Improve Focus with Behavioral Tools & Medication for ADHD | Dr. John Kruse
Andrew Huberman:
安德鲁·休伯曼：
Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.
欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。
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。
My guest today is Dr. John Kruse.
今天我的嘉宾是约翰·克鲁斯博士。
Dr. John Kruse is an MD, PhD, and practicing psychiatrist who specializes in the treatment of ADHD in both kids and in adults.
约翰·克鲁斯 (John Kruse) 博士是医学博士、哲学博士和执业精神科医生，专门研究儿童和成人多动症的治疗。
As you'll see during today's episode, Dr. Kruse is among the world's top experts in understanding the various treatments for ADHD and tools for helping to overcome non-clinical issues with focus and attention.
正如您将在今天的节目中看到的那样，克鲁斯博士是世界顶级专家之一，他了解 ADHD 的各种治疗方法以及帮助集中精力克服非临床问题的工具。
We, of course, discuss the drug treatments for ADHD.
当然，我们讨论多动症的药物治疗。
So those include Adderall, Ritalin, Vyvanse, Modafinil, Wellbutrin, basically all the drugs that are used to treat ADHD, and we cover their relative advantages and disadvantages.
这些包括阿德拉、利他林、Vyvanse、莫达非尼、维布特林，基本上所有用于治疗多动症的药物，我们涵盖了它们的相对优点和缺点。
We also talk about the use of caffeine for focus and how caffeine can interact with those various drugs.
我们还讨论了使用咖啡因来集中注意力以及咖啡因如何与这些不同的药物相互作用。
Dr. Kruse also educates us on how specific behaviors like our sleep timing, so not just the amount of sleep we get, but when we sleep, as well as our meals, our exercise, how all that can shape our levels of attention and focus.
克鲁斯博士还教育我们一些具体的行为，比如我们的睡眠时间，不仅仅是我们的睡眠时间，还有我们的睡眠时间、我们的饮食、我们的锻炼，以及所有这些如何影响我们的注意力和专注程度。
And that, of course, is relevant not just to people struggling with attention and focus or who have ADHD, but to everybody.
当然，这不仅与注意力不集中的人或患有多动症的人有关，而且与每个人有关。
Dr. Kruse isn't just a psychiatrist.
克鲁斯博士不仅仅是一位精神病学家。
He also has a background in circadian biology research, and he offers the intriguing idea that ADHD and other deficits in focus may, in many cases, be the consequence of a misregulated circadian rhythm.
他还拥有昼夜节律生物学研究背景，他提出了一个有趣的想法，即在许多情况下，多动症和其他注意力缺陷可能是昼夜节律失调的结果。
He tells us how to test that idea and potentially how to fix it.
他告诉我们如何测试这个想法以及如何解决它。
By the end of today's episode, you'll understand what stimulants do, the possible origins of ADHD in both kids and adults, and both the behavioral and drug treatments and non-prescription approaches to overcoming brain fog and focus challenges.
在今天的节目结束时，您将了解兴奋剂的作用、儿童和成人 ADHD 的可能起源，以及克服脑雾和注意力障碍的行为和药物治疗以及非处方方法。
So by the end of today's episode, you'll be armed with a ton of new knowledge, and you'll have a lot of practical tools you can apply.
因此，到今天的课程结束时，您将掌握大量新知识，并且拥有许多可以应用的实用工具。
Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.
在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。
It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public.
然而，我的愿望和努力的一部分是向公众提供有关科学和科学相关工具的零成本消费者信息。
In keeping with that theme, this episode does include sponsors.
为了与这个主题保持一致，这一集确实有赞助商。
And now for my discussion with Dr. John Kruse.
现在我与约翰·克鲁斯博士进行了讨论。
Dr. John Kruse, welcome.
约翰·克鲁斯博士，欢迎光临。
Dr. John Kruse:
约翰·克鲁斯博士：
I'm glad to be here today.
我很高兴今天来到这里。
Andrew Huberman:
安德鲁·休伯曼：
Let's talk about ADHD, and probably best if we start off by just laying out what it is.
让我们来谈谈注意力缺陷多动症（ADHD），如果我们首先列出它是什么，可能是最好的。
Is the H, is the hyperactivity component always in there?
H，多动成分总是在那里吗？
Childhood ADHD, adult ADHD.
儿童多动症，成人多动症。
Maybe if you would just give us the top contour of this, and then we can get into ways to combat ADHD depending on different circumstances, different needs, this sort of thing.
也许如果你能给我们一个大概的轮廓，然后我们就可以根据不同的情况、不同的需求等找到对抗多动症的方法。
Dr. John Kruse:
约翰·克鲁斯博士：
I'll just start out by saying that like most things in neuroscience and psychiatry, we have some definitions, and we have lots of different thoughts and frameworks to approach things.
我首先要说的是，就像神经科学和精神病学中的大多数事物一样，我们有一些定义，并且我们有很多不同的想法和框架来处理事物。
So I'll start with our diagnostic category or how we diagnose ADHD, and that is there are 18 different symptoms.
因此，我将从我们的诊断类别或如何诊断 ADHD 开始，即有 18 种不同的症状。
Nine of them are hyperactive-impulsive, nine of them are inattentive.
其中九人是多动冲动的人，九人是注意力不集中的人。
So the inattentive ones are things like forgetting to follow through on things, losing items, being easily distracted.
因此，注意力不集中是指忘记跟进事情、丢失物品、容易分心等。
The impulsive and hyperactive ones are cutting people off in conversations, blurting things out, running around, fidgeting.
冲动、多动的人会打断别人的谈话、脱口而出、到处乱跑、坐立不安。
But the definitions themselves were designed with a child population in mind because until roughly the mid-'90s, it was dogma that this was a neurodevelopmental disease of childhood, and that every child who had it outgrew it.
但这些定义本身是针对儿童人群设计的，因为直到大约 90 年代中期，人们都认为这是一种儿童神经发育疾病，并且每个患有这种疾病的孩子长大后都会摆脱这种疾病。
That is dramatically wrong.
这是大错特错的。
Some kids do.
有些孩子会。
Most kids don't.
大多数孩子不会。
The latest work suggests that most adults fluctuate in time with the severity of their ADHD symptoms.
最新的研究表明，大多数成年人的注意力随多动症症状的严重程度而变化。
So jumping back to the definition.
所以跳回定义。
So we have these 18 different symptoms.
所以我们有这 18 种不同的症状。
As an adult, you need to have at least five of them, and when we say have them, all of these are things that normal people can display at any time.
作为一个成年人，你至少需要具备五个，而当我们说拥有时，这些都是正常人可以随时表现出来的。
So any of us might interrupt someone, might have trouble sitting, might have trouble attending to a task.
因此，我们中的任何人都可能会打断某人，可能无法坐下，可能无法专注于某项任务。
But to meet the criteria, these have to be displayed in excessive amount of time or to an excessive degree to the extent that they're causing some dysfunction or distress, and that they have to be displayed in multiple realms of life.
但为了满足标准，这些必须在过多的时间或过度的程度上表现出来，以至于造成一些功能障碍或痛苦，并且它们必须在生活的多个领域表现出来。
So if it's only at work that you have trouble completing your task, that might have something to do with your boss or an uncomfortable chair or something.
因此，如果您只是在工作中难以完成任务，则可能与您的老板或不舒服的椅子或其他原因有关。
So these have to be traits that are displayed in multiple realms of life.
因此，这些特征必须在生活的多个领域中表现出来。
They have to cause, again, distress or dysfunction.
它们必须再次引起痛苦或功能障碍。
They have to be to an extent that's beyond what a normal person does.
他们必须达到超出正常人所能做到的程度。
And what's strange is often ADHD has a stigma it's not a real diagnosis, partly because there isn't some, a fancy word, pathognomonic, some classic symptom that's characteristic exactly of that.
奇怪的是，多动症通常有一种耻辱，它不是一个真正的诊断，部分原因是没有一些，一个花哨的词，特征性的，一些典型的症状完全是它的特征。
So with schizophrenia, we have hallucinations.
因此，对于精神分裂症，我们会产生幻觉。
Most people aren't having hallucinations.
大多数人并没有出现幻觉。
If you have those, you might have schizophrenia or a drug effect, but that's unusual.
如果你有这些，你可能患有精神分裂症或药物效应，但这是不寻常的。
Again, with ADHD, they're all usual behaviors.
再说一次，对于多动症来说，这些都是常见的行为。
It's just to an unusual extent.
这只是到了一个不寻常的程度。
So the diagnosis comes under a lot of stigma and questioning.
因此，这个诊断受到了很多耻辱和质疑。
Isn't this just normal behavior carried to a ridiculous extent?
这不是正常的行为，到了可笑的程度吗？
Andrew Huberman:
安德鲁·休伯曼：
So you mentioned that there can be a lot of environmental dependence.
所以你提到可能存在很大的环境依赖性。
One thing that I, and I know a lot of people wonder about, is with the advent of more people working at home, and certainly during lockdowns, kids were at home for school as well.
我和我知道很多人都想知道的一件事是，随着越来越多的人在家工作，当然在封锁期间，孩子们也在家上学。
But is it the case that when somebody with ADHD is in their home environment where they're Typically, more options of things to do that the symptoms get worse, as opposed to when they go to, say, a restaurant or to school or to play a sport or to work where sure, there are multiple things you can do in those environments, but they're more constrained in terms of the different sides of oneself, the different activities that one tends to engage in.
但是，当患有注意力缺陷多动症的人在他们的家庭环境中时，通常有更多的事情可以做，症状会变得更糟，而不是当他们去餐馆、学校、运动或工作时，当然，在这些环境中你可以做很多事情，但他们在自己的不同方面、一个人倾向于从事的不同活动方面受到更多限制。
Is that common?
这很常见吗？
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
So back up a little bit.
所以稍微后退一点。
Like all of our other mental health or psychiatric conditions, there's clearly both a biological component to ADHD and clearly a social environment, or the nature and nurture question isn't which is it, it's always both.
就像我们所有其他心理健康或精神疾病一样，多动症显然既有生物学因素，也有社会环境因素，或者先天和后天的问题不在于哪个，而总是两者兼而有之。
So with ADHD, we know there's a very strong genetic component.
因此，我们知道多动症有很强的遗传因素。
The heritability factor is around 0.8, which is about as strong as the heritability factor for height or for schizophrenia.
遗传因子约为 0.8，与身高或精神分裂症的遗传因子大致相同。
Andrew Huberman:
安德鲁·休伯曼：
So does that mean that if you're an identical twin and your twin has ADHD, that there's a sort of essentially a 0.8 probability that you'll have it as well?
那么，这是否意味着，如果您是同卵双胞胎，而您的双胞胎患有 ADHD，那么您也患有 ADHD 的概率基本上为 0.8 吗？
Or is this through the-
或者这是通过-
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
Heritability is a little more technically-
遗传力的技术含量更高一些——
Andrew Huberman:
安德鲁·休伯曼：
Sure
当然可以
Dr. John Kruse:
约翰·克鲁斯博士：
...
...
sophisticated, and it's about the variance due to gen-
复杂，这是关于由于生成而产生的方差
Andrew Huberman:
安德鲁·休伯曼：
Sure
当然可以
Dr. John Kruse:
约翰·克鲁斯博士：
But it's high likelihood.
但可能性很大。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. John Kruse:
约翰·克鲁斯博士：
So this tends to run in families.
所以这往往会在家庭中发生。
But again, it has a social-- You're not just a brain in the world, you're a brain interacting with the world.
但同样，它具有社交性——你不仅仅是世界上的大脑，你还是与世界互动的大脑。
And with ADHD, we like to frame it as both structure is important and demands are important.
对于多动症，我们喜欢将其框架化，因为结构很重要，需求也很重要。
So one of the aspects of ADHD, separate from the official how we categorize it or diagnose it in terms of symptoms, we most often are understanding at this day and age as a problem with executive functions of the brain, how the brain's working memory works, how selective attention works or doesn't work, how emotional regulation is working or not, how impulse control is working.
因此，ADHD 的一个方面，与官方如何对它进行分类或根据症状进行诊断不同，我们在当今这个时代最常将其理解为大脑执行功能的问题，大脑的工作记忆如何工作，选择性注意力如何发挥或不起作用，情绪调节如何发挥作用，冲动控制如何发挥作用。
And essentially, the ADHD brain is less able to provide the structure it needs, so it's more reliant on an optimal structure in the outside world.
从本质上讲，多动症大脑无法提供所需的结构，因此它更依赖于外部世界的最佳结构。
So getting the home versus working in a office environment, part of the problem is if you're in a traditional office environment, you're starting a specific time.
因此，与在办公室环境中工作相比，回到家中，部分问题在于，如果您处于传统的办公环境中，那么您将在特定的时间开始工作。
Everyone else is doing their work at a certain time.
其他人都在特定的时间做他们的工作。
When you go to lunch, it's clear.
当你去吃午饭时，一切就很清楚了。
You may have people checking in or seeing you in the hallway.
可能有人在走廊里登记或见到您。
"Larry, how far along are you on this coding project?
“拉里，你这个编码项目进展到什么程度了？
Are you going to be ready for it on time?" When you're home, you don't get any of that reinforcement.
你能按时做好准备吗？”当你在家时，你不会得到任何强化。
You don't have any of that structure.
你没有任何这样的结构。
So, structure is a Goldilocks issue.
所以，结构是一个金发姑娘的问题。
It's not just more structure is always good, because if you put or impose too much structure on someone, so most people with ADHD are really lousy assembly line workers.
这不仅仅是更多的结构总是好的，因为如果你给某人施加或强加太多的结构，那么大多数患有多动症的人都是非常糟糕的装配线工人。
They don't want to be just picking up one bolt, screwing it on the side of a Lexus or whatever, and watching the car move down the line.
他们不想只是拿起一个螺栓，将其拧到雷克萨斯或其他什么的侧面，然后看着汽车沿着生产线移动。
That's too stultifying, too limiting, too structured.
这太乏味了，太有限了，太结构化了。
So you need the optimal amount of structure, and with COVID and working from home and kids being at the home, so one thing it created is less structure for the day, but it also increased the demand side of the equation.
因此，你需要最佳的结构量，并且由于新冠疫情、在家工作和孩子们在家，所以它造成的一件事是一天的结构减少，但它也增加了等式的需求方面。
So the cognitive demand, not only did you have to manage your own time and schedule now, in addition to doing your work, you had to schedule it, but you might have had screaming kids in the other room, or you might have had your partner who wants to use that room for their quiet meetings some of the time when you're trying to do it.
因此，认知需求，你现在不仅必须管理自己的时间和日程安排，除了做你的工作之外，你还必须安排它，但你可能在另一个房间里有尖叫的孩子，或者当你试图这样做时，你可能有你的伴侣想要使用那个房间进行安静的会议。
So the demands increased for many people, and the structure decreased, and that was sort of a perfect storm for creating more ADHD.
因此，对许多人来说，需求增加了，结构却减少了，这对于创造更多的多动症来说是一场完美的风暴。
And what's really interesting from a mental health perspective, at the very start of the COVID epidemic, public mental health figures said, "We know if this is a massive epidemic, and we're going to have to do quarantine, and people-- We know depression's going to go up.
从心理健康的角度来看，真正有趣的是，在新冠疫情流行之初，公共心理健康数据表示，“我们知道这是否是一场大规模的流行病，我们将不得不进行隔离，人们——我们知道抑郁症将会上升。
We know anxiety's going to go up.
我们知道焦虑会加剧。
We know alcohol and substance abuse is going to go up.
我们知道酒精和药物滥用将会增加。
We know PTSD and domestic violence is going to go up." They claimed suicide would go up.
我们知道创伤后应激障碍和家庭暴力将会增加。”他们声称自杀率会上升。
That was incorrect, and we can get into that, but I think there's an ADHD reason why it didn't go up.
这是不正确的，我们可以讨论这个问题，但我认为有一个多动症的原因导致它没有上升。
Nobody that I heard was mentioning that ADHD would go up.
我听到没有人提到多动症会上升。
And part of it is because partly to hold onto its legitimacy as a real psychiatric diagnosis, both many patients and many researchers in the field hold so strongly to, this is a biological condition.
部分原因是为了保持其作为真正的精神病学诊断的合法性，许多患者和该领域的许多研究人员都强烈认为这是一种生物学状况。
Why would it change?
为什么会改变呢？
We can understand why PTSD, more people are being traumatized.
我们可以理解为什么更多的人受到创伤后应激障碍（PTSD）的伤害。
Uncle Joe just died from coughing his lungs out from COVID.
乔叔叔刚刚因新冠肺炎咳出肺部而去世。
PTSD, it's easy to see.
创伤后应激障碍（PTSD），很容易看出。
Or depression.
或者抑郁症。
You've just lost your job and your whole industry.
你刚刚失去了工作和整个行业。
You're a restaurant worker, that's not coming back.
你是一名餐馆工作人员，你不会再回来了。
So we could easily relate stories as to why these other conditions were going to go up, but there was no prediction, again, mostly because I think the defensiveness of the ADHD community and not wanting to acknowledge as much that there's a real nurture component and not just a nature component.
因此，我们可以很容易地讲述为什么这些其他情况会上升的故事，但同样没有预测，主要是因为我认为多动症群体的防御性，并且不想承认存在真正的后天因素，而不仅仅是先天因素。
And yet what we've seen, just looking at prescriptions, and the media's jumped all over this, not only have ADHD diagnosis gone up considerably, but also prescription stimulants have shot up dramatically in the last few years.
然而，我们所看到的，只要看看处方，媒体就对此进行了广泛报道，不仅多动症的诊断率大幅上升，而且处方兴奋剂在过去几年中也急剧增加。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to take a quick break and thank our sponsor, Eight Sleep.
我想稍微休息一下，并感谢我们的赞助商“八睡”。
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。
Now, I've spoken before on this podcast about the critical need for us to get adequate amounts of quality sleep each night.
现在，我之前在这个播客上谈到过我们迫切需要每晚获得充足的优质睡眠。
Now, one of the best ways to ensure a great night's sleep is to ensure that the temperature of your sleeping environment is correct And that's because in order to fall and stay deeply asleep, your body temperature actually has to drop by about one to three degrees.
现在，确保一夜好眠的最佳方法之一是确保睡眠环境的温度正确，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 about one to three degrees.
为了醒来时感到神清气爽、精力充沛，您的体温实际上必须升高约一到三度。
Eight Sleep makes it very easy to control the temperature of your sleeping environment by allowing you to program the temperature of your mattress cover at the beginning, middle, and end of the night.
八睡眠让您可以轻松控制睡眠环境的温度，您可以在晚上开始、中间和结束时对床垫罩的温度进行编程。
I've been sleeping on an Eight Sleep mattress cover for nearly four 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四年了，它彻底改变并改善了我的睡眠质量。
Eight Sleep recently launched their newest generation of the pod cover, called the Pod 4 Ultra.
八睡眠最近推出了他们最新一代的 Pod 4 Ultra。
The Pod 4 Ultra has improved cooling and heating capacity.
Pod 4 Ultra 改进了制冷和制热能力。
I find that very useful because I like to make the bed really cool at the beginning of the night, even colder in the middle of the night, and warm as I wake up.
我发现这非常有用，因为我喜欢让床在夜刚开始时非常凉爽，在半夜更冷，而在我醒来时却很温暖。
That's what gives me the most slow-wave sleep and rapid eye movement sleep.
这就是给我最慢波睡眠和快速动眼睡眠的原因。
It also has snoring detection that will automatically lift your head a few degrees to improve your airflow and stop your snoring.
它还具有打鼾检测功能，可自动将您的头部抬起几度，以改善气流并停止打鼾。
If you'd like to try an Eight Sleep mattress cover, go to eightsleep.com/huberman to save up to $350 off their Pod 4 Ultra.
如果您想尝试 8 Sleep 床垫套，请访问 foursleep.com/huberman，Pod 4 Ultra 最多可节省 350 美元。
Eight Sleep currently ships in the USA, Canada, UK, select countries in the EU, and Australia.
八睡眠目前在美国、加拿大、英国、欧盟部分国家和澳大利亚发货。
Again, that's eightsleep.com/huberman.
再说一遍，这是八睡眠.com/huberman。
Today's episode is also brought to us by Joovv.
今天的节目也是Joovv给我们带来的。
Joovv makes medical-grade red light therapy devices.
Joovv 生产医疗级红光治疗设备。
Now, if there's one thing that I have consistently emphasized on this podcast, it is the incredible impact that light can have on our biology.
