形式的脂肪，即单不饱和脂肪，但不含那么多的 omega-3 脂肪酸等。

So 9.6 grams of fish oil per day over four months is a lot of fish oil to be ingesting on a given day.

因此，四个月内每天摄入 9.6 克鱼油就相当于一天要摄入的大量鱼油。

This was a double-blind study.

这是一项双盲研究。

This was only carried out, I should mention, in 30 subjects, but it was males and females, and the age range was pretty broad, anywhere from 18 all the way up to 64 years of age, which is important given the sort of longitudinal or changes over time that one sees in bipolar disorder.

我应该提到的是，这项研究只在 30 名受试者中进行，但有男性和女性，而且年龄范围相当广泛，从 18 岁一直到 64 岁，考虑到双相情感障碍的纵向或随时间的变化，这一点很重要。

Here's the major takeaway.

这是主要的收获。

Supplementing with high-dose omega-3s does seem to be beneficial for a good number of people with bipolar disorder.

补充高剂量的 omega-3 似乎确实对很多双相情感障碍患者有益。

However, again, I want to highlight, however, it should not be viewed as the only treatment approach for bipolar disorder.

然而，我想再次强调，它不应被视为双相情感障碍的唯一治疗方法。

But I don't think I can overemphasize enough that especially for bipolar disorder and the great risk of suicide and suffering and inappropriate spending, or I should say maladaptive spending and impulsivity that's associated with bipolar disorder, that it's hard to imagine a scenario in which just talk therapy and fish oil and lifestyle interventions are going to completely suppress or treat bipolar disorder.

但我认为我不能过分强调这一点，特别是对于双相情感障碍以及自杀、痛苦和不当支出的巨大风险，或者我应该说与双相情感障碍相关的适应不良支出和冲动，很难想象仅通过谈话疗法、鱼油和生活方式干预就能完全抑制或治疗双相情感障碍。

People with bipolar disorder really need to consider the full picture of treatments, the drug treatments, the talk therapy treatments, and lifestyle treatments, and nutraceutical, or we can say supplement-based treatments such as omega-3 supplementation, as a full and necessary picture for dealing with their illness.

双相情感障碍患者确实需要全面考虑治疗方案，包括药物治疗、谈话治疗、生活方式治疗以及营养保健品，或者我们可以说基于补充剂的治疗，例如补充 omega-3，作为应对疾病的全面且必要的方案。

I'd like to take a quick break and acknowledge our sponsor, Eight Sleep.

我想稍微休息一下，并向我们的赞助商“八睡”表示感谢。

Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity.

August Sleep 生产具有冷却、加热和睡眠跟踪功能的智能床垫套。

One of the best ways to ensure you get a great night's sleep is to make sure that the temperature of your sleeping environment is correct.

确保您睡个好觉的最佳方法之一是确保睡眠环境的温度正确。

And that's because in order to fall asleep and stay deeply asleep, your body temperature actually has to drop by about one to three degrees.

这是因为为了入睡并保持深度睡眠，您的体温实际上必须下降约一到三度。

And in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees.

为了醒来时感觉神清气爽、精力充沛，您的体温实际上必须升高约一到三度。

Eight Sleep automatically regulates the temperature of your bed throughout the night according to your unique needs.

八睡眠会根据您的独特需求自动调节整个晚上的床温。

I've been sleeping on an Eight Sleep mattress cover for nearly five years now, and it has completely transformed and improved the quality of my sleep.

我已经睡在八睡眠床垫罩上近五年了，它彻底改变并改善了我的睡眠质量。

The latest Eight Sleep model is the Pod 5.

最新的八睡眠型号是 Pod 5。

This is what I'm now sleeping on, and I absolutely love it.

这就是我现在睡觉的地方，我非常喜欢它。

It has so many incredible features.

它有很多令人难以置信的功能。

For instance, the Pod 5 has a feature called Autopilot, which is an AI engine that learns your sleep patterns and then adjusts the temperature of your sleeping environment across different sleep stages.