现在，如果我在这个播客中一直强调一件事，那就是光对我们的生物学产生的令人难以置信的影响。
Now, in addition to sunlight, red light and near-infrared light sources have been shown to have positive effects on improving numerous aspects of cellular and organ health, including faster muscle recovery, improved skin health and wound healing, improvements in acne, reduced pain and inflammation, even mitochondrial function, and improving vision itself.
现在，除了阳光之外，红光和近红外光源已被证明对改善细胞和器官健康的许多方面具有积极作用，包括更快的肌肉恢复、改善皮肤健康和伤口愈合、改善痤疮、减少疼痛和炎症，甚至线粒体功能，以及改善视力本身。
What sets Joovv lights apart, and why they're my preferred red light therapy device, is that they use clinically proven wavelengths, meaning specific wavelengths of red light and near-infrared light in combination to trigger the optimal cellular adaptations.
Joovv 灯的与众不同之处以及它们成为我首选红光治疗设备的原因在于它们使用经过临床验证的波长，这意味着特定波长的红光和近红外光相结合可以触发最佳的细胞适应。
Personally, I use the Joovv whole body panel about three to four times a week, and I use the Joovv handheld light both at home and when I travel.
就我个人而言，我每周大约使用 Joovv 全身面板三到四次，在家和旅行时我都会使用 Joovv 手持灯。
If you'd like to try Joovv, you can go to Joovv, spelled J-O-O-V-V, .com/huberman.
如果您想尝试 Joovv，可以访问 Joovv，拼写为 J-O-O-V-V，.com/huberman。
Joovv is offering an exclusive discount to all Huberman Lab listeners with up to $400 off Joovv products.
Joovv 为所有 Huberman Lab 听众提供独家折扣，Joovv 产品最高可享受 400 美元的折扣。
Again, that's Joovv, spelled J-O-O-V-V, .com/huberman to get up to $400 off.
同样，这是 Joovv，拼写为 J-O-O-V-V，.com/huberman 最高可享受 400 美元折扣。
I'm fascinated by this relationship between optimal structure and difficulty, or at least optimal structure versus having some margins for exploration at one's job.
我对最佳结构和难度之间的关系着迷，或者至少是最佳结构与在工作中进行探索的余地之间的关系。
I realize it's very difficult to throw out pan statements about what sorts of work and professions are going to be best for people with ADHD.
我意识到很难对哪种工作和职业最适合多动症患者做出笼统的陈述。
But, in your clinical observation, can you perhaps point us to clusters of professions where people with ADHD tend to gravitate toward because they have sufficient or even hyper-proficiency there?
但是，在您的临床观察中，您能否向我们指出多动症患者倾向于从事的职业集群，因为他们在这些职业上有足够的甚至超熟练的能力？
Like would we say like the creative arts, where as long as they can get themselves to the theater, they tend to do well when improv, I'm using extreme kind of almost silly examples, but those are professions indeed, versus a job where people have quote unquote banker's hours, where it's 9:00 to 5:00.
就像我们所说的创意艺术一样，只要他们能够进入剧院，他们在即兴创作时往往会表现出色，我使用的是极端的几乎愚蠢的例子，但这些确实是职业，而不是人们引用银行家工作时间的工作，即 9:00 到 5:00。
I could see that being an advantage, also being very difficult and, of course, or accounting, where literally decimal points matter and every digit counts.
我可以看到这是一个优势，但也非常困难，当然，或者会计，小数点字面上很重要，每个数字都很重要。
So are there sort of clusters?
那么是否存在某种集群呢？
Dr. John Kruse:
约翰·克鲁斯博士：
I'm going to step back and answer.
我要退后一步来回答。
I'll get to your answer, but I'm going to frame it two different ways first.
我会得到你的答案，但我会首先用两种不同的方式来表达它。
One is, and I didn't come up with this, but I think it's one of the most insightful quips about ADHD, is that non-ADHD brains are importance-driven.
一是，我没有想到这一点，但我认为这是关于多动症最有洞察力的俏皮话之一，即非多动症大脑是重要性驱动的。
If you know you have to move your car because you'll get a parking ticket, you go out and move it.
如果你知道你必须移动你的车，因为你会收到停车罚单，你就会出去移动它。
If you know taxes need to be paid in April, it's a boring, thankless job.
如果你知道四月份需要缴税，那这是一项无聊、吃力不讨好的工作。
Maybe a few people enjoy it, but most of us aren't CPAs are, you take care of it.
也许少数人喜欢它，但我们大多数人都不是注册会计师，你照顾它。
The ADHD brain, in contrast, is an interest-driven brain.
相比之下，多动症大脑是一个兴趣驱动的大脑。
So they know, "Yeah, yeah, yeah, I should be doing my taxes, but hey, look at how the Warriors are doing in their basketball playoff game.
所以他们知道，“是的，是的，是的，我应该报税，但是嘿，看看勇士队在篮球季后赛中的表现。
Look at this cool cat video.
看看这个很酷的猫视频。
Oh, I'd rather do something else." So regarding career or work, I think the most important thing is that it's interesting to you.
哦，我宁愿做点别的事。”所以无论是事业还是工作，我认为最重要的是你感兴趣。
So we can talk about realms of work or certain career paths, but if it's not compelling to you, if it's not interesting to you, it's going to be hard to work at it, even if it structurally may be a better support for you.
因此，我们可以讨论工作领域或某些职业道路，但如果它对你没有吸引力，如果你不感兴趣，那么就很难从事它，即使它在结构上可能对你有更好的支持。
Andrew Huberman:
安德鲁·休伯曼：
Does that carry over to other domains of life?
这会延续到生活的其他领域吗？
Do you see, for instance, that people with ADHD have a harder time with parenting?
例如，您是否发现患有多动症的人在养育子女方面遇到困难？
Not that kids aren't super interesting, but some of their activities might be less interesting to parents than others, versus people who are just, I think of this word importance-driven as just kind of really dutiful.
并不是说孩子们不是超级有趣，而是他们的某些活动对父母来说可能不如其他人那么有趣，而与那些只是，我认为“重要性驱动”这个词只是一种真正的尽职尽责。
Like you do it because you're supposed to do it.
就像你这样做是因为你应该这样做一样。
Dr. John Kruse:
约翰·克鲁斯博士：
Part of how the field actually in the '90s started becoming aware that adults could have ADHD is that all these clinicians who were having ADHD clinics for kids were starting to notice, wait a minute, this parent is showing up 20 minutes late to pick up his kid.
实际上，该领域在 90 年代开始意识到成年人可能患有 ADHD 的部分原因是，所有为儿童开设 ADHD 诊所的临床医生都开始注意到，等一下，这位家长迟到了 20 分钟来接他的孩子。
Wait a minute, a parent didn't fill the prescription, so the kid went for two weeks without the medication.
等一下，一位家长没有按处方配药，所以孩子两周没有吃药。
They started becoming more aware of ADHD in adults by seeing that the adults who were parents of these kids, and again, there's a strong genetic connection, had ADHD.
当他们看到这些孩子的父母的成年人患有多动症时，他们开始更加意识到成年人的多动症，而且这与遗传有很强的联系。
So there are certainly wonderful, loving, supportive, nurturing parents with ADHD, but studies that have looked at trying to find some objective measures.
因此，肯定有一些出色的、充满爱心的、支持性的、养育性的多动症父母，但研究试图找到一些客观的衡量标准。
Are things more likely to be forgotten, misplaced, mislaid?
东西是否更容易被遗忘、放错地方、放错地方？
Go off track with an ADHD family?
与多动症家庭偏离轨道？
Absolutely.
绝对地。
And one of the more powerful sets of interventions for kids with ADHD, separate from medications, is family-based training that helps get the whole family, one, to understand how the kid's brain is working differently, but actually it might not be that different.
对于患有多动症的孩子来说，除了药物之外，更有效的干预措施之一是以家庭为基础的培训，帮助全家人了解孩子的大脑如何以不同的方式工作，但实际上可能并没有那么不同。
It might be exactly how dad or mom's brain is working.
这可能正是爸爸或妈妈大脑的工作方式。
But to help them function as more consistent parents.
但要帮助他们成为更加稳定的父母。
So the other bias, I'd say again before identifying specific careers, is that as a society, we've long cherished or valued the guy who worked 50 years for Eastman Kodak Company and got the gold watch at the end, was sort of the epitome of what you should strive for in a career.
因此，在确定具体职业之前，我想再说一遍，另一个偏见是，作为一个社会，我们长期以来一直珍视或重视为伊士曼柯达公司工作 50 年并最终获得金表的人，他是你在职业生涯中应该努力奋斗的缩影。
But if you're interest-driven and your interests change, so for many people with ADHD, the best career is actually not one 50-year career, it's ten 5-year careers or five 10-year careers.
但如果你是兴趣驱动的，而且你的兴趣会改变，那么对于很多患有多动症的人来说，最好的职业实际上不是一个50年的职业生涯，而是10个5年的职业生涯或5个10年的职业生涯。
And part of it is, as the whole work world has become more fragmented, and upheaval is the name of the game, and break things quickly is the motto of Silicon Valley.
部分原因是，整个工作世界变得更加分散，剧变是游戏的名称，而快速打破事物是硅谷的座右铭。
I didn't phrase that quite right, but the message, I think, is still there.
我的措辞不太正确，但我认为这个信息仍然存在。
We're accepting more that many career trajectories are going to look not like just one beautiful arc, but I think there's a sort of a normocentric bias to it.
我们更多地接受的是，许多职业轨迹看起来不仅仅是一条美丽的弧线，但我认为其中存在一种以常态为中心的偏见。
That is what you should strive for, and if you are changing careers, that's a bad thing.
这就是你应该努力的目标，如果你正在改变职业，那是一件坏事。
And yet, lots of people who do worthwhile things in life, and often because of their more varied experience, are bringing more to what they're doing.
然而，许多人在生活中做了有价值的事情，而且往往因为他们的经历更加多样化，他们为他们正在做的事情带来了更多。
So I think we need to value that and embrace that as an option and accept that maybe for some people, that is an optimal career path.
因此，我认为我们需要重视这一点，并将其作为一种选择，并接受也许对于某些人来说，这是一条最佳的职业道路。
Andrew Huberman:
安德鲁·休伯曼：
I can relate.
我能体会到。
I spent 20-plus years training to become a bench scientist and run a lab, and then now I still teach and hold my appointment, still involved in a bit of research, but I'm in a second career now-ish.
我花了 20 多年的时间训练成为一名实验科学家并经营一个实验室，现在我仍然在教书并担任职务，仍然参与一些研究，但我现在正在从事第二职业。
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And I imagine there'll be a third.
我想还会有第三个。
We can talk later if you think I have ADHD or not.
如果你认为我是否患有多动症，我们可以稍后再谈。
I certainly consume a lot of caffeine, and we'll come back to the idea, the relationship between levels of caffeine consumption and possible ADHD.
我当然消耗了大量的咖啡因，我们会回到这个想法，即咖啡因消耗水平与可能的多动症之间的关系。
We're seeding the discussion for later on that.
我们正在为稍后的讨论做准备。
We hear pretty often that social media and scrolling X or scrolling Instagram or TikTok is "giving people ADHD." Are there any data, either clinical or otherwise, that suggests that the mere practice of looking at 10,000 different contexts or even 15 videos for a minute while standing at the bus stop is somehow creating more distractibility in other domains of life?
我们经常听说社交媒体和滚动 X 或滚动 Instagram 或 TikTok 会“让人多动症”。是否有任何数据（无论是临床数据还是其他数据）表明，仅仅站在公交车站观看 10,000 个不同的背景甚至 15 个视频一分钟的做法就会在某种程度上在生活的其他领域造成更多的分心？
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
So I'd say there's a lot of good neuroscience research, or neuropsychological data, that the more time you spend immersed in social media, and it's the constant barrage of information, and not just the volume of information, but that you are constantly being interrupted, and that most of these interruptions are intentionally designed to attract your attention, and that the more people practice thinking that way or being in the world that way, yes, it's harder to sustain attention for long periods of time, that you train yourself to overreact to any new distractions.
所以我想说，有很多好的神经科学研究或神经心理学数据表明，你花在社交媒体上的时间越多，就会出现持续不断的信息弹幕，不仅仅是信息量，而且你会不断被打断，而这些打断大多是故意设计来吸引你的注意力，而且越多的人练习以这种方式思考或以这种方式生活在世界上，是的，长时间保持注意力就越难，你训练自己对任何新的干扰反应过度。
So, the core elements of some of the executive functions that are impaired in ADHD, we are all becoming more ADHD-like.
因此，一些因多动症而受损的执行功能的核心要素，我们都变得越来越像多动症。
So that's the thesis of the book that I've been working on that's still several months from going anywhere, but I call it "Attention Deficit World." And one of the things that's been frustrating is that there's been this huge disconnect.
这就是我一直在写的书的主题，距离任何地方还有几个月的时间，但我称之为“注意力缺陷世界”。令人沮丧的事情之一是存在巨大的脱节。
There have been people writing about the question you're asking, about the neuroscience.
有人写过关于你所问的问题，关于神经科学的文章。
Are our brains getting more distracted?
我们的大脑是否变得更加分心？
It's not just distracted.
这不仅仅是分心。
Immersion in this media world, or social media, cellphone, however you want to break it down, it's not all bad.
沉浸在这个媒体世界，或者社交媒体、手机中，无论你想如何分解它，这并不全是坏事。
It's not just that concentration is worse.
不仅仅是注意力更差。
So, detecting visual items in the environment, there's some things that people become more adept at.
因此，在检测环境中的视觉项目时，人们会变得更加擅长。
Whether that's actually a good thing to be more adept at, people do multitask more quickly or switch in and out of it.
不管这实际上是一件好事，还是人们更擅长处理多项任务，或者可以更快地切换多项任务。
They're still not doing as well on that task if they had no distractions and just focused solely, but they're multitasking better than people who don't immerse themselves a lot in the Internet.
如果他们没有任何干扰，只专注于这项任务，那么他们在这项任务上的表现仍然不佳，但他们比那些不经常上网的人更能同时处理多项任务。
So there's a whole literature and popular books and attention.
所以有完整的文献和流行书籍和关注。
We know everyone's getting a little more distracted.
我们知道每个人都变得更加分心。
But all the books that talk about that say, "Well, this is just sort of everyday stuff.
但所有谈论这一点的书都说：“嗯，这只是日常生活中的事情。
This has nothing to do with ADHD." And there's lots of wonderful ADHD books out there, and they say, "ADHD is this discrete condition," even if they acknowledge it's on a spectrum of severity, but that it's really serious stuff, and just because you forgot your homework or you left your car keys, or you can't remember where you parked your car, everyone does that, and we want to make sure that you respect that ADHD is a serious and potentially disruptive condition.
这与多动症无关。”市面上有很多关于多动症的精彩书籍，他们说，“多动症是一种离散的病症”，即使他们承认它的严重程度有一定范围，但它确实是很严重的事情，仅仅因为你忘记了作业，或者你忘记了车钥匙，或者你不记得你把车停在哪里，每个人都会这样做，我们希望确保你尊重多动症是一种严重的、潜在的破坏性病症。
And when I say serious, and I'm going to go on this tangent for a little bit, the caricatures of ADHD is, oh, there's the squirrel.
当我说认真的时候，我要继续切题一点，多动症的漫画是，哦，那是松鼠。
It's silly.
这很愚蠢。
People are distracted, ditzy, late, doing things that we Make fun of in society, and we ignore that many of these things can have more serious repercussions inside to it.
人们心烦意乱、昏昏欲睡、迟到，做着我们在社会上取笑的事情，而我们却忽视了其中许多事情可能会在社会内部产生更严重的影响。
So a kid who has ADHD, their life expectancy is about 10 years shorter than their non-ADHD peers.
因此，患有多动症的孩子，他们的预期寿命比非多动症同龄人短约 10 年。
That is the same extent of cutting off life as having diabetes or having major depression.
这与患糖尿病或重度抑郁症的生命中断程度相同。
Andrew Huberman:
安德鲁·休伯曼：
Is that because of accidents, addiction, injury?
是因为事故、成瘾、受伤吗？
Dr. John Kruse:
约翰·克鲁斯博士：
Almost all of it is two factors, and they're almost equal.
几乎都是两个因素，而且它们几乎相等。
One is accidents, so motor vehicle accidents, if you're driving distracted, you're more likely to be involved in accidents.
一是事故，所以机动车事故，如果你分心驾驶的话，就更有可能发生事故。
But it's also the kid who's probably being more daring with the tractor on the farm or daring the bull, or all sorts of accidents, not just motor vehicle accidents.
但也可能是孩子在农场里更大胆地使用拖拉机或敢于挑战公牛，或各种事故，而不仅仅是机动车事故。
And the other is suicide.
另一个就是自杀。
And some of the suicide is because there is an overlap with depression and anxiety and other factors.
而有的自杀是因为与抑郁和焦虑等因素有重叠。
But I'm convinced, and not many people are looking at this angle, some are, with suicide, we focus so much on the despair, the misery that someone hates their life.
但我相信，并没有多少人从这个角度来看，有些人，对于自杀，我们非常关注绝望，有人讨厌自己的生活的痛苦。
But there's lots and lots of depressed people who don't kill themselves.
但有很多很多抑郁症患者并没有自杀。
The other really important element to suicide is impulsivity.
自杀的另一个真正重要的因素是冲动。
Lots of people feel really bad, but we know having guns in households increases the likelihood someone's going to shoot them.
很多人感觉很糟糕，但我们知道家里拥有枪支会增加有人开枪射击的可能性。
Accessibility to tools that you can quickly use to kill yourself, which shows if you slow down the thinking process, if you give people more time, if they are less impulsive, they are less likely to kill them.
您可以快速使用工具来自杀，这表明如果您放慢思考过程，如果您给人们更多的时间，如果他们不那么冲动，他们就不太可能杀死他们。
They still might be miserable.
他们可能仍然很痛苦。
And that's my explanation for why, even though during COVID lockdowns, and we did see increases in depression, we did see increases of PTSD, we did see increases in domestic abuse and battering, and we saw actually a decrease in suicide during that time.
这就是我的解释，为什么即使在新冠疫情封锁期间，我们确实看到了抑郁症的增加，我们确实看到了创伤后应激障碍的增加，我们确实看到了家庭暴力和殴打的增加，而且我们确实看到了在那段时间自杀率的减少。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. John Kruse:
约翰·克鲁斯博士：
How does that make any sense?
这有什么意义呢？
And it wasn't huge, but since suicide's been going up every year prior to that, it's pretty clear and blatant in the data and remarkable.
虽然这个数字并不大，但由于在此之前自杀率每年都在上升，因此数据中的这一数字非常清楚、明显，而且引人注目。
And my claim is so many more people were at home, your kid's not around to play with the gun or find the gun, or you know what's going on, or poison, or hanging themselves from the door, or whatever else they might do.
我的说法是，家里有更多的人，你的孩子不在身边玩枪或找到枪，或者你知道发生了什么，或者投毒，或者在门上吊死，或者他们可能会做的任何其他事情。
Andrew Huberman:
安德鲁·休伯曼：
Very interesting.
非常有趣。
I didn't realize that ADHD carried this lifespan liability, and 10 years is certainly significant.
我没有意识到注意力缺陷多动症会带来这种终生责任，10 年当然很重要。
Dr. John Kruse:
约翰·克鲁斯博士：
There's also the middle ground.
还有中间立场。
So I sort of mentioned the caricature is sort of the silliness and the trivial of being late for your friends at the restaurant or forgetting your car keys, and the extreme is death.
所以我提到漫画有点愚蠢和微不足道，比如在餐厅迟到你的朋友或忘记了你的车钥匙，而极端的是死亡。
But in between, we know ADHD measurably derails education, disrupts social relationships, impacts your likelihood of your earning potential.
但在这两者之间，我们知道多动症会严重破坏教育、扰乱社会关系、影响你的收入潜力。
ADHD isn't just an academic cognitive problem.
多动症不仅仅是一个学术认知问题。
It isn't just who's going to jump through the hoops and get through school.
问题不在于谁能冲破重围并完成学业。
It isn't just who's turning in their reports or doing their work on time in the work world.
这不仅仅是工作世界中谁交报告或按时完成工作的问题。
It's also having social implications.
它还具有社会影响。
And in all those areas, it's having measurable, detrimental, significant impacts on people's lives.
在所有这些领域，它都对人们的生活产生了可衡量的、有害的、重大的影响。
Andrew Huberman:
安德鲁·休伯曼：
My understanding, and you'll see how this weaves into the previous question in a moment, my understanding is that people with ADHD have the ability to focus quite intensely on things that really capture their interest.
我的理解是，您稍后会看到这如何与上一个问题交织在一起，我的理解是，患有多动症的人有能力非常专注于真正引起他们兴趣的事情。
I don't know if I have ADHD or not.
我不知道我是否患有多动症。
I suspect if I do, it's rather mild, or I just feel lucky that I went through the educational system at a time when there were no smartphones.
我怀疑如果我这样做了，那是相当温和的，或者我只是觉得幸运，因为我在没有智能手机的时代接受了教育系统。
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
I'm really grateful for that.
我对此非常感激。
I actually used to unplug the phone in the laboratory where I was a PhD student so that I could just do experiments from 5:00 PM on because that was the only way people could reach me.
事实上，当我还是一名博士生时，我曾经在实验室里拔掉电话，这样我就可以从下午 5:00 开始做实验，因为这是人们联系我的唯一方式。
And I certainly am familiar with the, it's almost a drug-like effect of dropping into an activity.
我当然很熟悉，这几乎就像投入一项活动的药物一样。
Sometimes people call it flow, but for me, it just is dropping into an activity.
有时人们称之为心流，但对我来说，它只是投入到一项活动中。
Did some early morning writing this morning, and gosh, the feeling of pleasure just everywhere from head to toe after doing 20 minutes of focused work or 30 minutes of focused work is so striking to me.
今天早上早上写了一些东西，天哪，在做了 20 分钟或 30 分钟的专注工作后，从头到脚无处不在的愉悦感对我来说是如此惊人。
And yet, I, like I think most people, find it difficult sometimes to just get rid of all the distractions unless there's a deadline, which is one of the reasons I love deadlines.
然而，我和大多数人一样，发现有时很难摆脱所有干扰，除非有最后期限，这就是我喜欢最后期限的原因之一。
So the question is this: Is it true that people with ADHD can in fact focus, but that somehow whatever neural or neurochemical thresholds are there to allow them to drop into focus, they're just much higher thresholds?
所以问题是：患有注意力缺陷多动症的人实际上可以集中注意力，但不知何故，不管有什么神经或神经化学阈值可以让他们集中注意力，它们只是阈值高得多吗？
It just takes more fear of a deadline or fear of a consequence or excitement about the activity.
只是需要更多地担心截止日期或担心后果或对活动的兴奋。
Is that true?
这是真的吗？
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
So back up a little bit, and I maybe should have said this when we were talking about diagnosis and what is ADHD, and many people think it's a horrible title because it focus on attention deficit hyperactivity disorder, and it's very clear as you're enumerating here, it's not a deficit of attention.
所以退一步来说，当我们谈论诊断和什么是多动症时，我也许应该这么说，很多人认为这是一个可怕的标题，因为它关注的是注意力缺陷多动障碍，正如你在这里列举的那样，很明显，这不是注意力缺陷。
If it's a deficit at all, it's a deficit of control over attention.
如果说这是一种缺陷的话，那就是对注意力的控制能力的缺陷。
And with attention, there's at least three different realms where we're controlling it.
通过注意力，我们至少可以控制三个不同的领域。
One is we direct attention, so if something's important going on over there, there, so we have to be able to shift it.
一是我们要引导注意力，所以如果那边发生了重要的事情，那么我们必须能够转移它。
Two, you have to be able to sustain it, so if it's a situation that's appropriate to be sustaining it.
第二，你必须能够维持它，所以如果情况适合维持它。
And three is you need to shift out of it if it's inappropriate to stay in it.
第三，如果呆在里面不合适，你就需要离开它。
And in all three of those realms, people with ADHD have less volitional control over their attention.
在所有这三个领域中，患有多动症的人对注意力的意志控制能力较差。
So many people in the ADHD who experience it describe hyperfocus as one of their superpowers, and that is where they're getting so absorbed in their work That they are so busy coding that actually everyone else in the office has left, and it's only when the janitor is coming and emptying the garbage cans at 11:00 PM that they say, "Oh my God, where is everyone?
很多患有 ADHD 的人都将注意力高度集中描述为他们的超能力之一，这就是他们如此专注于工作的原因，以至于他们忙于编码，实际上办公室里的其他人都离开了，只有当清洁工在晚上 11:00 来清空垃圾桶时，他们才会说：“天哪，大家都在哪儿？
I'm still here because I was so intently working on the project." Some people strongly resist the idea that flow, and I'm going to butcher the Csik...
我还在这里，因为我非常专注地致力于这个项目。”有些人强烈抵制流动的想法，我要屠杀 Csik...
Andrew Huberman:
安德鲁·休伯曼：
Csikszentmihalyi.
契克森米哈伊。
Dr. John Kruse:
约翰·克鲁斯博士：
Csikszentmihalyi.
契克森米哈伊。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, no one can pronounce his name.
是啊，没有人能念出他的名字。
Dr. John Kruse:
约翰·克鲁斯博士：
That's his name.
那是他的名字。
Andrew Huberman:
安德鲁·休伯曼：
Even fewer can spell it.
能拼出来的就更少了。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So we're okay.
所以我们没事。
Yeah.
是的。
Dr. John Kruse:
约翰·克鲁斯博士：
My reading of when I sort of delved into this, I think hyperfocus is exactly a flow state because people are describing the same lack of awareness of time, and it's a task that's somewhat challenging, engaging, and interesting.
当我深入研究这个问题时，我认为过度专注正是一种心流状态，因为人们描述了同样缺乏时间意识，这是一项有点挑战性、引人入胜且有趣的任务。
If it were just about enjoyment or bliss, you could hyperfocus looking at a beautiful flower.
如果只是为了享受或幸福，你可以全神贯注地看着一朵美丽的花。
People don't describe that.
人们不会描述这一点。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. John Kruse:
约翰·克鲁斯博士：
So it needs the right amount of challenge.
所以它需要适量的挑战。
It can't be too easy, it can't be too hard, has to be something important and interesting to you.
它不能太容易，也不能太难，必须是对你来说重要且有趣的事情。
It involves oblivion, not just to time, but also to lots of space going around you.
它涉及到遗忘，不仅是时间的遗忘，还有你周围的许多空间的遗忘。
So I think they are pretty close, if not the same phenomena, flow and hyperfocus.
所以我认为它们在流动和超聚焦方面非常接近，即使不是相同的现象。
And some people with ADHD, and I think some are ones who learn what situational factors or what internal factors can help get them into that state, but many of them still struggle with it showing up when they don't want to be hyperfocused on something or have trouble engaging it when it would be useful to.
有些患有注意力缺陷多动症的人，我认为有些人知道哪些情境因素或哪些内部因素可以帮助他们进入这种状态，但当他们不想过度专注于某件事或在有用的时候遇到困难时，他们中的许多人仍然挣扎于它的出现。
Andrew Huberman:
安德鲁·休伯曼：
I sometimes use the absent-minded professor excuse, but only half-jokingly.
我有时会用教授心不在焉的借口，但只是半开玩笑的。
There's a photograph that I love of the great Oliver Sacks, the neurologist turned writer, "The Man Who Mistook His Wife for a Hat," "Awakenings," and so forth.
我很喜欢一张伟大的奥利弗·萨克斯（Oliver Sacks）的照片，他是一位神经学家，后来成为作家，《错把妻子当帽子的男人》、《觉醒》等等。
People may be familiar with Oliver's work, and it's a photograph of Oliver at a train station.
人们可能对奥利弗的作品很熟悉，这是一张奥利弗在火车站的照片。
Lots of bodies moving around him, some blurry, so there's motion there, and he's standing there with, I think he's got his pipe in his mouth, and he's writing outside the train station.
很多身体在他周围移动，有些模糊，所以那里有运动，他站在那里，我想他嘴里叼着烟斗，他正在火车站外写字。
His bag has fallen to the floor.
他的包掉到了地板上。
Some items are coming out.
有些物品即将问世。
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And he was a known and self-professed methamphetamine addict for a great portion of his medical and writing career, and sort of alluded to the idea that he had these tendencies.
在他的医学和写作生涯的很大一部分时间里，他是一位众所周知的、自称的甲基苯丙胺成瘾者，并且有点暗示他有这些倾向。
And I raise this as an example because I see that photo, and I see somebody who's in hyperfocus in a very busy environment.
我举这个例子是因为我看到那张照片，我看到有人在非常繁忙的环境中高度专注。
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
But he wrote, I've spent a lot of time with his work and his autobiography, et cetera, and talked to people who knew him, and it seemed that he was constantly seeking novel environments where there was a lot of stimulation, and somehow that allowed him to drop into these tunnels of focus.
但他写道，我花了很多时间研究他的作品和自传等，并与认识他的人交谈，似乎他一直在寻找有很多刺激的新奇环境，不知何故，这让他陷入了这些焦点隧道。
Whereas when he spent a lot of time alone, there were bouts of focus, but the quiet actually became a distraction.
而当他独处的时间较长时，他会集中注意力，但安静实际上会分散注意力。
It was as if somebody in here were speculating about diagnoses, but that there's something about external anchors and internal anchors, and that finding that sweet spot is really about knowing ourselves and where we work best at particular times.
就好像这里有人在猜测诊断，但有一些关于外部锚和内部锚的东西，找到最佳点实际上是了解我们自己以及我们在特定时间的最佳工作地点。
And this is something I'd like to transition into here, is talking about the fact that there isn't just one environment that works for somebody.
这是我想在这里过渡的事情，谈论这样一个事实：不只有一种环境适合某人。
It seems like it's often the case that it's certain environments for morning, certain environments for afternoon, certain environments having returned from vacation.
似乎经常出现这样的情况：早上在某些环境中，下午在某些环境中，度假回来后在某些环境中。
You can probably see where I'm going with this.
你大概可以明白我的意思了。
What are your thoughts on people, with ADHD or not, trying to identify sort of best conditions for them, and how important is circadian time here?
您对人们（无论是否患有多动症）有何看法，试图为他们确定最佳条件？昼夜节律在这里有多重要？
I know you have, and of course, I mentioned in the introduction that you have a lot of background in circadian biology, which I think brings in a really additional and unique dynamic to your understanding of ADHD.
我知道你有，当然，我在介绍中提到你在昼夜节律生物学方面有很多背景，我认为这为你对多动症的理解带来了真正额外和独特的动力。
Dr. John Kruse:
约翰·克鲁斯博士：
So many people come to me as a psychiatrist for ADHD are primarily focused on medications, and we still know that the stimulants are the single most powerful, in terms of extent of symptom reduction overall and in terms of the percentage of people they help, they're our most potent tool.
很多人来找我治疗多动症的精神科医生主要关注的是药物治疗，我们仍然知道兴奋剂是最有效的，就整体症状减轻的程度以及它们所帮助的人的百分比而言，它们是我们最有效的工具。
The medicine's not going to change everything, and you need to be focusing on your life as well, and I always start with scheduling.
药物不会改变一切，你也需要关注你的生活，我总是从日程安排开始。
And many people with ADHD find scheduling anathema, that that's like the slaves on the galley ship being told that you have to row stroke, stroke, stroke.
许多患有多动症的人都对日程安排感到厌恶，这就像厨房船上的奴隶被告知你必须划桨、划桨、划桨。
And what I tell them is that the part of you that's going to help make the schedule that works for you isn't some evil taskmaster trying to make you do what you don't want to do.
我告诉他们的是，你的那部分会帮助你制定适合你的时间表的部分，而不是某个邪恶的工头试图让你做你不想做的事情。
It's actually the wisest, smartest, nicest, kindest part of you that's identified what are your bigger goals, how are we going to match what you're doing in the minute to line up with those bigger goals?
实际上，你内心最明智、最聪明、最善良、最善良的部分决定了你的更大目标是什么，我们如何使你当下正在做的事情与这些更大的目标保持一致？
And this analogy isn't perfect, but the best one I've come up with, so rather than the guy on the Viking ship, the part of you that's making your schedule is a mother hen who's sort of counting all the chicks and making things aligned and nestling down and hunkering around you and taking care of you and nurturing you.
这个类比并不完美，但却是我想出的最好的类比，所以，你制定日程的部分不是维京船上的那个人，而是一只母鸡，她在数所有的小鸡，让一切排列整齐，依偎在你身边，照顾你、养育你。
And with scheduling, what I tell people is before you slot in your work or your homework or your school or externally derived tasks, I tell people you need to have the four basics.
对于日程安排，我告诉人们的是，在你安排工作、家庭作业、学校或外部衍生任务之前，我告诉人们你需要具备四个基本知识。
And sleep is far and away the biggest basic.
睡眠无疑是最重要的基础。
It's essential for all of us, but it's particularly critical for ADHD, and there's particular reasons why it's a particular challenge for people with ADHD.
这对我们所有人来说都是至关重要的，但对于多动症患者来说尤其重要，并且有特殊原因表明它对多动症患者来说是一个特殊的挑战。
But I'm trying to think if I can imagine a counterexample.
但我正在尝试思考是否可以想象一个反例。
I would say All the successful people I know with ADHD have found some way to try to regularize their sleep compared to what it would be if they were just...
我想说的是，我认识的所有患有注意力缺陷多动症的成功人士都找到了一些方法来尝试规范他们的睡眠，与如果他们只是......
So the four essentials I say are sleep, eating, exercise or some amount of movement, because again, with the hyperactivity, there's people who can sit at a desk for 12 hours, not even getting up for a bathroom break or to eat or anything.
所以我说的四个要素是睡眠、饮食、锻炼或一定量的运动，因为同样，由于多动症，有些人可以坐在办公桌前 12 个小时，甚至不起来上厕所、吃饭或做任何事情。
That's bad for your brain, bad for your body.
这对你的大脑有害，对你的身体有害。
And then the fourth thing I put in is a miscellaneous category of me time, relaxation, meditation.
然后我放入的第四件事是我的时间、放松、冥想的各种类别。
I put all those in the same slot.
我把所有这些都放在同一个插槽中。
Maybe they shouldn't.
也许他们不应该。
And all those need to be in place.
所有这些都需要到位。
We can talk more about sleep, but I'll just say a little bit more about the eating component.
我们可以更多地谈论睡眠，但我只想多谈谈饮食部分。
So we have our diagnostic criteria for ADHD, but I had, over the years, two different real-life tests.
因此，我们有 ADHD 的诊断标准，但多年来我进行了两种不同的现实生活测试。
The office I had was in an old Victorian home, so it's a home office.
我的办公室位于一栋维多利亚时代的老房子里，所以它是一个家庭办公室。
The office itself, the entrance was at the end of a short but very steep driveway, so it's a separate door.
办公室本身，入口位于一条短但非常陡峭的车道的尽头，所以它是一扇单独的门。
And I would always explain to every new patient the exact same thing.
我总是会向每个新病人解释完全相同的事情。
There's a house at 45 Hartford.
哈特福德 45 号有一栋房子。
The office is at 45A.
办公室位于45A。
The entrance is at the end of the driveway.
入口位于车道的尽头。
And I actually did the data on it.
我实际上做了数据。
The only people who ever showed up at the front door, the home door, were the people with ADHD.
唯一出现在前门、家门口的人是患有多动症的人。
Now, it was specific for ADHD.
现在，它专门针对多动症。
It wasn't completely sensitive, so some of the ADHD people got it right, but never did anyone who was coming in for OCD or depression or PTSD show up at the front door.
它并不完全敏感，所以一些多动症患者是对的，但从来没有任何患有强迫症、抑郁症或创伤后应激障碍的人出现在前门。
And I gave the instructions the same time, and sometimes I didn't know beforehand that the person was coming in for ADHD because they didn't know.
我同时给出了指示，有时我事先并不知道这个人是因为多动症来的，因为他们不知道。
But if they showed up at the front door, that always made me, "Uh-oh, I better make sure I ask specific detailed questions about the ADHD possible component." So the other sort of real-life diagnostic test I had, if someone during the evaluation would say something like, or in a subsequent session, "Oh, it was 4:00 yesterday, and I just realized I hadn't eaten all day." Ding, ding, ding, ding, ding.
但如果他们出现在前门，我总是会说，“哦，我最好确保提出有关多动症可能成分的具体详细问题。”因此，我进行的另一种现实生活中的诊断测试是，如果有人在评估期间或在随后的会议中说类似的话，“哦，昨天是 4:00，我刚刚意识到我一整天都没有吃东西。”叮，叮，叮，叮，叮。
I have people who diet, I have people who have fasting regimens or others, but they're not forgetting to eat.
我有人节食，有人实行禁食疗法或其他疗法，但他们并没有忘记吃饭。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. John Kruse:
约翰·克鲁斯博士：
And it's not that everyone with ADHD does that, but either you're not getting the right interoceptive cues from your body, or not paying attention to them is something that's been measurable in people with ADHD.
并不是每个患有多动症的人都会这样做，但要么你没有从你的身体获得正确的内感受线索，要么没有注意它们，这是多动症患者可以测量到的。
Andrew Huberman:
安德鲁·休伯曼：
So having a regular meal schedule.
所以要有规律的膳食安排。
Dr. John Kruse:
约翰·克鲁斯博士：
So having a regular meal schedule, and again, getting back to the COVID and workplace, I had lots of people in tech who really lamented, "Now I have to work from home.
因此，有规律的膳食安排，再次回到新冠疫情和工作场所，我有很多科技界人士感叹道：“现在我必须在家工作。
They were giving me lunch, a healthy, nice lunch each day at work." They're scrambling to even use the home meal delivery systems because getting that organized and set up is just too overwhelming for them.
他们每天在工作时给我提供午餐，健康美味的午餐。”他们甚至争先恐后地使用家庭送餐系统，因为组织和设置该系统对他们来说太难以承受了。
And again, these are bright people who are succeeding in most parts of their life.
再说一次，这些人都是聪明人，他们一生中的大部分时间都取得了成功。
Andrew Huberman:
安德鲁·休伯曼：
Are these people with ADHD sometimes also starting a meal, taking a few bites, and then going back to work, and then the meal never really ends.
这些患有多动症的人有时也会开始吃饭，咬几口，然后回去工作，然后这顿饭就永远不会真正结束。
It just sort of fragments into the rest of the day.
它只是一天中剩下的时间的碎片。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
That can be one variation.
这可能是一种变体。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. John Kruse:
约翰·克鲁斯博士：
But it's often just completely forgetting or being oblivious to it.
但通常只是完全忘记或忽视它。
Or, the other ways ADHD can play a role is, I was meaning to have breakfast before I left the house, but always when it's time to leave the house, you forget that you hadn't done this, and the kids' shoes need to be tied, and, "Oh, do I need a new toothbrush?
或者，多动症发挥作用的其他方式是，我本来想在离开家之前吃早餐，但总是当要离开家的时候，你忘记你没有这样做，孩子们的鞋子需要系好，并且，“哦，我需要一把新牙刷吗？
I better go check upstairs before I go out because I'm going to the CVS store." Time management is a problem with ADHD, an executive function problem.
我出去之前最好先上楼看看，因为我要去 CVS 商店。”时间管理是注意力缺陷多动症（ADHD）的一个问题，是一种执行功能问题。
Interestingly, it's not one of the 18 symptoms in our official checklist.
有趣的是，这并不是我们官方清单中的 18 种症状之一。
So our official checklist is sort of a crude clinical attempt to map out a lot of the aspects of ADHD, but it misses a lot.
因此，我们的官方清单是一种粗略的临床尝试，旨在列出多动症的许多方面，但它遗漏了很多东西。
So there's emotional regulation problems.
所以存在情绪调节问题。
We know something like 60% of people with ADHD acknowledge that emotions explode or come up bigger or stronger and are harder to regulate, and that's nowhere acknowledged in our official diagnostic symptomatology.
我们知道大约 60% 的多动症患者承认情绪会爆发或变得更大或更强烈，并且更难以调节，而我们的官方诊断症状学中没有承认这一点。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to take a quick break and thank our sponsor, AG1.
我想稍微休息一下并感谢我们的赞助商 AG1。
AG1 is an all-in-one vitamin, mineral, probiotic drink with adaptogens.
AG1 是一种含有适应原的一体化维生素、矿物质、益生菌饮料。
I've been taking AG1 daily since 2012, so I'm delighted that they're sponsoring this podcast.
自 2012 年以来，我每天都服用 AG1，所以我很高兴他们赞助这个播客。
The reason I started taking AG1, and the reason I still take AG1, is because it is the highest quality and most complete foundational nutritional supplement.
我开始服用 AG1 的原因，以及我仍然服用 AG1 的原因，是因为它是最高品质和最完整的基础营养补充剂。
What that means is that AG1 ensures that you're getting all the necessary vitamins, minerals, and other micronutrients to form a strong foundation for your daily health.