例如，Pod 5有一个名为Autopilot的功能，这是一个人工智能引擎，可以学习你的睡眠模式，然后在不同的睡眠阶段调整你的睡眠环境温度。

It'll even elevate your head if you're snoring, and it makes other shifts to optimize your sleep.

如果您打鼾，它甚至会抬高您的头部，并进行其他转换以优化您的睡眠。

If you'd like to try Eight Sleep, go to eightsleep.com/huberman to get up to $350 off the new Pod 5.

如果您想尝试八睡眠，请访问八睡眠.com/huberman，新款 Pod 5 最高可享受 350 美元优惠。

Eight Sleep ships to many countries worldwide, including Mexico and the UAE.

八号睡眠船运往世界各地的许多国家，包括墨西哥和阿联酋。

Again, that's eightsleep.com/huberman to save up to $350.

同样，访问八睡眠.com/huberman 最多可节省 350 美元。

Before we begin to conclude our discussion about bipolar disorder, I want to talk a little bit about this word disorder.

在我们开始结束关于双相情感障碍的讨论之前，我想谈谈这个词障碍。

And this is a theme that doesn't just relate to bipolar disorder, but other psychiatric disorders as well.

这个主题不仅与双相情感障碍有关，还与其他精神疾病有关。

And when we think of a disorder, we think of something that is really detrimental to us, something that really impairs our ability to function in work, in school, in relationships, and really starts to pull down our health status in a variety of ways.

当我们想到某种疾病时，我们会想到一些对我们真正有害的东西，一些真正损害我们在工作、学校、人际关系中发挥作用的能力，并真正开始以各种方式降低我们的健康状况的东西。

And certainly bipolar disorder meets those criteria.

当然，双相情感障碍也符合这些标准。

However, there is this idea that things like bipolar disorder, even things like schizophrenia in some cases, are responsible for some of the creative aspects or the creative works that have been observed and carried out by human beings for many centuries.

然而，有一种观点认为，像双相情感障碍这样的疾病，甚至在某些情况下像精神分裂症这样的疾病，是人类几个世纪以来观察和进行的一些创造性方面或创造性工作的原因。

And believe it or not, there are good data to support the fact that certain aspects of mania are associated with creativity.

不管你相信与否，有充分的数据支持这样一个事实：狂热的某些方面与创造力有关。

It's been explored at a research level.

人们已经在研究层面对此进行了探索。

Really, there are data pointing to the fact that certain individuals of certain occupations tend to be more creative, and that creativity is associated with, again, associated, this isn't causal, it's associated or correlated with higher levels or incidents of bipolar depression and maybe even other forms of depression.

事实上，有数据表明，某些职业的某些人往往更具创造力，而且创造力与双相抑郁症甚至其他形式的抑郁症的较高水平或事件相关或相关，这不是因果关系。

So this is a study looking at mood disorders in eminent individuals, so these are people that are not just good at what they do, but are exceptional at what they do, and explored the percentage of people in given professions with either depression or mania.

这是一项针对杰出人士情绪障碍的研究，这些人不仅擅长他们所做的事情，而且在他们所做的事情上表现出色，并探讨了特定职业中患有抑郁症或躁狂症的人的百分比。

And this was actually a data set gleaned from more than a thousand 20th century Westerners based on their biographies that were reviewed by other people.

这实际上是从一千多名20世纪西方人的传记中收集到的数据集，并经过其他人的审查。

So it's a bit of an indirect measurement.

所以这有点间接测量。

This isn't psychiatrist data.

这不是精神病学家的数据。

This is data, or I should say, these are data that were compiled from self-reports or from reads of self-reports, and they explored a number of different professions.

这是数据，或者我应该说，这些数据是根据自我报告或阅读自我报告编写的数据，他们探索了许多不同的职业。

So for instance, they looked at people in the military, or people who were professional athletes, or natural scientists, or social scientists, people who occupied positions in public office, or were musical performers, artists, nonfiction writers, poetry, et cetera.

例如，他们研究了军人、职业运动员、自然科学家、社会科学家、担任公职的人、音乐表演者、艺术家、纪实作家、诗歌等等。

Turns out that if you were to look at the profession, those in the military and those who are professional athletes or had jobs in the social or natural sciences, of those, there was a lower percentage of those that had depression or mania.