这意味着 AG1 可确保您获得所有必需的维生素、矿物质和其他微量营养素，为您的日常健康奠定坚实的基础。
AG1 also has probiotics and prebiotics that support a healthy gut microbiome.
AG1 还含有支持健康肠道微生物群的益生菌和益生元。
Your gut microbiome consists of trillions of microorganisms that line your digestive tract and impact things such as your immune system status, your metabolic health, your hormone health, and much more.
您的肠道微生物组由数万亿微生物组成，这些微生物排列在您的消化道中，并影响您的免疫系统状态、代谢健康、激素健康等。
So I've consistently found that when I take AG1 daily, my digestion is improved, my immune system is more robust, and my mood and mental focus are at their best.
因此，我一直发现，当我每天服用 AG1 时，我的消化能力得到改善，我的免疫系统更加强大，我的情绪和精神集中度也处于最佳状态。
In fact, if I could take just one supplement, that supplement would be AG1.
事实上，如果我只能服用一种补充剂，那么该补充剂就是 AG1。
If you'd like to try AG1, you can go to drinkag1.com/huberman to claim a special offer.
如果您想尝试 AG1，可以访问 Drinkag1.com/huberman 申请特别优惠。
They'll give you five free travel packs plus a year's supply of vitamin D3 K2 with your order of AG1.
您订购 AG1 时，他们将赠送您五个免费旅行包以及一年的维生素 D3 K2。
Again, go to drinkag1.com/huberman to claim this special offer.
请再次访问 Drinkag1.com/huberman 领取此特别优惠。
So we've got sleep, eating, exercise or movement, and relaxation.
所以我们有睡眠、饮食、锻炼或运动以及放松。
Maybe Before we start talking about some medications and some other factors that modulate ADHD, if we could maybe step through each of those and you could share with us some of your favorite tools that you give your patients and that you teach online.
也许在我们开始讨论一些药物和其他一些调节多动症的因素之前，如果我们可以逐步介绍每一个因素，您可以与我们分享一些您为患者提供并在线教授的最喜欢的工具。
Realizing, of course, that each one of those is a vast topic that we have done entire podcasts on.
当然，我们意识到其中每一个都是一个巨大的主题，我们已经完成了整个播客。
But I'm curious about your favorite go-to tools.
但我很好奇你最喜欢的常用工具。
We were talking about a few of these before we started.
在开始之前我们已经讨论了其中的一些内容。
So sleep, regular to bed and wake-up times?
那么睡眠时，有规律的就寝和起床时间吗？
Dr. John Kruse:
约翰·克鲁斯博士：
Matthew Walker and his great book on sleep.
马修·沃克和他关于睡眠的伟大著作。
One of my favorite things about it is he really emphasizes this point, that quality sleep isn't just about eight hours.
我最喜欢的一件事是他确实强调了这一点，即优质睡眠不仅仅是八个小时。
It isn't just duration.
这不仅仅是持续时间。
It's getting quality sleep, and the timing of your sleep is every bit as important as the duration.
获得高质量的睡眠，睡眠的时间与持续时间同样重要。
So if you're used to sleeping midnight to 8:00 a.m.
因此，如果您习惯于午夜睡觉至早上 8:00
and you're staying up dancing or partying until 4:00 a.m.
你会一直跳舞或参加派对直到凌晨 4:00
and you say, "Oh, it's a weekend, I can sleep until noon," you may still get those eight hours, but they're not restorative to the same extent as if you had slept at your regular time.
然后你说，“哦，这是一个周末，我可以睡到中午”，你可能仍然可以得到这八个小时，但它们并不能像你在正常时间睡觉那样恢复精力。
My PhD research was on circadian rhythms.
我的博士研究是昼夜节律。
We had realms of data back then.
那时我们拥有数据领域。
So this was 40, 30 plus years ago.
这是 40、30 多年前的事了。
We had every bit as much data then that the timing of sleep was as important as the duration, and yet every public service announcement just says, "Get your eight hours of sleep." Why are we leaving out this other piece?
当时我们掌握的数据表明，睡眠时间与持续时间同样重要，但每项公共服务公告都只是说：“睡八个小时。”为什么我们要忽略另一部分？
We've known for decades that people with ADHD have a strong propensity to being night owls, to have a different chronotype where they're maybe more effective or functional later in the day, a tendency to stay up.
几十年来，我们就知道患有注意力缺陷多动症的人有很强的夜猫子倾向，他们有一种不同的生物钟类型，他们在一天的晚些时候可能会更有效率或更有活力，有熬夜的倾向。
For many years now, we've actually known that this is strongly genetically controlled.
多年来，我们实际上已经知道这是受基因强烈控制的。
So there are genetic markers affecting sleep timing that are over-represented strongly in the ADHD community.
因此，影响睡眠时间的遗传标记在多动症群体中占有很大比例。
So some of it is you're pushed that way, but some of it is the nature of ADHD, that if you-- Procrastinating is part of ADHD.
所以有些是你被迫这样做的，但有些是多动症的本质，如果你——拖延是多动症的一部分。
If you procrastinate, you're going to push things off till the end of the day.
如果你拖延，你就会把事情拖到一天结束。
Some people, the end of the day is a better time to work because there's fewer distractions.
对于某些人来说，一天结束时是更好的工作时间，因为干扰更少。
If everyone else is asleep finally, no one's going to come in and interrupt your work or ask what your thoughts on this project are.
如果其他人最终都睡了，就没有人会进来打扰你的工作或询问你对这个项目的想法。
But again, getting regular sleep, and regular and sufficient, doesn't mean it has to be what I'd say normal.
但同样，有规律的睡眠，规律且充足的睡眠，并不意味着它必须是我所说的正常。
If it works for you, if you can build your career and your social life around sleeping from 2:00 a.m.
如果这对您有用，如果您可以围绕凌晨 2:00 睡觉来建立自己的职业生涯和社交生活。
till 10:00 a.m.
至上午 10:00
every day, I'd say go for it if you can be consistent with it.
每天，我都会说，如果你能坚持下去，就去做吧。
So what are the things that help with getting regular sleep?
那么有哪些事情可以帮助保证睡眠呢？
One thing, paradoxically for many people, is actually being on stimulant medications.
对许多人来说矛盾的是，一件事实际上是在服用兴奋剂药物。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. John Kruse:
约翰·克鲁斯博士：
So stimulants do have, as a side effect, some people have insomnia, some people stay up later, but more people with ADHD tend to, either because the drug is wearing off at the end of the day and there's some crash in alertness or energy, or because they're being more productively expending energy and are more tired at the end of the day, or it's just helping synchronize circadian clocks by getting a consistent start early in the day.
因此，兴奋剂确实有副作用，有些人会失眠，有些人会熬夜，但更多的多动症患者往往会出现这种情况，要么是因为药物在一天结束时药效减弱，警觉性或精力下降，要么是因为他们更有效地消耗能量，在一天结束时更加疲劳，或者只是通过在一天的早些时候开始一致的开始来帮助同步生物钟。
We don't know the mechanism by which it works.
我们不知道它的工作机制。
There's lots of plausible and overlapping ones.
有很多看似合理且重叠的说法。
But again, daytime alertness medications can help.
但同样，白天警觉药物可以有所帮助。
Andrew Huberman:
安德鲁·休伯曼：
Can I run something by you in that context-
我可以在这种情况下由你运行一些东西吗-
Dr. John Kruse:
约翰·克鲁斯博士：
Sure
当然可以
Andrew Huberman:
安德鲁·休伯曼：
...
...
before we jump back?
在我们跳回来之前？
I don't consistently take stimulants except caffeine, and I limit my caffeine intake to prior to 2:00 p.m., and I stack it pretty heavy in the early part of the day.
除了咖啡因外，我不会一直服用兴奋剂，而且我将咖啡因的摄入量限制在下午 2:00 之前，并且在一天的早些时候我会摄入大量咖啡因。
But on occasion, I'll take 25 to 50 milligrams of Wellbutrin, which, as you know better than I, is slightly dopaminergic, but certainly triggers noradrenergic release.
但有时，我会服用 25 至 50 毫克维布特林，正如你比我更了解的那样，它具有轻微的多巴胺能，但肯定会触发去甲肾上腺素能释放。
So epinephrine, norepinephrine.
所以肾上腺素，去甲肾上腺素。
It's a stimulant.
这是一种兴奋剂。
On the days when I take that, which again is very rare, and I track my sleep every night, I notice a significant improvement in my sleep and significant increase in my rapid eye movement sleep.
在我服用这种药物的日子里（这也是非常罕见的），我每晚跟踪我的睡眠，我注意到我的睡眠有显着改善，并且我的快速眼动睡眠显着增加。
It's extremely consistent.
这是非常一致的。
So from that, I sort of reverse engineered the major effect being norepinephrine.
因此，我对去甲肾上腺素的主要作用进行了逆向工程。
Epinephrine, I decided, well, I would do something else that I know raises epinephrine, which is I'll do a cold plunge first thing in the morning of one to three minutes long.
肾上腺素，我决定，好吧，我会做一些我知道会提高肾上腺素的事情，那就是我早上第一件事就是做一到三分钟的冷跳。
And the effect isn't quite as strong, but on those same days when I do that, clearly adrenaline-raising activity, I also see, for me, a significant increase in my rapid eye movement sleep and the quality of sleep later that night.
效果并不那么强烈，但在同一天，当我这样做时，明显会增加肾上腺素的活动，对我来说，我也看到我的快速眼动睡眠和当晚晚些时候的睡眠质量显着增加。
So I think there really is something to this epinephrine obviously going hand-in-hand with stimulants.
所以我认为肾上腺素确实与兴奋剂密切相关。
Epinephrine spike early and throughout the day with better rapid eye movement sleep at night.
肾上腺素在全天早些时候出现峰值，夜间快速动眼睡眠效果更好。
Does that logically hold for you?
这在逻辑上对你来说成立吗？
It's just a story.
这只是一个故事。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
I was going to say, as both of us have some science background, so I'd say I'm glad it works, and what's hard to sort out as why it's working is one is potential placebo effect.
我想说的是，由于我们俩都有一定的科学背景，所以我会说我很高兴它有效，而很难弄清楚为什么它有效的原因之一是潜在的安慰剂效应。
You're doing it because you're thinking or hoping it works.
你这样做是因为你在想或希望它能起作用。
Good.
好的。
And two, I'd say maybe even more importantly than the placebo effect is the days that you're deciding to do this, there's something different about those days to begin with, because you're not doing it every day.
第二，我想说，也许比安慰剂效应更重要的是你决定这样做的日子，那些日子一开始就有些不同，因为你并不是每天都这样做。
So those potential issues aside, I'll jump into insomnia, and Matthew Walker talks about some of this.
因此，抛开这些潜在的问题不谈，我会陷入失眠，马修·沃克谈到了其中的一些问题。
To me, maybe the biggest finding in insomnia sleep medicine in the last 20 years is that almost everyone who has a problem with insomnia doesn't have a problem with sleep.
对我来说，也许过去 20 年失眠睡眠医学的最大发现是，几乎所有有失眠问题的人都没有睡眠问题。
Huh?
啊？
What?
什么？
That does sound like I'm contradicting myself.
这听起来确实像是我自相矛盾。
What I mean is The sleep system's intact.
我的意思是睡眠系统完好无损。
It's there.
它就在那里。
It's waiting to arrive and put you to sleep each night.
它每天晚上都在等待着您的到来并让您安然入睡。
What the problem, and this is from the sleep researchers, with at least 90% of, probably more, of people who have insomnia problems, is the failure of the daytime arousal system to shut off properly.
睡眠研究人员指出，至少 90%（甚至可能更多）的人有失眠问题，问题在于白天的唤醒系统未能正常关闭。
So normally, we have these two mutually inhibitory systems, a wakefulness arousal system and a sleep sedation system.
所以通常情况下，我们有这两个相互抑制的系统，一个觉醒唤醒系统和一个睡眠镇静系统。
And usually, when one turns on, the other turns off.
通常，当一个打开时，另一个关闭。
And with most people's problem with insomnia, it isn't that sleep is weak or insufficient or not there.
而大多数人的失眠问题，并不是睡眠不足、睡眠不足或不存在。
It's sitting, it's waiting there.
它坐在那里，它在那里等待。
It just can't land on the landing pad because you're too aroused or too awake.
它只是无法降落在着陆垫上，因为您太兴奋或太清醒。
Maybe that helps the arousal system to turn off better at the end of the day if it's gotten more fully engaged during the day.
如果在白天更加充分地参与的话，也许这有助于唤醒系统在一天结束时更好地关闭。
I don't know.
我不知道。
But it feeds back more into some of the non-medication approaches to helping with sleep, and that is doing everything you can, again, not just to force sleep or push it, because that doesn't work very well.
但它更多地反馈到一些非药物帮助睡眠的方法中，那就是尽你所能，再次强调，不仅仅是强迫睡眠或推动睡眠，因为这效果不太好。
It's getting rid of arousal.
它正在摆脱兴奋。
It's dampening arousal.
它会抑制性兴奋。
So for people with ADHD, one is deciding on what's a reasonable bedtime, thinking about this ahead of time.
因此，对于患有多动症的人来说，需要提前考虑一下，决定什么是合理的就寝时间。
And two, eliminating any stimulation or arousal.
第二，消除任何刺激或唤醒。
So exercise, I'm a big fan of.
所以锻炼身体，我是它的忠实粉丝。
I'm a marathon runner.
我是一名马拉松运动员。
I know you're heavily into exercise as well.
我知道你也很热衷于锻炼。
Exercising too late in the evening can elevate body temperature, disrupt falling asleep.
晚上锻炼太晚会导致体温升高，影响睡眠。
So physical arousal, we don't want to be doing a lot of late in the day, and emotional, intellectually, cognitive arousal too.
因此，我们不想在一天的晚些时候做太多的身体唤醒，以及情感、智力和认知唤醒。
So the biggest single tool in modern life is do not have your phone in your bedroom.
因此，现代生活中最大的单一工具就是不要把手机放在卧室里。
And that's hard for lots of people to do, but if it's there, you're going to be checking it.
这对很多人来说很难做到，但如果它存在，你就会去检查它。
Studies have even shown, even if you're not checking it, if it's there, you're thinking about it or looking at it.
研究甚至表明，即使你没有检查它，如果它存在，你就会在思考它或看着它。
Just having it away out of sight is better than having it visible and turned off.
只是将其放在看不见的地方比让它可见并关闭要好。
Two is using, if you have someone you're sharing a bed with or family members, using them to help reinforce.
二是使用，如果你有与你同床共枕的人或家人，用他们来帮助强化。
Yes, and it's really helpful to talk about this ahead of time because the exact same words can either be sounding like a nag or someone trying to exert their power over you, rather than with people with ADHD, we know need reminders.
是的，提前谈论这一点确实很有帮助，因为完全相同的词可能听起来像是一个唠叨，或者是有人试图对你施加影响，而不是对于患有多动症的人，我们知道需要提醒。
They know they need some of that external structure.
他们知道他们需要一些外部结构。
And if you are on the same page and can have a partner or a kid or someone else present, "Hey, Dad, shouldn't you be turning off the computer and heading to bed right now?" that can be helpful.
如果你们意见一致，并且有伴侣、孩子或其他人在场，“嘿，爸爸，你现在不应该关掉电脑去睡觉吗？”这可能会有帮助。
Again, it can be destructive if it's not done in a framework where both people are on board, and it's not fair to make the other person responsible for your own behavior.
再说一遍，如果不是在两个人都参与的框架中进行，那么这可能会具有破坏性，而且让对方为自己的行为负责是不公平的。
But lots of people are usually happy to help the person with ADHD be more organized in their life.
但很多人通常很乐意帮助多动症患者的生活更有条理。
So we were also talking a little bit before, one of my favorite tools for falling asleep is actually cyclic sighing.
所以我们之前也讨论过，我最喜欢的入睡工具之一实际上是循环叹息。
There are other box breathing and other techniques that help someone relax.
还有其他盒式呼吸和其他技巧可以帮助人们放松。
So we know cyclic sighing engages the parasympathetic nervous system, our rest and digest system.
所以我们知道周期性叹息会影响副交感神经系统、我们的休息和消化系统。
One of the things that happens normally in the transition every night when you fall asleep is you're going from primarily sympathetic tone to primarily parasympathetic tone.
每晚入睡时，在过渡过程中通常会发生的一件事是，您将从主要交感神经张力转变为主要副交感神经张力。
So anything that is strengthening or putting you there already makes it easier.
所以任何能增强你力量或让你达到目标的事情都会让事情变得更容易。
I know you have videos about cyclic sighing, and I do too.
我知道你们有关于周期性叹息的视频，我也有。
My own experience, which I was sharing with you before we started talking, was not only does cyclic sighing help me fall asleep better, it actually helped me stay asleep throughout the night better.
在我们开始交谈之前，我与大家分享了我自己的经验，周期性叹息不仅可以帮助我更好地入睡，而且实际上可以帮助我更好地整夜入睡。
Andrew Huberman:
安德鲁·休伯曼：
That's a remarkable thing because many people, including myself, have very little trouble falling asleep, especially given how I stack caffeine in the early part of the day and then stop in the afternoon.
这是一件了不起的事情，因为很多人，包括我自己，入睡都没有什么困难，特别是考虑到我如何在一天的早些时候摄入咖啡因，然后在下午停止。
It allows me to fall asleep within seconds, somewhere for me, typically around 10:00 p.m.
它可以让我在几秒钟内入睡，对我来说，通常是晚上 10:00 左右。
Somewhere between 10:00 and 11:00 p.m.
晚上 10:00 到 11:00 之间的某个时间
is my typical bedtime.
这是我典型的就寝时间。
But then I consistently wake up at 3:00 in the morning.
但后来我总是在凌晨 3:00 起床。
Usually get up, use the restroom, and then go back to sleep, most of the time without too much trouble, provided there isn't a lot of stress in my external life and provided the phone is not in the bedroom.
通常起床，上厕所，然后回去睡觉，大多数时候都不会太麻烦，只要我的外部生活没有太大压力，并且手机不在卧室里。
But as we were also talking about before we turned on the microphones, this idea that our bladders get smaller as we age is complete nonsense, right?
但正如我们在打开麦克风之前所讨论的那样，随着年龄的增长，我们的膀胱会变小，这种想法完全是无稽之谈，对吗？
So that can't be the explanation why people wake up more in the middle of the night as they get older.
所以这不能解释为什么随着年龄的增长人们会在半夜醒来。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
Some might.
有些可能。
Some, it may be a prostate issue.
有些，可能是前列腺问题。
Clearly, that isn't accounting for half the population, but I think it's much more the neurologic innervation of our bladder.
显然，这并不占人口的一半，但我认为这更多的是我们膀胱的神经支配。
All our nerves start functioning not quite as well, and they're just getting the signal that I really need to urinate right now, when pretty clearly, most of those people don't.
我们所有的神经开始运作不太好，它们只是收到我现在确实需要小便的信号，而很明显，大多数人都不需要。
They could wait, but the signal is arriving that says you have to, and it's believable, and you don't want to not listen to it if it is right.
他们可以等待，但信号正在到来，告诉你必须等待，而且这是可信的，如果它是正确的，你不想不听。
Andrew Huberman:
安德鲁·休伯曼：
How much cyclic sighing are you doing before sleep, and how long before sleep is the cyclic sighing done?
您在睡前进行多少次周期性叹息，以及在入睡前多长时间进行周期性叹息？
Dr. John Kruse:
约翰·克鲁斯博士：
So when I read your paper with Spiegel and others, January, for years, I've said I don't have a meditation practice.
因此，当我多年来与斯皮格尔和其他人一起阅读你的论文时，我已经说过我没有冥想练习。
Most people think I'm sort of so chill or relaxed that I do.
大多数人认为我有点冷静或放松，我确实如此。
Andrew Huberman:
安德鲁·休伯曼：
You seem like a pretty mellow dude.
你看上去是个很温柔的家伙。
Dr. John Kruse:
约翰·克鲁斯博士：
I haven't ever taken the time to do it, which I'm embarrassed by.
我从来没有花时间去做这件事，这让我感到尴尬。
So I said, read the paper.
所以我说，读读报纸。
I can do five minutes a day of cyclic sighing, and I tried, and some days I was getting it in, and many days, I wasn't getting it in till bedtime.
我可以每天做五分钟的周期性叹息，我尝试过，有些天我能做到这一点，很多天，我直到睡前才得到它。
I slept really well till I was around 40 and not so well in the next 20 years, both the- Mostly with the trouble falling asleep, even though I knew of relaxation techniques and others.