事实证明，如果你观察一下职业，那些军人、职业运动员或从事社会或自然科学工作的人，就会发现患有抑郁症或躁狂症的人比例较低。

In some cases, like those who are professional athletes, there was no incidents of mania, at least in this data set.

在某些情况下，比如职业运动员，至少在这个数据集中没有出现躁狂事件。

Whereas at the opposite extreme of the graph, those that were poets, so these are eminent individuals, people that were exceptional poets, exceptional fiction writers, exceptional artists or nonfiction writers, well, there, especially for the poets, you find that as many as 90% of these very successful poets had either depression or mania.

而在图表的另一个极端，那些诗人，所以这些都是杰出的个人，杰出的诗人，杰出的小说作家，杰出的艺术家或非小说作家，嗯，在那里，特别是对于诗人来说，你会发现多达 90% 的非常成功的诗人要么患有抑郁症，要么患有躁狂症。

Again, associative, correlative, no causal relationship here.

再次强调，这里是关联的、相关的，没有因果关系。

But it is really striking to see how the creative occupations, poetry, fiction, art, nonfiction writing, even though nonfiction writing is about nonfiction, it's still creative, music composition, theater, much higher incidents of things like mania.

但看到创造性的职业、诗歌、小说、艺术、非小说写作，确实令人震惊，尽管非小说写作是关于非小说的，但它仍然是创造性的、音乐创作、戏剧，以及狂热等更高的事件。

And in fact, for the people in theater, the actors, even though the overall occurrence of depression and mania is lower than that in poets, the fraction of those individuals that have mania is exceedingly high.

事实上，对于戏剧界的演员来说，尽管抑郁症和躁狂症的总体发生率低于诗人，但患有躁狂症的比例却非常高。

It's about 30% of those that they looked at who are actors have manic episodes or have full-blown mania.

在他们调查的演员中，约有 30% 患有躁狂症或患有全面的躁狂症。

So I'm referring to these data because, first of all, I find them incredibly interesting.

所以我提到这些数据是因为，首先，我发现它们非常有趣。

Up until now, we've been talking about bipolar disorder and other mood disorders for their maladaptive effects, and again, they're extremely maladaptive, much, much higher incidence of suicide, et cetera.

到目前为止，我们一直在谈论双相情感障碍和其他情绪障碍的适应不良影响，再说一次，它们的适应不良性非常高，自杀率高得多，等等。

But we'd be wrong to say that certain aspects of manic episodes don't lend themselves well to creativity, or that certain aspects of major depression don't lend themselves well to creativity, or to the performing arts, or to poetry.

但如果我们说躁狂发作的某些方面不利于创造力，或者重度抑郁症的某些方面不利于创造力、表演艺术或诗歌，那就错了。

So today, we've really done a deep dive into bipolar disorder and to both the manic and the depressive components that are present or can be present in bipolar disorder, and the different forms of bipolar disorder, and some of the major treatments for bipolar disorder, in particular, lithium and its underlying mechanisms.

今天，我们真正深入研究了双相情感障碍、双相情感障碍中存在或可能存在的躁狂和抑郁成分、不同形式的双相情感障碍，以及双相情感障碍的一些主要治疗方法，特别是锂及其潜在机制。

I do hope you found it beneficial, both for yourself and for others.

我确实希望您发现它对您自己和他人都有好处。

I just want to remind people that bipolar disorder is an extremely serious condition.

我只是想提醒人们，双相情感障碍是一种极其严重的疾病。

If you suspect that you have bipolar disorder or you know somebody who does, please make sure that you or they talk to a qualified health professional.

如果您怀疑自己患有双相情感障碍或您认识的人患有双相情感障碍，请确保您或他们与合格的健康专业人士交谈。

So once again, thank you for joining me today for our discussion about the biology and treatment of bipolar disorder.

再次感谢您今天与我一起讨论双相情感障碍的生物学和治疗。

And last but certainly not least, thank you for your interest in science.

最后但并非最不重要的一点是，感谢您对科学的兴趣。