我在 40 岁左右之前睡得很好，但在接下来的 20 年里睡得不太好，主要是入睡困难，尽管我知道放松技巧和其他技巧。
So I wound up just consistently doing it to do it more for the general health, and I do have slightly elevated blood pressure, and relaxation, and to see what effect it would have, and it was clear.
所以我最终只是坚持这样做，更多地为了整体健康，我的血压确实略有升高，放松，看看它会产生什么效果，很明显。
So I do about five minutes, and much more than five minutes, I tell people, and I might be doing it a little slower than most, count out about 20 or 25 reps of it.
所以我会做大约五分钟，而且远远超过五分钟，我告诉人们，我可能比大多数人做得慢一点，算一下大约 20 或 25 次。
And if you lose track, doesn't matter.
如果你迷失了方向，也没关系。
Just go back to the lowest number.
只要回到最低的数字即可。
Because, again, everything we're trying to do is decrease arousal.
因为，我们所做的一切都是为了减少兴奋。
If you have a timer on it and you do it for five minutes and then you're woken up, you're reversing or mitigating some of the benefit of doing it.
如果你有一个计时器，你做了五分钟，然后你就醒了，那么你就逆转或减轻了这样做的一些好处。
So my recommendation is do it for five minutes about, but do it by counting reps and don't focus or if it's six minutes, if it's four.
所以我的建议是做五分钟左右，但是通过计算次数来完成，不要集中注意力，或者如果是六分钟，如果是四分钟。
There's so many aspects of this, and we know the exhalation has to be longer.
这涉及很多方面，我们知道呼气必须更长。
I was trying to find, is anyone systematically, is a four-second exhalation better than 10 versus six?
我试图找出，是否有人系统地指出，4 秒的呼气比 10 秒与 6 秒的呼气更好？
And those studies would be so simplistic and easy to do, but there's lots of variables that we can play with to see what's optimal.
这些研究非常简单且容易进行，但我们可以利用很多变量来看看什么是最佳的。
I don't think we know at all what's optimal, but we know what's good enough to work.
我认为我们根本不知道什么是最佳的，但我们知道什么足以发挥作用。
Andrew Huberman:
安德鲁·休伯曼：
Delighted to hear that it's worked so well for you.
很高兴听到它对您非常有效。
As people know, I'm a huge fan of the physiological sigh-
众所周知，我非常喜欢生理叹息——
Dr. John Kruse:
约翰·克鲁斯博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
and I take no credit for having discovered it.
我不认为自己发现了它。
It was discovered by physiologists in the 1930s.
它是由生理学家在 20 世纪 30 年代发现的。
Right
右
Dr. John Kruse:
约翰·克鲁斯博士：
So throughout the data point that I shared with you is that prior to trying cyclic sighing at nighttime, I was waking up virtually every single night, once a night to urinate, and in the 18 months, 20 months since I've been doing it, I think it's been a total of four times that I've woken up during the night to urinate.
因此，我与大家分享的整个数据点是，在尝试夜间周期性叹息之前，我几乎每天晚上都会醒来，每晚一次小便，而在我这样做的 18 个月、20 个月里，我认为我在夜间醒来小便的次数总共有四次。
Andrew Huberman:
安德鲁·休伯曼：
Fantastic.
太棒了。
So we're talking about sleep.
所以我们谈论的是睡眠。
You mentioned earlier, encouraging people with ADHD or who think they might have ADHD to keep a somewhat regular eating schedule, or at least to make sure that they're eating
您之前提到过，鼓励患有注意力缺陷多动症或认为自己可能患有注意力缺陷多动症的人保持有规律的饮食计划，或者至少确保他们正在饮食
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
And to not let their meals get fragmented into starting a meal then finishing it later.
并且不要让他们的膳食变得支离破碎，先吃完一顿饭，然后再吃完。
For some people, it's breakfast, lunch, and dinner.
对于某些人来说，这是早餐、午餐和晚餐。
For some people, like myself, it's lunch, snack, dinner.
对于一些人来说，比如我自己，这是午餐、小吃、晚餐。
Whatever it is, keeping a regular schedule.
不管怎样，保持规律的作息时间。
Exercise.
锻炼。
Aside from encouraging people to not exercise too late in the day, certainly not caffeine and exercise late in the day, are there any data about specific types of exercise being better for ADHD independent of effects on sleep?
除了鼓励人们不要在一天中太晚锻炼（当然不是咖啡因和在一天中晚些时候锻炼）之外，是否有任何数据表明特定类型的锻炼对注意力缺陷多动症（ADHD）更有效，且与睡眠影响无关？
I realize they're hard to tease apart.
我意识到他们很难分开。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
There's a few studies looking at acute aerobic exercise.
有一些研究着眼于急性有氧运动。
Part of it is that it's hard to study people when they're exercising during many exercise.
部分原因是，当人们在进行多次锻炼时，很难研究他们。
You're not going to wire someone up when they're swimming, for example.
例如，当某人游泳时，您不会给他们连接电线。
So there's not a lot of studies in any one approach, and there's so much diversity that often it just gets lumped together.
因此，对任何一种方法的研究都不是很多，而且多样性如此之多，以至于常常被混为一谈。
So there do seem to be some acute effects of measurably improving some of the executive functions associated with better attention from acute exercise, and there seem to be some more general or longer-term benefits from people who are consistently actively exercising, being able to concentrate longer, being able to switch attention more appropriately or effectively.
因此，显着改善与急性锻炼更好的注意力相关的一些执行功能似乎确实会产生一些急性影响，而且持续积极锻炼的人似乎会产生一些更普遍或更长期的好处，能够更长时间地集中注意力，能够更适当或更有效地转移注意力。
And there's a huge body of clinical literature of patients reporting, "I know I feel much more alert the day I get my workout in the gym in," or, "I feel better," or, "The week I took off from that was a big mistake." But I would say identifying at what's the most valuable or what's the best duration, I ran through the data about a year or two ago, and I would say that we can't make any conclusions.
有大量的临床文献记录了患者的情况，“我知道我在健身房锻炼的那天感觉更加清醒”，或者“我感觉好多了”，或者“我停止锻炼的那一周是一个很大的错误。”但我想说的是，要确定什么是最有价值的或什么是最好的持续时间，我大约在一两年前浏览了这些数据，我想说我们无法得出任何结论。
And I would say at some level, try it and see what works for you, and that's what's important.
我想说，在某种程度上，尝试一下，看看什么对你有用，这才是重要的。
It isn't what works for everyone.
这并不适合每个人。
Andrew Huberman:
安德鲁·休伯曼：
Is there a relationship between ADHD and addiction because of the impulsivity component?
由于冲动成分，多动症和成瘾之间是否存在关系？
Dr. John Kruse:
约翰·克鲁斯博士：
Yes, and so the answer is, and these are really rough statistics.
是的，所以答案是，这些都是粗略的统计数据。
One of my pet peeves is people who quote, "Oh, the rate of this is 27.43%." Well, it might have been in that study, but that's looking at one population, at one set of...
我最讨厌的事情之一是有人引用“哦，这个比率是 27.43%”。嗯，可能是在那项研究中，但那是针对一个人群、一组......
So I use ballpark figures.
所以我使用大概数字。
The ballpark figure is Americans in the last 20 years, more than that, about 20% of Americans run into some substance addiction problem, either alcohol or drugs.
美国人在过去20年的大致数字是，不仅如此，大约20%的美国人遇到了某种物质成瘾问题，要么是酒精，要么是毒品。
People with ADHD have a rate that's almost double that, and it's higher in men than in women.
患有多动症的人的发病率几乎是这一数字的两倍，而且男性的发病率高于女性。
Andrew Huberman:
安德鲁·休伯曼：
Double?
双倍？
Dr. John Kruse:
约翰·克鲁斯博士：
Almost double.
几乎双倍。
Almost 40% risk.
几乎40%的风险。
Andrew Huberman:
安德鲁·休伯曼：
And that's for substance abuse and not-
那是针对药物滥用而不是-
Dr. John Kruse:
约翰·克鲁斯博士：
That's substance
这就是物质
Andrew Huberman:
安德鲁·休伯曼：
...
...
behavioral addictions.
行为成瘾。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
That's substance abuse, and that's looking at abuse, and we can get into the related topic of what's misuse versus abuse, and I have pet peeves there.
这就是药物滥用，这就是滥用，我们可以讨论什么是滥用与滥用的相关话题，我对此很恼火。
However, kids who are put on stimulant medications when they're young, and I should say the stimulants themselves do have a small potential for addiction, but putting kids on stimulants pretty much normalizes their rate of addiction problems.
然而，年轻时服用兴奋剂药物的孩子，我应该说兴奋剂本身确实有很小的成瘾潜力，但让孩子服用兴奋剂几乎可以使他们的成瘾问题率正常化。
Andrew Huberman:
安德鲁·休伯曼：
So it protects them.
所以它保护他们。
Dr. John Kruse:
约翰·克鲁斯博士：
It cuts it in half.
它把它切成两半。
It protects them.
它保护他们。
Andrew Huberman:
安德鲁·休伯曼：
This is a really important point that I think maybe we just hover on for a second, because I think many people, including myself, assume that, well, if you were putting these kids on amphetamines, of which, many of the medications for ADHD are, that we're creating kids that are addicted-
这是一个非常重要的观点，我认为也许我们只是徘徊一秒钟，因为我认为很多人，包括我自己，都会认为，好吧，如果你让这些孩子服用安非他明，其中许多治疗多动症的药物都是，我们正在创造上瘾的孩子 -
Dr. John Kruse:
约翰·克鲁斯博士：
Addicted
上瘾了
Andrew Huberman:
安德鲁·休伯曼：
...
...
to amphetamines-
安非他明-
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
or to a hyperstimulation period.
或进入过度刺激期。
But you're telling me it's actually protective to put kids with-
但你告诉我，把孩子放在一起实际上是有保护作用的-
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
real ADHD on medication for ADHD.
真正的注意力缺陷多动症（ADHD）关于治疗注意力缺陷多动症（ADHD）的药物。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
I can say not absolutely every study has found this, but several large meta-analyses have gone back, and most of them have found this fairly dramatic benefit to being on stimulants as a kid in terms of specifically reducing substance abuse risk.
我可以说并非所有研究都发现了这一点，但几项大型荟萃分析已经回溯，其中大多数都发现，在专门降低药物滥用风险方面，小时候服用兴奋剂有相当显着的好处。
And some of them that have looked at this, when I said it was a yes and, it seems to be that it's not just the impulsivity traits, but some of the inattentive ones, too.
他们中的一些人看过这个，当我说这是肯定的时，似乎这不仅仅是冲动的特征，还有一些不专心的特征。
If your teacher's lecturing about the risks of alcohol or this and this, and you're zoning out at the window and looking at the plane flying by, you have less pertinent information on the topics.
如果你的老师正在讲授酒精或这个或这个的风险，而你却在窗外发呆，看着飞机飞过，那么你对这些主题的相关信息就会较少。
You may be less attentive to the negative effects that other kids are seeing among the classmates who are stoners at this age or X, Y, or Z.
您可能不太注意其他孩子在这个年龄段或 X、Y 或 Z 吸毒的同学中看到的负面影响。
So it seems that both inattentive sets of ADHD symptoms and the impulsive, thrill-seeking, not weighing the consequences as heavily, are all contributing to this heightened risk.
因此，注意力不集中的多动症症状和冲动、寻求刺激、不重视后果的行为似乎都导致了这种风险的增加。
Andrew Huberman:
安德鲁·休伯曼：
I have this model in my head that is perhaps completely wrong, maybe partially wrong.
我脑子里的这个模型也许是完全错误的，也许是部分错误的。
And it goes something like this.
事情是这样的。
That we know that the neural circuits involved in executive control and directing attention and maintaining attention and avoiding distraction, this kind of thing, use dopamine and epinephrine and norepinephrine, at least to some extent.
我们知道，涉及执行控制、引导注意力、维持注意力和避免分心的神经回路，至少在某种程度上使用多巴胺、肾上腺素和去甲肾上腺素。
And we know that people with ADHD are capable of focus.
我们知道患有多动症的人有能力集中注意力。
As you said, it's a failure to direct that focus, maintain, et cetera.
正如你所说，这是未能集中注意力、维持等等。
So I've heard from you before this discussion that people that tend to drink lots and lots of caffeine or who can drop into an activity but have a lot of distractibility, that they might have ADHD.
因此，在这次讨论之前，我从你们那里听说，那些倾向于喝大量咖啡因的人，或者那些可以投入某项活动但很容易分心的人，他们可能患有注意力缺陷多动症。
So what I'm imagining here is that the threshold to get dopamine, epinephrine, and norepinephrine released is either much higher or more complicated for people with ADHD.
所以我在这里想象的是，对于多动症患者来说，释放多巴胺、肾上腺素和去甲肾上腺素的阈值要么更高，要么更复杂。
And so what they're seeking is these catecholamines, these three chemicals, dopamine, epinephrine, norepinephrine, and that if they're given a medication that puts them in that range where they're getting it, then they're good.
所以他们正在寻找的是这些儿茶酚胺，这三种化学物质，多巴胺，肾上腺素，去甲肾上腺素，如果他们服用的药物使他们处于他们能得到的范围内，那么他们就很好。
They can stop seeking it, so to speak.
可以这么说，他们可以停止寻找它。
And I'm raising this now because we're talking about addiction.
我现在提出这个问题是因为我们正在谈论成瘾问题。
Addiction is a pursuit of things, essentially.
本质上，成瘾是一种对事物的追求。
And I guess what I'm saying is it seems to me that the model of ADHD that we hear about is that people can't focus, their dopamine circuits are all out of whack, and then you put them on this dopaminergic drug, and basically you get them addicted to that tunnel vision or something.
我想我想说的是，在我看来，我们听到的多动症模型是人们无法集中注意力，他们的多巴胺回路都出了问题，然后你给他们服用这种多巴胺能药物，基本上你就会让他们沉迷于隧道视野之类的东西。
But I have this model in mind now that what we are all seeking is to have portions of our day where we are directing our focus towards a meaningful build, the things that are generative in our life, work, school, relationships, et cetera.
但我现在脑子里有这个模型，我们都在寻求的是一天中的某些部分，我们将注意力集中在有意义的构建上，即在我们的生活、工作、学校、人际关系等中产生生产力的事物。
And that whether or not it's pharmacology or exercise or what have you, that it's just about getting into this plane of consciousness.
无论是药理学还是锻炼或者其他什么，这只是为了进入这个意识层面。
And I say that in no woo or abstract terms.
我这么说并不是用任何吸引或抽象的术语。
Is that right?
是这样吗？
Are what we're really talking about here is a failure to access enough of these neuromodulators, and these medications which we're about to talk about are really about putting us in the realm where those neuromodulators are just more accessible?
我们在这里真正讨论的是无法获得足够的神经调节剂，而我们即将讨论的这些药物实际上是为了让我们更容易获得这些神经调节剂？
Dr. John Kruse:
约翰·克鲁斯博士：
I'll just say I can go with that.
我只是说我可以接受。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Well, you're the expert.
嗯，你是专家。
I'm putting this together based on what we're talking about.
我根据我们正在讨论的内容将其放在一起。
Getting enough sleep, to me, is a way of being able to have enough arousal during the day.
对我来说，获得充足的睡眠是白天保持足够兴奋的一种方式。
Exercise or these medications, just different ways of being able to access arousal.
锻炼或这些药物，只是获得唤醒的不同方式。
If you don't sleep, you can't access arousal during the day.
如果你不睡觉，白天就无法觉醒。
So, okay.
那么，好吧。
Well, I'm going to hold that model in mind, and I'm going to keep testing it to try and destroy it as we go forward.
好吧，我将牢记这个模型，并且我将继续测试它，并在我们前进的过程中尝试摧毁它。
Let's talk about the medications, since you raised those.
既然你提出了这些问题，我们就来谈谈药物吧。
And the first one I ever heard about was Ritalin.
我听说的第一个药物是利他林。
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Let's start with Ritalin.
让我们从利他林开始。
How often is Ritalin used nowadays, and what is Ritalin doing neurochemically, and what are your thoughts on Ritalin as a useful drug for childhood and adult ADHD?
现在利他林的使用频率如何？利他林在神经化学方面的作用是什么？您对利他林作为治疗儿童和成人多动症的有用药物有何看法？
And I'm happy to repeat those questions.
我很高兴重复这些问题。
Dr. John Kruse:
约翰·克鲁斯博士：
So Ritalin is, or generic methylphenidate, and there are dozens now of slow-release versions, and there's even a skin patch instead of an oral version.
利他林就是通用哌醋甲酯，现在有几十种缓释版本，甚至还有皮肤贴剂而不是口服版本。
Our definition of what a stimulant is is really squishy and vague.
我们对兴奋剂的定义非常模糊和模糊。
In its broadest sense, it's any drug that has an effect on the body, like the sympathetic nervous system, which is a norepinephrine-driven fight or flight arousal system.
从最广泛的意义上讲，它是对身体产生影响的任何药物，例如交感神经系统，这是一种由去甲肾上腺素驱动的战斗或逃跑唤醒系统。
So by the loosest criteria, caffeine's a stimulant.
因此，按照最宽松的标准，咖啡因是一种兴奋剂。
Wellbutrin's a stimulant, even though we classify it as an antidepressant.
维布特林是一种兴奋剂，尽管我们将其归类为抗抑郁药。
Some of the decongestants are stimulants.
一些减充血剂是兴奋剂。
But more often when we're talking ADHD medicines, we're using stimulant more specifically for amphetamine-based products like Adderall and Vyvanse, and again, there's a host now of newer branded extended-release forms and methylphenidate.
但更常见的是，当我们谈论多动症药物时，我们更具体地使用兴奋剂来治疗基于安非他明的产品，如 Adderall 和 Vyvanse，而且，现在有许多新品牌的缓释形式和哌醋甲酯。
And we lump the two together.
我们将两者混为一谈。
Probably most ADHD experts agree with, and this is where I'm going to be disagreeing with most of them.
可能大多数多动症专家都同意这一点，这就是我不同意他们中的大多数的地方。
I don't consider Ritalin a full stimulant.
我不认为利他林是一种完全兴奋剂。
So the neuropharmacologists differ a little bit, but amphetamine is a strong dopamine and norepinephrine reuptake blocker.
因此，神经药理学家略有不同，但安非他明是一种强效的多巴胺和去甲肾上腺素再摄取阻滞剂。
So it prevents what's already been released from being taken back up, so more is available longer.
因此，它可以防止已发布的内容被收回，从而使更多内容可用的时间更长。
But in addition to that, amphetamine is a pretty potent, let's just say, vesicle manipulator.
但除此之外，安非他明还是一种非常有效的囊泡操纵剂。
So it's actually forcing a bigger release from the vesicles when they're synaptically released.
因此，当囊泡突触释放时，它实际上会迫使囊泡释放更多的物质。
So it's not just that the signal lasts longer and is stronger because of that, it's a bigger signal.
因此，信号不仅持续时间更长、更强，而且信号更大。
Depending on what study you look at, most of the studies suggest that methylphenidate is actually a pretty weak vesicular manipulator, and some studies don't find any impact there at all.
根据您所查看的研究，大多数研究表明哌醋甲酯实际上是一种相当弱的囊泡操纵剂，有些研究根本没有发现任何影响。
Which means if methylphenidate is basically a norepinephrine and dopamine reuptake inhibitor, that's what Wellbutrin is.
这意味着如果哌醋甲酯基本上是一种去甲肾上腺素和多巴胺再摄取抑制剂，那么维布特林就是这样的。
That's one of the components.
这是其中的组成部分之一。
And so why I would further say, if you look at the efficacy data, how well do these work in resolving ADHD symptoms?
那么为什么我要进一步说，如果你看一下功效数据，这些药物在解决多动症症状方面效果如何？
All the meta-analyses lump Adderall products, amphetamine, and methylphenidate products here, and say, "They're here because they work better." This is success in reducing ADHD symptoms.
所有的荟萃分析都将阿得拉产品、安非他明和哌醋甲酯产品归为一类，并说：“它们在这里是因为它们效果更好。”这是减少多动症症状的成功。
And all of our Strattera, atomoxetine, Wellbutrin, I use Cymbalta a lot, modafinil, guanfacine, all these other things are down here as less effective.
我们所有的 Strattera、阿托莫西汀、维布特林、我经常使用 Cymbalta、莫达非尼、胍法辛，所有这些其他药物都在这里，效果较差。
But if you actually look at any of the plots that I've looked at and separate out, methylphenidate is actually closer to the pack below.
但如果你真的看一下我看过并分离出来的任何图表，就会发现哌醋甲酯实际上更接近下面的图表。
It's the amphetamine products are head and shoulders above everything else.
安非他明产品遥遥领先于其他产品。
Methylphenidate's usually at the top of the rest of the crowd.
哌醋甲酯通常是人群中的佼佼者。
But if you're just looking at the data objectively, there's a clear decision point.
但如果您只是客观地查看数据，就会有一个明确的决策点。
So in terms of efficacy, amphetamine products are stronger.
所以从功效上来说，安非他明类产品更强一些。
But in terms of some of the side effect that I worry most about, it's not at all common, but it's one of the horrible ones, is amphetamine-induced psychosis.
但就我最担心的一些副作用而言，它并不常见，但它是最可怕的副作用之一，即安非他明引起的精神病。
Now that we're finally looking at that a little more closely, because for years, ADHD experts have said, "Yeah, it's really rare.
现在我们终于更仔细地研究了这一点，因为多年来，多动症专家一直说，“是的，这真的很罕见。
Let's not look at it at all.
我们根本不看它。
Let's not pay attention.
我们不去关注吧。
Move along.
继续前进。
Don't look." With amphetamine Adderall products, and that's probably dose-dependent, but it's close to one out of 500 people.
别看。”对于安非他明 Adderall 产品，这可能具有剂量依赖性，但接近五百分之一的人。
I'm going off on a tangent here, but I'll keep following it because it's an important tangent.
我在这里偏离了主题，但我会继续关注它，因为这是一个重要的主题。
It's only one out of 500 people.
这只是五百人中的一个。
That's uncommon, but this is a really bad condition.
这并不常见，但这是一个非常糟糕的情况。
So amphetamine-induced psychosis is a schizophrenic-like picture.
因此，安非他明引起的精神病是一幅类似精神分裂症的画面。
Usually, someone is really paranoid, really worried that their friends are manipulating them or the police are spying on them.
通常，有人真的很偏执，真的担心他们的朋友正在操纵他们或者警察正在监视他们。
If you drink too much alcohol, you can be batshit crazy, that's a highly technical term there.
如果你喝太多酒，你就会发疯，这是一个技术性很强的术语。
You can be out of touch with reality.
你可能会脱离现实。
You can be hallucinating.
你可能出现幻觉了。
You can be saying all sorts of nasty things.
你可以说各种令人讨厌的话。
But if it's alcohol-induced, you fall asleep at the end of that night, you wake up the next morning, you may feel horrible with a hangover.
但如果是酒精引起的，当晚你睡着了，第二天早上醒来，你可能会因宿醉而感到可怕。
You're not hallucinating.
你不是出现幻觉了。
You're not psychotic anymore.
你不再是精神病了。
Hopefully, you're regretting what you did.
希望你对你所做的事感到后悔。
Probably not remembering much of what you did.
可能不太记得你做了什么。
Andrew Huberman:
安德鲁·休伯曼：
People will let you know.
人们会让你知道的。
Dr. John Kruse:
约翰·克鲁斯博士：
With amphetamine-induced psychosis, on the other hand, classically and characteristically in what I've seen clinically, it continues for days, weeks, or months after stopping the medication, which means we've changed someone's brain, and we don't have lots and lots of data, and it's actually only come to us because people are concerned about marijuana causing a similar picture, so now we're studying this a little more.
另一方面，对于安非他明引起的精神病，从我在临床上看到的典型和特征来看，它会在停止用药后持续数天、数周或数月，这意味着我们已经改变了某人的大脑，而我们没有大量的数据，而它实际上只是因为人们担心大麻会导致类似的情况而来到我们这里，所以现在我们正在对此进行更多的研究。
But with amphetamine-induced psychosis, and these are again, rounding from different studies, if you look 20 years out, about 20% of those people are in a permanent psychotic state still.
但对于苯丙胺诱发的精神病，这些又是从不同的研究中得出的，如果你展望 20 年后，其中大约 20% 的人仍然处于永久性精神病状态。
So again, it's uncommon, but it's such a bad outcome that we really should be alerting people to it.
再说一次，这种情况并不常见，但这是一个非常糟糕的结果，我们确实应该提醒人们注意这一点。
I saw much higher risk of this for, I can get into it if we need the reasons in my population in San Francisco.
我看到这种情况的风险要高得多，如果我们需要旧金山人口的原因，我可以参与其中。
But I've had people coming from all the most prominent ADHD clinics over the years who just moved to the area.
但多年来，我遇到过来自所有最著名的多动症诊所的人，他们刚刚搬到这个地区。
And when I'd say this, give this as my introduction to, I'm happy to continue on this, but are you aware, to a person they said, "No one ever told me that." Now, maybe they have ADHD and weren't listening, but it's so uniformly consistent that they didn't hear or know that that was a side effect.
当我这么说时，将此作为我的介绍，我很高兴继续这个话题，但你知道吗，他们对一个人说，“没有人告诉过我这一点。”现在，也许他们患有注意力缺陷多动症并且没有听，但它是如此一致，以至于他们没有听到或不知道这是副作用。
Andrew Huberman:
安德鲁·休伯曼：
And one in 500 isn't a trivially small number.
五百分之一并不是一个微不足道的数字。
Dr. John Kruse:
约翰·克鲁斯博士：
No, it's not trivial.
不，这不是小事。
And why I got alerted to it is my rate in San Francisco is actually higher than one out of 100.
为什么我收到通知是因为我在旧金山的比率实际上高于百分之一。
And so I'll go into, I think, a couple different reasons.
我认为，我将探讨几个不同的原因。
One is I worked with a lot of HIV positive men, and we know HIV, particularly in the days before we had effective antivirals, is a virus that goes to the brain and affect-- there's a HIV-induced dementia.
一是我与许多艾滋病毒呈阳性的男性一起工作，我们知道艾滋病毒，特别是在我们有有效的抗病毒药物之前的日子里，是一种进入大脑并影响艾滋病毒引起的痴呆症的病毒。
So probably some of these people had brains that were compromised because of that, and were vulnerable.
因此，可能其中一些人的大脑因此受到损害，并且很脆弱。
Two, a high incidence of methamphetamine.
二、冰毒发病率高。
So methamphetamine, street speed, is a chemically different molecule than amphetamine, has an extra methyl group, and an extra methyl group can mean a lot.
因此，甲基苯丙胺，街头速度，是一种与苯丙胺在化学上不同的分子，有一个额外的甲基，而一个额外的甲基可能意味着很多。
So it's a cousin, but methamphetamine, we know, has higher rates of psychosis, higher rates of addiction, tends to be more rewarding.
所以它是一个表亲，但我们知道，甲基苯丙胺的精神病发病率更高，成瘾率更高，而且往往更有价值。
But again, in that population, and many of them would hide that history from me, but I think that the very first person I had with methamphetamine-induced psychosis, a guy in his 40s, HIV positive for years, this was back in early mid-'90s, was able to finish school in his mid-40s, get a good paying job in two years on stimulants, and then had a full-blown psychotic episode where his dad had died of a heart attack 10 years earlier.
但同样，在那个人群中，他们中的许多人都会向我隐瞒这段历史，但我认为我遇到的第一个患有甲基苯丙胺引起的精神病的人，是一个 40 多岁的人，多年来艾滋病毒呈阳性，这要追溯到 90 年代中期，他在 40 多岁的时候完成了学业，靠兴奋剂在两年内找到了一份高薪工作，然后发生了一场全面的精神病发作，他的父亲在 10 年前死于心脏病早些时候。
He was threatening his mom because he believed his mom had poisoned her.
他威胁他的妈妈，因为他相信他的妈妈毒死了她。
He flew over to Rhode Island where she was living.
他飞往她居住的罗德岛州。
He was making threats from a payphone, and because Rhode Island's so small, he was actually calling from out of state, so it was a federal crime.
他通过公用电话发出威胁，而且由于罗德岛州很小，他实际上是从州外打电话的，所以这是联邦犯罪。
He got thrown in federal prison for this.
他因此被投入联邦监狱。
And he stayed psychotic for months after he wasn't using anything.
在没有使用任何东西后，他的精神状态持续了几个月。
But it later turned out he had had a psychotic episode 10 years earlier on street meth, which he lied about when I did the evaluation.
但后来事实证明，他十年前曾因吸食毒品而出现精神病发作，在我进行评估时他撒了谎。
So the other high-risk group I had was I was known in San Francisco as someone who worked with adults with ADHD at the early stages of recognizing ADHD.
因此，我遇到的另一个高风险群体是在旧金山，我被认为是在识别多动症的早期阶段与患有多动症的成年人一起工作的人。
So, and I was comfortable with a broader range of stimulant dosages, and many providers are.
因此，我对更广泛的兴奋剂剂量感到满意，许多提供者也是如此。
So I had people, and they were all young white males, straight males, and I don't know how many of those demographics are relevant, but who had histories of taking stimulants, having a psychotic episode, again, being really paranoid.
所以我有一些人，他们都是年轻的白人男性，异性恋男性，我不知道这些人口统计数据中有多少是相关的，但他们有服用兴奋剂的历史，有精神病发作，再次，非常偏执。
And again, the numbers aren't huge, but at least five people with this general profile.
再说一遍，人数虽然不多，但至少有五个人具有这种总体特征。
But even though they were paranoid, even though they were severely impaired enough that each of them wound up in a psychiatric inpatient hospital, which is pretty hard to get into in this day and age or even 20 years ago, they all liked something about the experience enough that they all wanted to get back on.
但尽管他们很偏执，尽管他们都受到了严重的伤害，以至于每个人都住进了精神病院，这在当今时代甚至20年前都很难进入，但他们都非常喜欢这段经历，以至于他们都想回去。
And all of them knew enough to lie about this past.
他们所有人都知道足以对这段过去撒谎。
So they didn't tell me.
所以他们没有告诉我。
All of them also had ADHD.
他们所有人都患有多动症。
They presented with ADHD.
他们患有多动症。
They'd say, "I'd been on stimulants before, and I'm not working with that doctor because my insurance changed," or they had moved to the area.
他们会说，“我以前服用过兴奋剂，但由于我的保险发生了变化，我不再与那位医生一起工作”，或者他们已经搬到了该地区。
So they gave plausible histories, and most of those, within a month or two of restarting it, wound up back in the psychiatric hospital.
因此，他们提供了可信的历史，其中大多数在重新启动后的一两个月内，最终又回到了精神病院。
I had one guy, bright computer programmer, late 20s, calling me from inside the psychiatric hospital to try to get me to prescribe more Adderall to him.
有一个人，20 多岁的聪明计算机程序员，从精神病院里给我打电话，试图让我给他开更多的阿得拉。
And not only that, he had convinced his inpatient psychiatrist that this was a good idea, that this was important to treating his ADHD and helping him retain his job.
不仅如此，他还说服了住院精神科医生这是一个好主意，这对于治疗他的多动症并帮助他保住工作很重要。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
So these are, as you said, straight white males who have psychotic episodes on their ADHD meds and continue to seek those meds because they, quote-unquote, "like the experience." It feels like a manic high, the high dopaminergic state.
所以，正如你所说，这些是白人异性恋男性，他们在服用多动症药物后出现精神病发作，并继续寻求这些药物，因为他们“喜欢这种经历”。感觉就像是一种躁狂的高潮，高多巴胺能状态。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah, and you put the word mania in there, manic, and lots of people define this as amphetamine-induced mania rather than psychosis.
是的，你把躁狂这个词放在那里，躁狂，很多人将其定义为安非他明引起的躁狂而不是精神病。
I don't, because one is uniformly, and maybe other people are seeing more, that these people were paranoid, they were worried, they were anxious, they were delusional, but they weren't overtly enjoying it.
我不这么认为，因为人们一致认为，也许其他人看到的更多，这些人是偏执的，他们担心的，他们焦虑的，他们妄想的，但他们并没有公开地享受它。
They weren't having a great time.
他们过得并不愉快。
They weren't saying, "I'm going to party with all you friends, and I'm only worried about the people there." And yes, they were talking more loudly.
他们并不是说，“我要和你们所有的朋友一起聚会，我只担心那里的人。”是的，他们说话的声音更大了。
They were sleeping less, which could be characteristic of mania, but there was no positive affect that I or police reports or often families give you extensive history of everything that was going on, that there was nothing euphoric they were describing about it.
他们睡得更少，这可能是躁狂症的特征，但我或警方的报告或家人经常向你提供所发生的一切的广泛历史，并没有产生积极的影响，他们对此没有任何欣快的描述。
I think the second piece is it's unclear how much they actually remember or recall, or either through psychological suppression of it or physiologic, they're in a different enough state, it didn't register properly.
我认为第二点是不清楚他们实际上记住或回忆了多少，或者通过心理抑制或生理抑制，他们处于足够不同的状态，它没有正确记录。
It's not clear, but they tend not to recall the paranoia.
目前尚不清楚，但他们往往不记得偏执狂。
And by paranoia, it's persecutory delusions.
偏执狂是一种迫害性妄想。
I have people who assaulted family members thinking that they were being spied on, manipulated, when they were the parents trying to take care of their kids.
我有一些人袭击了家庭成员，认为他们被监视、被操纵，而当他们是试图照顾孩子的父母时。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to take a quick break and thank one of our sponsors, LMNT.
我想稍微休息一下并感谢我们的赞助商之一 LMNT。
LMNT is an electrolyte drink that has everything you need and nothing you don't.
LMNT 是一种电解质饮料，拥有您需要的一切，没有您不需要的东西。
That means the electrolytes, sodium, magnesium, and potassium in the correct ratios, but no sugar.
这意味着电解质、钠、镁和钾的比例正确，但没有糖。
We should all know that proper hydration is critical for optimal brain and body function.
我们都应该知道，适当的水分对于最佳的大脑和身体功能至关重要。
In fact, even a slight degree of dehydration can diminish your cognitive and physical performance to a considerable degree.
事实上，即使是轻微程度的脱水也会在很大程度上降低您的认知和身体表现。
It's also important that you're not just hydrated, but that you get adequate amounts of electrolytes in the right ratios.
同样重要的是，您不仅要补充水分，还要以正确的比例获得足量的电解质。
Drinking a packet of LMNT dissolved in water makes it very easy to ensure that you're getting adequate amounts of hydration and electrolytes.
喝一包溶解在水中的 LMNT 可以很容易地确保您获得足够的水分和电解质。
To make sure that I'm getting proper amounts of both, I dissolve one packet of LMNT in about 16 to 32 ounces of water when I wake up in the morning, and I drink that basically first thing in the morning.
为了确保我摄入适量的两者，当我早上醒来时，我将一包 LMNT 溶解在大约 16 至 32 盎司的水中，并且我基本上早上第一件事就是喝它。
I'll also drink a packet of LMNT dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and losing water and electrolytes.
在进行任何体育锻炼时，我还会喝一包溶解在水中的 LMNT，尤其是在炎热的日子里，当我大量出汗并失去水分和电解质时。
There are a bunch of different great-tasting flavors of LMNT.
LMNT 有多种不同的美味口味。
I like the watermelon, I like the raspberry, I like the citrus.
我喜欢西瓜，我喜欢覆盆子，我喜欢柑橘。
Basically, I like all of them.
基本上，我都喜欢。
If you'd like to try LMNT, you can go to drinklmnt.com/huberman to claim an LMNT sample pack with the purchase of any LMNT drink mix.
如果您想尝试 LMNT，可以访问 Drinklmnt.com/huberman，购买任何 LMNT 混合饮料即可领取 LMNT 样品包。
Again, that's Drink LMNT, spelled L-M-N-T, so it's drinklmnt.com/huberman to claim a free sample pack.
同样，这是 Drink LMNT，拼写为 L-M-N-T，因此可以通过 Drinklmnt.com/huberman 索取免费样品包。
What are the options for people that think that they may have ADHD?
对于那些认为自己可能患有多动症的人来说，有哪些选择？
Let me phrase it differently.
让我换一种说法。
Someone comes in, and let's say an adult, they have five of the 18 criteria.
有人进来，假设是一个成年人，他们符合 18 条标准中的 5 条。
They meet the criteria for ADHD.
他们符合多动症的标准。
After telling them about sleep, food, exercise, and relaxation, after that's squared away, if the decision is to medicate, and assuming they're not on any other medications, which cluster in this two sets of clusters that you described before, the amphetamine type, the Adderall, Vyvanse, et cetera, versus the, I realize you put Ritalin at the top of the bottom cloud.
在告诉他们有关睡眠、食物、运动和放松的信息之后，在这些都摆平后，如果决定用药，并假设他们没有服用任何其他药物，这些药物聚集在您之前描述的这两组集群中，安非他明类型、阿得拉、Vyvanse 等，与其他药物相比，我意识到您将利他林放在了底部云的顶部。
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Wellbutrin, Ritalin, Modafinil, you mentioned Cymbalta.
维布特林、利他林、莫达非尼，你提到了欣百达。
Which cluster do you go to first?
你先去哪个集群？
Dr. John Kruse:
约翰·克鲁斯博士：
I mean, some of this is just individual style rather than intellectually thinking one is better or not, and my style is usually to listen as closely as I can to what the patient wants.
我的意思是，其中一些只是个人风格，而不是理智地思考一个人更好或不好，我的风格通常是尽可能仔细地倾听患者的需求。
That doesn't mean agree with them, but to explain in as much detail as I can what I perceive the risks and the likelihood of those are and what I perceive the benefits to be.
这并不意味着同意他们的观点，而是尽可能详细地解释我所认为的风险和可能性，以及我所认为的好处。
For years, just statistically, I had many more people who were on non-stimulants than stimulants compared to the general ADHD population, and that's even accounting for by many variables I had.
多年来，仅从统计数据来看，与一般多动症人群相比，我服用非兴奋剂的人比服用兴奋剂的人要多得多，这甚至可以通过我拥有的许多变量来解释。
I've always worked with a lot of people who are on disability from Medicare.
我一直与许多因医疗保险而患有残疾的人一起工作。
I also work with people who are on Medicaid in the cities, insurance before Obamacare happened.
我还与城市中享受医疗补助的人们一起工作，这是奥巴马医改之前的保险。
So I worked with, not entirely, but a skewed, more dysfunctional, more severely afflicted population, which again, you would think would be a better match for the more powerful drugs.
因此，我的工作对象并非完全是一群扭曲的、功能失调的、患病更严重的人群，你可能会再次认为，这些人群更适合使用更强大的药物。
I'll jump back, but this actually is a situation where we have more powerful drugs.
我会跳回来，但这实际上是我们拥有更强大药物的情况。
So often when I treat people with depression, they'll try one or two or three antidepressants and say, "Well, give me something that's more powerful." And with depression, maybe we can put ketamine out of the picture, and I know this is a side issue, but all of our antidepressants seem to work equally well.
通常，当我治疗抑郁症患者时，他们会尝试一种或两种或三种抗抑郁药，然后说：“好吧，给我一些更有效的药物。”对于抑郁症，也许我们可以将氯胺酮排除在外，我知道这是一个次要问题，但我们所有的抗抑郁药似乎都同样有效。
We don't have potent antidepressants and non-- If it got FDA-approved, it works in a certain range of likelihood.
我们没有有效的抗抑郁药，而且如果它获得 FDA 批准，它在一定范围内可能会起作用。
But with the stimulants, amphetamine-based products really are more powerful, and more so than with depression or many of our other conditions where it's more a categorical, this will help or not, as long as you're above a threshold, there's a more linear relationship.
但对于兴奋剂来说，基于安非他明的产品确实更强大，而且比抑郁症或我们的许多其他情况更有效，在这些情况下，它更明确，这会有所帮助或没有，只要你高于阈值，就会有更线性的关系。
If a little bit of Wellbutrin helps a lot, it's likely to help more.
如果一点点维布特林有很大帮助，那么它的帮助可能会更大。
I mean, you might start getting more side effect issues, and there may be good reasons to not keep going up, but there's a more linear dosage results relationship.
我的意思是，您可能会开始出现更多副作用问题，并且可能有充分的理由不继续增加，但剂量结果之间存在更线性的关系。
Andrew Huberman:
安德鲁·休伯曼：
Do you worry about strain on the heart with amphetamine products?
您是否担心安非他明产品会对心脏造成压力？
Just even if it's relatively low dose over time, just the strain on the calcium channels and on the heart.
即使随着时间的推移剂量相对较低，也会对钙通道和心脏造成压力。
Is it true that stimulant-based medications for ADHD can "weaken the heart?"
用于治疗多动症的兴奋剂药物真的会“削弱心脏”吗？
Dr. John Kruse:
约翰·克鲁斯博士：
When you used that term, I was talking with Rob beforehand about running marathons, and when I ran the 100th anniversary of the Boston Marathon, they had some of the medical literature from the previous decades, and one of the medical warnings was, maybe you could do one or two marathons in your life, but don't do more than that because your heart will wear out.
当你使用这个术语时，我事先和罗布谈论过跑马拉松，当我参加波士顿马拉松100周年纪念日时，他们有一些过去几十年的医学文献，其中一个医学警告是，也许你一生中可以跑一两次马拉松，但不要跑得更多，因为你的心脏会磨损。
And I've run 100, and my heart, I think, is still beating, so we know things we thought we know at one point.
我已经跑了 100 场，我想我的心仍在跳动，所以我们知道一些我们曾经以为我们知道的事情。
Common cardiovascular effects of not just the stimulants but the non-stimulants that are affecting norepinephrine, so Wellbutrin, Cymbalta, Modafinil, it's less clear, and we can get into that when we talk about Modafinil, but clearly methylphenidate, amphetamine, on average, increase at therapeutic doses, increase heart rate a few points, increase blood pressure a few points.
影响去甲肾上腺素的不仅是兴奋剂，还有非兴奋剂的常见心血管作用，所以维布特林、欣百达、莫达非尼，还不太清楚，当我们谈论莫达非尼时，我们可以深入探讨这一点，但很明显，哌醋甲酯、安非他明平均会增加治疗剂量，使心率增加几个点，血压增加几个点。
But part of that obscures that probably 80% of people don't have any change, and maybe 20% have maybe a more slightly significant change.
但其中一部分掩盖了，可能 80% 的人没有任何变化，而 20% 的人可能有稍微显着的变化。
So we know that there's some impact there.
所以我们知道那里有一些影响。
We know there's some people with extremely rare genetic underlying conditions, usually related to the neurologic wiring of the heart, who are particularly vulnerable to dropping dead from a stimulant.
我们知道，有些人患有极其罕见的遗传基础疾病，通常与心脏的神经系统相关，他们特别容易因兴奋剂而死亡。
And almost every year, there's a well-trained athlete, either professional player or more often a high school or college player, college, who will take cocaine, take Ritalin, take prescription stimulant, and drop dead of a heart attack.
几乎每年，都会有训练有素的运动员，要么是职业运动员，要么更常见的是高中或大学运动员、大学运动员，他们会服用可卡因、服用利他林、服用处方兴奋剂，然后死于心脏病。
The risk of that's so uncommon.
这种风险非常罕见。
This is 15 years ago, when Adderall XR came out, the Canadian government was worried enough about this risk that they banned Adderall XR for almost a year, and because they have a comprehensive medical system, they could look more extensively at the numbers, and this is looking at kids.
这是15年前，当Adderall XR问世时，加拿大政府非常担心这种风险，他们禁止了Adderall XR将近一年，而且因为他们有完善的医疗体系，所以他们可以更广泛地关注数字，而这是在关注儿童。
The percentage of kids who drop dead with Adderall was tiny, and not just tiny, it was lower than the kids who aren't on Adderall who dropped out of a heart attack.
服用阿得拉后死亡的孩子比例很小，而且不仅是很小，还低于未服用阿得拉的因心脏病发作而死亡的孩子。
So part of it is, if you're in this rare genetic condition, almost always there's family members, or you've had some other near-death or syncopal episode where you passed out.
所以部分原因是，如果你患有这种罕见的遗传疾病，几乎总是有家人，或者你有过其他濒死或晕厥的经历，导致你昏倒。
So history taking of the individual and family history.
因此，要对个人和家族史进行病史采集。
And if you're at all worried or concerned, you can do EKGs, which detect most of those electrical abnormalities.
如果您完全担心或担心，可以做心电图，它可以检测大部分电气异常。
But the cardiology and lots of my colleagues practice may be a more conservative cover-your-ass medicine approach, where everyone has to have an EKG before they're on a stimulant.
但心脏病学和我的许多同事的做法可能是一种更为保守的掩护医学方法，每个人在服用兴奋剂之前都必须进行心电图检查。
But even the cardiology associations have said that seems to be a waste of resources.
但就连心脏病学协会也表示，这似乎是一种资源浪费。
Absolutely do a thorough history, absolutely do a thorough family history.
绝对做彻底的病史，绝对做彻底的家族史。
If there's anything of concern or if the patient's anxious about it, get an EKG.
如果有任何担忧或患者对此感到焦虑，请进行心电图检查。
But other than that, these should be generally safe for most people's hearts.
但除此之外，这些对于大多数人来说应该是安全的。
So there was a meta-analysis that came out earlier this year on-- So most of the studies looking at more serious, other than just mild hypertension or mild elevation of heart rate, haven't found much, but most of them only look a year out or a year of treatment.
今年早些时候发表了一项荟萃分析——因此，除了轻度高血压或轻度心率升高之外，大多数研究都着眼于更严重的情况，但没有发现太多结果，但大多数研究只着眼于一年后或一年的治疗。
Do we see rates of heart attacks?
我们看到心脏病发作率了吗？
Do we see rates of strokes?
我们看到中风的发生率吗？
Do we see rates of dangerous arrhythmias?
我们是否看到危险心律失常的发生率？
And in general, they're looking at a young population where these events are really uncommon anyway, and most of them didn't find any evidence of problems in a year or two out.
总的来说，他们关注的是年轻人，无论如何，这些事件确实不常见，而且他们中的大多数人在一两年内没有发现任何问题的证据。
The more recent study looked as long as 14 years out, and there they found measurable, statistically significant increase in risk that increased during the first three years of being on a stimulant and increased at a much lower rate for the next 10 years.
最近的一项研究看起来长达 14 年，他们发现，在服用兴奋剂的前三年内，风险出现了可测量的、统计上显着的增加，而在接下来的 10 年中，风险增加的速度要低得多。
Sort of plateaued out, but still measurably higher than people with ADHD who weren't on a stimulant.
有点趋于稳定，但仍然明显高于未服用兴奋剂的多动症患者。
But the absolute rate is still really, really low.
但绝对比率仍然非常非常低。
So for most people, it's not a risk.
所以对于大多数人来说，这不是一个风险。
On the other hand, if you start these medicines when you're 10 or 20 and may be on them for 60 years, we don't know whether potentially more people are getting into more trouble.
另一方面，如果您在 10 岁或 20 岁时开始服用这些药物，并且可能服用 60 年，我们不知道是否会有更多的人陷入更多麻烦。
Andrew Huberman:
安德鲁·休伯曼：
So if somebody presents as having ADHD as an adult and they've never touched stimulants, would you start them on Ritalin, Wellbutrin or Adderall, or something in the Adderall Vyvanse class?
因此，如果有人在成年后表现出患有注意力缺陷多动症，并且从未接触过兴奋剂，您会开始给他们服用利他林、维布特林或阿德拉，或阿德拉 Vyvanse 类的药物吗？
Dr. John Kruse:
约翰·克鲁斯博士：
So thanks for bringing me back to your question.
谢谢你让我回到你的问题。
Andrew Huberman:
安德鲁·休伯曼：
Sure.
当然。
Dr. John Kruse:
约翰·克鲁斯博士：
And I'm going to jump it.
我要跳过它。
You threw in that sort of qualifying phrase, never been on any stimulant in their life or tried it or something.
你添加了那种限定短语，他们一生中从未服用过任何兴奋剂或尝试过它或其他东西。
Or at least-
或者至少——
Andrew Huberman:
安德鲁·休伯曼：
At least not consistently
至少不是始终如一
Dr. John Kruse:
约翰·克鲁斯博士：
...
...
what I would say-
我会说什么-
Andrew Huberman:
安德鲁·休伯曼：
Yeah
是啊
Dr. John Kruse:
约翰·克鲁斯博士：
...
...
what I would say is these drugs are fairly common in our society, both illicitly and licitly.
我想说的是，这些药物在我们的社会中相当普遍，无论是非法的还是合法的。
We know lots of kids, lots of adults with ADHD share their medication.
我们知道很多患有多动症的孩子和成年人都会分享他们的药物。
Lots of people have tried these things, even if it's just once or twice, and that itself is valuable clinical data, if they felt too revved up from it.
很多人都尝试过这些事情，即使只是一两次，如果他们感到太兴奋的话，这本身就是有价值的临床数据。
So if they have, I try to find out what dose was it, what did it do for you, what good things did it do for you, what bad things did it do for you?
所以如果有的话，我会试着找出它的剂量是多少，它对你做了什么，它对你做了什么好事，它对你做了什么坏事？
So my presentation is usually, Adderall is likely to be the most strongly effective, or I more often are using Vyvanse.
所以我的演示通常是，Adderall 可能是最有效的，或者我更经常使用 Vyvanse。
These are the other options.
这些是其他选项。
But Adderall also has, again, greater rare, but risk for these bad problems.
但阿得拉也存在出现这些严重问题的更罕见但风险更大的风险。
Does that scare you?
这吓到你了吗？
Some people are petrified they're not going to go anywhere near that.
有些人吓呆了，他们不会去任何接近的地方。
Some people say, "Nah, I'm not that concerned about it." And most people do come in with some friends at work, family members, X, Y, or Z.
有些人说：“不，我对此并不担心。”大多数人确实是和工作中的朋友、家人、X、Y 或 Z 一起来的。
They think they know what the drug is likely to have as an effect on them.
他们认为他们知道这种药物可能会对他们产生什么影响。
And I tend to, at least as a starting point, listen to that.
至少作为一个起点，我倾向于倾听这一点。
And now, there are certain reasons I absolutely would not.
现在，有某些原因我绝对不会。
My worry, again, I saw more of it than I think most people in a higher rate with amphetamine induced psychosis, but a friend from college was just trying to refer a friend's son who's 27 and had a psychotic episode on marijuana and does have ADHD and is in bed depressed and not going to work and is being evaluated by two New York City doctors, but the psychiatrist kept him on Adderall.
我再次担心，我看到的安非他明诱发精神病的比例比我想象的要高，但一位大学朋友只是想转介一位朋友的儿子，他今年 27 岁，因吸食大麻而出现精神病发作，确实患有多动症，躺在床上郁郁寡欢，无法上班，正在接受两名纽约市医生的评估，但精神科医生让他继续服用阿得拉。
Again, the likelihood of recurrence seems so high that if you have a family history of schizophrenia or psychosis or you've had any experience of it, I would not prescribe a stimulant, an amphetamine based stimulant.
再次强调，复发的可能性似乎非常高，如果您有精神分裂症或精神病的家族史，或者您有过任何此类经历，我不会开兴奋剂，即基于安非他明的兴奋剂。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Could we go so far as to say, and I suspect the answer is no, but because nowadays we're hearing more about the possibility, I want to highlight possibility, of high THC cannabis causing psychotic episodes.
我们是否可以这么说，我怀疑答案是否定的，但因为现在我们听到更多关于高 THC 大麻导致精神病发作的可能性，我想强调这种可能性。
This is something I've stressed on this podcast, on social media.
这是我在这个播客和社交媒体上强调的事情。
I took a lot of heat for this from the traditional press.
我为此受到了传统媒体的强烈批评。
And then ironically, they're now putting out information that essentially speaks to the same.
讽刺的是，他们现在发布的信息本质上是相同的。
I'm not saying this happens in everybody, but there's certainly a possibility there.
我并不是说每个人都会发生这种情况，但肯定存在这种可能性。
Would you say that if somebody is a regular high THC cannabis user, that they are at greater risk to developing psychosis if they're taking these stimulant form ADHD meds?
您是否会说，如果某人经常服用高 THC 大麻，如果他们服用这些兴奋剂形式的 ADHD 药物，他们患精神病的风险会更大？
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
You could actually play that both ways.
实际上你可以用两种方式来玩。
You could claim that if they've already been on an agent without developing psychosis, then maybe they're more impervious to that as a potential side effect.
你可以说，如果他们已经服用了某种药物而没有出现精神病，那么他们可能更不会受到潜在副作用的影响。
Or where you were coming more from is if we're already on one agent that's pushing them in that direction, why the heck would you ever add another that could also...
或者你更多的想法是，如果我们已经有了一个正在推动他们朝这个方向发展的特工，那你为什么还要添加另一个也可以......
My approach clinically would be more, what do you think the marijuana's doing for you?
我的临床方法会更多，你认为大麻对你有什么作用？
And might it be more helpful to just clear that out of the picture before we add anything new onto it?
在我们添加任何新内容之前，将其从图片中清除出来是否会更有帮助？
But depending on what they say or don't say.
但取决于他们说什么或不说什么。
So my reading of the data is very clear that there is some, even at low THC, there is some risk.
所以我对数据的解读非常清楚，即使 THC 较低，也存在一定的风险。
Is it reefer madness that everyone who puffs a joint is freaking out?
每个吸大麻的人都吓坏了，这是冷藏疯狂吗？
Clearly not.
显然不是。
But again, it's much more potent than it was 10 year, or that was 70 years ago, I guess.
但我想，它比 10 年前，或者 70 年前要强大得多。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Especially as I understand, we had an expert from the cannabis research community on, in edible form in particular, it's harder for people to control the dosage, whereas when people use inhalation as the means to deliver, it seems like they kind of find the right plane without going overboard more often than with edibles.
特别是据我了解，我们有一位来自大麻研究界的专家，特别是在食用形式时，人们更难控制剂量，而当人们使用吸入作为输送方式时，似乎他们比食用食物更容易找到合适的飞机，而不会过度使用。
In any case.
无论如何。
Dr. John Kruse:
约翰·克鲁斯博士：
Well, one other big factor is that CBD actually seems in some studies to have an antipsychotic effect.
嗯，另一个重要因素是 CBD 实际上在一些研究中似乎具有抗精神病作用。
So, maybe strains of marijuana 50 years ago that had a, whatever nature thought was a more balanced view, had less of a risk.
因此，也许 50 年前的大麻品种，无论大自然认为是更平衡的观点，风险较小。
But now that you can get pure THC products, and I'm sure you've highlighted that a big problem with this whole industry is even in Colorado, which three years ago was the state with the most close regulation and inspection and Almost a majority of what the labels say don't correlate with what you're really getting.
但现在你可以获得纯 THC 产品，我相信你已经强调了整个行业的一个大问题甚至在科罗拉多州，三年前，科罗拉多州是监管和检查最严格的州，几乎大部分标签上的内容与你真正得到的东西并不相关。
So, this is not a well-regulated industry, even though states are trying to regulate their industry.
因此，尽管各州正在努力监管其行业，但这并不是一个监管良好的行业。
So you may not know what you're getting.
所以你可能不知道你得到了什么。
CBD, again, may have some protective effects, so getting pure and higher potency THC may be particularly undesirable.
同样，CBD 可能具有一些保护作用，因此获得纯净且效力更高的 THC 可能特别不可取。
So in my own YouTube podcast series, I've researched lots of subjects, and most of them I wind up saying, "We don't have a lot of data on it," and there's not a lot of data on marijuana.
因此，在我自己的 YouTube 播客系列中，我研究了很多主题，其中大多数主题我最后都会说，“我们没有很多关于它的数据”，而且也没有很多关于大麻的数据。
It's the one subject I've actually changed my mind from reading what was out there.
这是我在阅读现有资料后实际上改变了主意的一个主题。
And for years, I would tell people, because being in San Francisco, even before the wave of legalization, lots of people were using it, lots of people felt it helped them.
多年来，我会告诉人们，因为在旧金山，即使在合法化浪潮之前，很多人都在使用它，很多人觉得它对他们有帮助。
And what I would tell them is the data we have, and these are from everyday users, is that there are measurable, the characteristic of the classic stoner has a grain of truth to it.
我要告诉他们的是我们拥有的数据，这些数据来自日常用户，是可测量的，经典吸毒者的特征有一定的真实性。
So measurably lower motivation, poorer organization of thought, lower energy, are strongly correlated with daily marijuana use.
因此，明显较低的动机、较差的思维组织、较低的精力，与日常吸食大麻密切相关。
Why would anyone with ADHD want any of that going on?
为什么患有多动症的人会希望发生这样的事情呢？
That seems like a perfect misfit for accentuating what's not working right.
这似乎是一个完美的不适合强调不正常工作的地方。
Over the years, though, I had a handful of people who would swear it worked better for them than stimulants.
不过，多年来，我有一些人发誓这比兴奋剂对他们更有效。
It worked better for them than the non-stimulant alternatives.
它比非兴奋剂替代品对他们更有效。
Clearly not everybody.
显然不是每个人。
And when I looked at the data, there is actually some tiny studies.
当我查看数据时，实际上有一些微小的研究。
There are some that are funded by marijuana organizations, so that doesn't mean they're wrong, but it's harder to evaluate how objective they were.
有些是由大麻组织资助的，所以这并不意味着他们是错的，但很难评估他们的客观程度。
But there is some research that suggests there is some subsegment, and I don't think it's people with ADHD in general, but some subset of that population who may actually do better.
但有一些研究表明存在一些子群体，我不认为一般患有多动症的人，而是该人群中的某些子集实际上可能做得更好。
And most of the time, they were looking at marijuana rather than pure THC.
大多数时候，他们关注的是大麻而不是纯四氢大麻酚。
And what I was going to say is there's probably at least 70 or 80 other psychoactive components to marijuana.
我想说的是，大麻中可能至少含有 70 或 80 种其他精神活性成分。
Not most of them is in higher concentration as the THC or CBD, but they're out there.
它们中的大多数浓度并不像 THC 或 CBD 那样高，但它们就在那里。
Maybe they are more important, even at lower concentrations.
也许它们更重要，即使浓度较低。
Andrew Huberman:
安德鲁·休伯曼：
I've heard this, that for some people, cannabis can help them focus, and I'm certainly not one of those.
我听说，对于某些人来说，大麻可以帮助他们集中注意力，而我当然不是其中之一。
But it certainly is interesting.
但这确实很有趣。
As long as we're on cannabis, excuse me, as long as we're discussing cannabis, neither of us are on cannabis to my knowledge.
只要我们在吸大麻，对不起，只要我们在讨论大麻，据我所知，我们俩都没有吸大麻。
Maybe I could just ping you for the relationship between various compounds that people use that are available over the counter, or with online access to these compounds, and ADHD symptoms specifically.
也许我可以向您询问人们使用的各种非处方化合物或在线获取这些化合物与 ADHD 症状之间的关系。
And then at some point, I'd like to return to the amphetamine-based drugs.
然后在某个时候，我想重新使用基于安非他明的药物。
So let's just start with nicotine.
那么让我们从尼古丁开始吧。
So these days, there's increased use of nicotine pouches, gums, not just smoking, vaping, dipping, and snuffing.
因此，如今，尼古丁袋、口香糖的使用越来越多，而不仅仅是吸烟、吸电子烟、蘸烟和吸鼻烟。
And it's certainly a stimulant, and certainly a lot of people, in particular young males, are using it more often.
它确实是一种兴奋剂，而且很多人，尤其是年轻男性，都更频繁地使用它。
The traditional media is now trying to create this picture of nicotine being part of the wellness and fitness community.
传统媒体现在正试图塑造尼古丁成为健康和健身社区一部分的形象。
But in my observation, many, many more people outside of that category are using it.
但根据我的观察，该类别之外的许多人正在使用它。
So what, in your experience, happens when somebody with ADHD, let's assume they're not medicating in any other way, starts dabbling in nicotine use?
那么，根据您的经验，当患有多动症的人（假设他们没有以任何其他方式进行药物治疗）开始涉足尼古丁使用时，会发生什么？
And let's assume they're going to do this in ways that do not cause cancer, because the smoking, dipping, vaping, snuffing part is what causes the cancer.
我们假设他们会以不会导致癌症的方式做到这一点，因为吸烟、吸食、吸电子烟、吸鼻部分是导致癌症的原因。
Let's just talk about the compound nicotine.
我们就来说说复合尼古丁吧。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
So there's some well-done research showing nicotine is helpful for improving some of the executive functions, sustained attention, and I'm not sure which of the executive functions, but they help people focus, be sharper, do better.
因此，有一些完善的研究表明，尼古丁有助于改善某些执行功能、持续注意力，我不确定是哪些执行功能，但它们可以帮助人们集中注意力，变得更敏锐，做得更好。
There was actually a major pharmaceutical company who was developing a nicotine receptor product specifically for ADHD, and they abandoned that several years ago, and I haven't been able to find word as to why that was abandoned, whether it was some other side effect.
实际上有一家大型制药公司正在开发专门针对多动症的尼古丁受体产品，但他们几年前就放弃了这一产品，我一直无法找到关于为什么放弃该产品的消息，是否是其他副作用。
It's worth throwing out there that although nicotine in many ways acts like a stimulant, it actually is moderately unique, and I hate people who say unique means one of a kind, so I can't modify it in any way.
值得一提的是，虽然尼古丁在很多方面都像一种兴奋剂，但它实际上是相当独特的，我讨厌那些说独特意味着独一无二的人，所以我无法以任何方式修改它。
Unusual, maybe not the only one.
不寻常，也许不是唯一的。
Unusual in that it both arouses people and reduces anxiety simultaneously.
不同寻常的是，它既能唤起人们的兴奋，又能同时减少焦虑。
Most of our stimulants are, again, banging away at the sympathetic nervous system, and that's banging away on good arousal and bad arousal, so anxiety.
我们的大多数兴奋剂都会再次刺激交感神经系统，从而刺激良好的兴奋和不良的兴奋，从而导致焦虑。
So nicotine, again, seems to be both calming and helping alert or focus people.
因此，尼古丁似乎又具有镇静作用，还能帮助人们警觉或集中注意力。
And as long as they're taking it in a way that's not clearly detrimental to their health, which smoking and vaping and probably chewing are, well, not probably, definitely are.
只要他们的服用方式不会明显损害他们的健康，吸烟、电子烟和咀嚼可能肯定会有害健康。
And if it's affordable, because some of these products are pretty pricey, at least the chewing gums or the Nicorette that was used for helping people with smoking cessation.
如果价格实惠的话，因为其中一些产品相当昂贵，至少是用来帮助人们戒烟的口香糖或尼古丁。
I have some people who feel that it's been an important and useful part of their regimen.
我有些人觉得这是他们养生法中重要且有用的一部分。
I have some people, small numbers, who prefer it to any other medications.
我有一些人，一小部分人，比任何其他药物都更喜欢它。
And almost no, again, other than sort of the basic neurophysiology showing that it can have beneficial effects on executive functions, there's no Research, at least as of a year or two ago, whenever I dipped my toe, not my anything else, into the snuff.
再说一次，除了基本的神经生理学表明它可以对执行功能产生有益影响之外，几乎没有任何研究，至少在一两年前，每当我将脚趾而不是其他任何东西浸入鼻烟中时。
Looked into it.
调查了一下。
There's no clinical research showing does this help or not help.
没有临床研究表明这是否有帮助。
Andrew Huberman:
安德鲁·休伯曼：
What about caffeine and, in particular, energy drinks?
咖啡因，特别是能量饮料呢？
These days, there just seems to be an explosion of drinks that include caffeine, but also fairly high dosages of things like taurine, alpha-GPC, theanine.
如今，含有咖啡因的饮料似乎激增，但也含有相当高剂量的物质，如牛磺酸、α-GPC、茶氨酸。
Dr. John Kruse:
约翰·克鲁斯博士：
And tyrosine.
还有酪氨酸。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, tyrosine.
是的，酪氨酸。
So, things that are thought to generally amplify the production or release of neuromodulators, like dopamine, acetylcholine, and so forth.
因此，人们认为通常会放大神经调节剂的产生或释放，例如多巴胺、乙酰胆碱等。
Dr. John Kruse:
约翰·克鲁斯博士：
And so the epidemiologists say that the most widely used psychoactive substance on this planet, and I thought it was alcohol for years, but it's actually caffeine, because lots of groups outlaw alcohol and won't outlaw caffeine.
因此，流行病学家说，这个星球上使用最广泛的精神活性物质，我多年来一直认为它是酒精，但实际上它是咖啡因，因为很多团体禁止酒精，但不会禁止咖啡因。
So lots and lots of people use it.
所以很多很多人都在使用它。
And this is a gross oversimplification, but this is what I tell people.
这是一种严重的过于简单化的说法，但这就是我告诉人们的。
Even though it's the most widely used, if you used it as an equivalent dose to our stimulants, essentially we're using it at a lower dose level.
尽管它是使用最广泛的，但如果您将其用作与我们的兴奋剂相同的剂量，本质上我们正在以较低的剂量水平使用它。
It's a pretty lousy stimulant.
这是一种非常糟糕的兴奋剂。
Separate from that, it's working primarily on adenosine and indirectly working on dopamine.
除此之外，它主要作用于腺苷，间接作用于多巴胺。
But associated with higher levels of anxiety, higher levels of jitteriness, higher levels of cardiac toxicity, if you were to use it at an equivalent dose.
但如果您以同等剂量使用它，则会导致更高水平的焦虑、更高水平的紧张、更高水平的心脏毒性。
But most people are using at a substantially lower dose.
但大多数人使用的剂量要低得多。
And the ADHD experts sort of historically have fallen into two different camps.
从历史上看，多动症专家分为两个不同的阵营。
Some of them have said, "It's going to interact with your stimulant or other medications.
他们中的一些人说：“它会与你的兴奋剂或其他药物相互作用。
It's complicated.
这很复杂。
We don't want it messing up the picture.
我们不希望它破坏图片。
Stay off of it." And the other half say, "It's a stimulant.
远离它。”另一半则说：“这是一种兴奋剂。
Lots of people are using it with these other stimulants, both full-blown stimulants and non-stimulant ADHD medications.
许多人将其与其他兴奋剂一起使用，包括成熟的兴奋剂和非兴奋剂多动症药物。
And as long as you know it's part of the picture and you're trying to be constant with your dosage or aware of it, then fine, and maybe it helps you get away with a lower dose of the prescription." The one little piece I'd add in there is that often you don't know what dose you're getting.
只要你知道这是问题的一部分，并且你试图保持剂量不变或意识到这一点，那就很好，也许它可以帮助你摆脱较低剂量的处方。”我要补充的一点是，你通常不知道自己服用的剂量是多少。
So people have the common experience, as I was saying earlier, I've only had three cups of coffee in my whole life, so this is all anecdotal or researched, not personal experience data.
所以人们有共同的经验，就像我之前说的，我一生只喝过三杯咖啡，所以这都是轶事或研究，而不是个人经验数据。
But lots of people have the experience, go to their local Starbucks or something and say, "Whoa, that feels way stronger than usual." And then invariably they say, "Oh, that must just be me.
但很多人都有过这样的经历，他们去当地的星巴克之类的地方会说，“哇，这感觉比平常强多了。”然后他们总是说：“哦，那一定是我。
I'm more anxious already.
我已经更着急了
I'm jacked up." Or because they think Starbucks, 7 billion stores around the country, everything's automated and precise.
我很兴奋。”或者因为他们认为星巴克，全国 70 亿家门店，一切都是自动化和精确的。
Starbucks, they control for the aromaticity, how many minutes each bean is cooked, which side it gets flipped over on.
星巴克，他们控制芳香度、每颗豆子的煮熟时间、翻到哪一面。
They're not controlling for caffeine intake, which is wild to you and me.
他们没有控制咖啡因的摄入量，这对你我来说都是疯狂的。
So a University of Florida study, and this is several years ago now, went into a Florida Starbucks, bought the same drink every day for three weeks, and compared the caffeine content.
因此，佛罗里达大学的一项研究（这是几年前的事了）进入佛罗里达州的星巴克，连续三周每天购买相同的饮料，并比较咖啡因含量。
The highest day compared to the lowest days was a threefold difference.
最高日与最低日相比，相差三倍。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. John Kruse:
约翰·克鲁斯博士：
And that's Starbucks.
那就是星巴克。
Who knows what smaller...
谁知道哪个小...
So one is, you may think you know what you're give, and maybe the bane of coffee drinkers, and maybe it sank in a teaspoon that you're dissolving may be the most consistent there.
所以一个是，你可能认为你知道你所提供的是什么，这可能是咖啡饮用者的祸根，也许它沉入一茶匙中，你正在溶解可能是那里最一致的。
But one of the risks with caffeine, and with pretty much any over-the-counter drug, is you may not know what dose you're getting.
但咖啡因以及几乎所有非处方药的风险之一是您可能不知道自己服用的剂量是多少。
Andrew Huberman:
安德鲁·休伯曼：
Very interesting.
非常有趣。
As I've said several times in this podcast, I think caffeine is a wonderful drug, mostly because I love the things it comes in, yerba mate being my preferred source of caffeine, but also coffee.
正如我在这个播客中多次说过的那样，我认为咖啡因是一种很棒的药物，主要是因为我喜欢它所含的东西，马黛茶是我首选的咖啡因来源，但也是咖啡。
And it certainly increases my focus.
这确实增加了我的注意力。
It's of a narrow plane, though.
不过，它是一个狭窄的平面。
Two sips too many, and I can start feeling myself veer toward more lack of focus.
喝了太多两口，我开始感觉自己变得更加缺乏注意力。
It doesn't seem to have a very pervasive effect.
它似乎没有产生非常普遍的影响。
And dosing it on an empty stomach versus after eating, I'm not that precise about it, but I don't see it as a very reliable stimulant.
空腹服用与饭后服用相比，我对此不太精确，但我不认为它是一种非常可靠的兴奋剂。
It's more to get to a plane of just normalcy for me, given how much I've been drinking it since I was a teen, really.
对我来说，更重要的是登上一架正常的飞机，因为我从十几岁起就已经喝了很多酒，真的。
I think most people are similar.
我想大多数人都是相似的。
They drink it to feel normal.
他们喝它是为了感觉正常。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
Well, and there's also lots of cultural and habitual, if it gives you your warm fuzzies or puts you in the right mode, or you think you're more alert, or you're listening to your favorite newscast in the morning as you're drinking it, that all is adding to its effect.
嗯，还有很多文化和习惯，如果它给你带来温暖的模糊感或让你处于正确的模式，或者你认为你更警觉，或者你在早上一边喝它一边听你最喜欢的新闻广播，所有这些都增加了它的效果。
In terms of combining with other over-the-counter things, there is some study looking at caffeine and L-theanine together and having some, at least in a tiny handful of studies, some measurable beneficial effect on, I think it's mostly kids that have been looked at, and nothing dangerous found across a pretty broad range of L-theanine dosages.
就与其他非处方药相结合而言，有一些研究将咖啡因和 L-茶氨酸放在一起，至少在少数研究中，有一些可测量的有益影响，我认为主要是针对儿童，在相当广泛的 L-茶氨酸剂量范围内没有发现任何危险。
But I'm not aware of any good research done with adding all the other things that are currently being added to it.
但我不知道是否有任何好的研究将当前正在添加的所有其他内容添加到其中。
And some logically may be doing something, some may be irrelevant, some may be more detrimental.
从逻辑上讲，有些可能正在做某事，有些可能无关紧要，有些可能更有害。
Andrew Huberman:
安德鲁·休伯曼：
L-theanine certainly is being added to a lot of caffeine-containing drinks because it seems to take the jitters-
L-茶氨酸肯定被添加到许多含咖啡因的饮料中，因为它似乎可以消除紧张情绪——
Dr. John Kruse:
约翰·克鲁斯博士：
Jitters off
紧张不安
Andrew Huberman:
安德鲁·休伯曼：
...
...
off and the assumption being that people can consume more of that drink as a consequence.
并假设人们因此可以消耗更多的这种饮料。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah, there's a tiny bit of evidence that suggests that it may both help with anxiety, but it may directly have some beneficial cognitive executive function Benefits itself.
是的，有一点证据表明它可能有助于缓解焦虑，但它本身可能直接具有一些有益的认知执行功能的好处。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, this is in keeping with the green tea hypothesis, which I believe green tea is enriched for theanine.
是的，这符合绿茶假说，我相信绿茶富含茶氨酸。
You are somebody who, quite refreshingly to me, has talked not just about prescription drugs and behavioral tools for ADHD, but also, actually, I think years ago you were the first person to first share with me the data about fish oil and the EPA omega-3s for depression.
令我耳目一新的是，您不仅谈论了治疗多动症的处方药和行为工具，而且实际上，我认为几年前您是第一个与我分享有关鱼油和 EPA omega-3 治疗抑郁症数据的人。
Those studies were starting to come out.
这些研究开始出来。
We were talking about those studies.
我们正在谈论那些研究。
And nowadays, I think while there's still a little bit of controversy out there about fish oils, I think most everybody believes that getting high quality omega-3s from good clean sources, including fish oil, is mostly beneficial or beneficial.
如今，我认为虽然关于鱼油仍然存在一些争议，但我想大多数人都认为从良好的清洁来源（包括鱼油）获取高质量的 omega-3 是最有益的或有益的。
What about fish oil for ADHD in particular, and what threshold dosages are relevant here?
鱼油对于注意力缺陷多动症（ADHD）的作用如何？这里的相关阈剂量是多少？
Dr. John Kruse:
约翰·克鲁斯博士：
So just as with the fish oil for cardiac benefits, there was a time period where the first few large, and they were pretty large, well-done studies showed benefits for cardiovascular health.
因此，就像鱼油对心脏有益一样，在一段时间内，前几项大型且相当大规模的研究表明，鱼油对心血管健康有益。
The more recent studies with fish oil haven't shown an effect or benefit.
最近的鱼油研究尚未显示出效果或益处。
And strangely to me, and not very scientifically, the cardiology community sort of looks at the more recent ones and say, "Okay, that's what it is." Well, you have to reconcile all the data in the pool.
对我来说奇怪的是，心脏病学界在研究最近的研究时会说：“好吧，就是这样。”好吧，您必须协调池中的所有数据。
The ADHD fish oil story is a little the opposite, and it's almost everything with ADHD.
多动症鱼油的故事有点相反，它几乎与多动症有关。
It's been kids that have been most strongly looked at.
受到最密切关注的是孩子们。
The first few studies with fish oil and kids didn't show any benefits at all, and then subsequently there have been several studies that looked at benefits.
最初的几项关于鱼油和儿童的研究根本没有显示出任何好处，随后出现了几项研究来探讨鱼油的好处。
And again, and the field jumps to the second set without reconciling, well, how do we do a good meta-analysis with everything in there?
再次，领域跳到第二组而不协调，那么，我们如何对其中的所有内容进行良好的荟萃分析？
And I haven't looked closely enough to know were there methodological differences, dosage differences, population differences that matter.
我还没有仔细观察，不知道是否存在重要的方法学差异、剂量差异、人群差异。
I'd say unless you're taking so big a dose that you're probably at risk for heavy metal poisoning, which is a possible issue with big doses of fish oil.
我想说，除非您服用的剂量太大，否则您可能有重金属中毒的风险，这是大剂量鱼油可能出现的问题。
Most of the recommendations are in the range that it seemed, and I'd say that depression has been the most consistent field, and that doesn't mean every study there has been positive either, but the most consistent field for a mental health benefit or a health benefit.
大多数建议都在看起来的范围内，我想说抑郁症是最一致的领域，这并不意味着每项研究都是积极的，但它是对心理健康有益或对健康有益的最一致的领域。
And there, the recommendation is usually target about 1,000 milligrams of EPA of eicosapentaenoic acid a day.
在那里，建议的目标通常是每天大约 1,000 毫克 EPA 二十碳五烯酸。
If you're seeing some benefit, but it feels like that there's more room for improvement, so this is my motto I tell people, then you could probably double it reasonably.
如果你看到了一些好处，但感觉还有更多改进的空间，所以这是我告诉人们的座右铭，那么你可能可以合理地加倍。
There were dramatic studies looking at fish oil for mania, people hospitalized with it, and they used dosages as high as 7,000 milligrams a day.
有一些引人注目的研究着眼于鱼油治疗躁狂症，人们因鱼油而住院，他们每天使用的剂量高达 7,000 毫克。
Andrew Huberman:
安德鲁·休伯曼：
To treat mania?
治疗躁狂症？
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
And that study, I think it was a Harvard area clinic that was doing it, the results were so dramatic that they ethically had to stop the study before its intended completion because the benefits seemed to be so robust in the fish oil group compared to the un-- that it was unethical to not put everyone on fish oil.
那项研究，我认为是哈佛地区的一家诊所正在做，结果是如此引人注目，以至于他们在道德上不得不在预期完成之前停止这项研究，因为与非鱼油组相比，鱼油组的好处似乎如此强大——不让每个人都服用鱼油是不道德的。
Andrew Huberman:
安德鲁·休伯曼：
That's a lot of fish oil.
那是很多鱼油。
Dr. John Kruse:
约翰·克鲁斯博士：
That's a lot of, yeah.
这是很多，是的。
Andrew Huberman:
安德鲁·休伯曼：
You probably need to get it in liquid form so it wasn't so expensive.
你可能需要以液体形式购买它，这样就不会那么贵。
But I find this recency effect incredible, which you mentioned a few moments ago, that, and I think this is helpful for people to hear, certainly it is for me.
但我发现这种近因效应令人难以置信，你刚才提到过，我认为这对人们听到有帮助，当然对我来说也是如此。
We hear studies over the years have explored fish oil for cardiac benefits, and then more recently, as I understand, these have not been demonstrated.
我们听说多年来的研究一直在探索鱼油对心脏的益处，但据我所知，最近这些还没有得到证实。
And there seems to be a focus on the recent studies as if the old ones don't exist.
而且人们似乎把注意力集中在最近的研究上，就好像旧的研究并不存在一样。
That's essentially what you described for both cardiac and ADHD.
这基本上就是您对心脏病和多动症的描述。
I think it's really important.
我认为这非常重要。
We hear this with alcohol, too.
我们在喝酒时也会听到这样的声音。
I've been involved in this debate.
我参与了这场辩论。
I don't care if people drink one way or the other, provided they take care of themselves and others.
我不在乎人们是否以某种方式饮酒，只要他们照顾好自己和他人。
And if you're an alcoholic adult, don't drink.
如果您是一个酗酒的成年人，请不要喝酒。
And if you're a kid, don't drink.
如果你是个孩子，就不要喝酒。
But if people want to drink a few drinks a week, I don't have a problem with it.
但如果人们想每周喝几杯，我没有问题。
But it's remarkable that every time a study comes out showing a mild benefit of moderate alcohol use, that seems to be the highlight, and then everything else is forgotten.
但值得注意的是，每次有研究表明适量饮酒有轻微好处时，这似乎都是亮点，然后其他一切都被遗忘了。
And the inverse is also true.
反之亦然。
One would think that the meta-analysis would include as many good studies as possible, but I think it's important that people hear that that's not always the case.
人们可能会认为荟萃分析会包含尽可能多的好的研究，但我认为重要的是让人们知道情况并非总是如此。
Just because there's a meta-analysis doesn't mean that it included all the relevant studies.
仅仅因为有荟萃分析并不意味着它包含了所有相关研究。
So I'm just restating.
所以我只是重申一下。
Thank you.
谢谢。
I make it a point to try and get one to two grams of EPA per day, just as a general mood.
我会尝试每天摄入一到两克 EPA，就像一般情绪一样。
I'm not clinically depressed, but just to support my mood, to support focus, to support wellbeing, including cardiac function.
我并没有临床上的抑郁症，只是为了支持我的情绪，支持注意力，支持健康，包括心脏功能。
Dr. John Kruse:
约翰·克鲁斯博士：
So the other thing that I think is understudied with the fish oil issue is that, and it's a Harvard guy who has a proprietary brand of purified EPA that pushes it.
因此，我认为关于鱼油问题尚未得到充分研究的另一件事是，哈佛大学的一个人拥有一个专有品牌的纯化 EPA 来推动这一问题。
So in nature, whether you're a whale or a human or a butterfly or a, maybe not insects, I'm not sure of that.
所以在自然界中，无论你是鲸鱼、人类、蝴蝶还是昆虫，也许不是昆虫，我都不确定。
Across the mammal, bird, reptile kingdom, the omega-3s are found in about a two-to-one ratio of EPA to DHA, eicosapentaenoic acid to docosahexaenoic acid.
在哺乳动物、鸟类和爬行动物王国中，omega-3 的 EPA 与 DHA、二十碳五烯酸与二十二碳六烯酸的比例约为二比一。
And what I tell people is, I think Mother Nature's probably smarter than any Harvard professor.
我告诉人们的是，我认为大自然可能比任何哈佛大学教授都聪明。
And the brain particularly is high in brain membranes of DHA.
大脑的脑膜中 DHA 含量特别高。
So some people seek out EPA purified or only EPA brands That to me doesn't make a lot of sense.
因此，有些人寻求 EPA 纯化或仅 EPA 品牌，这对我来说没有多大意义。
So I would say we can still count or do the numbering based on about 1,000 milligrams of EPA, but don't worry that you're getting about 300, 400 milligrams of DHA, and probably that's better for you.
所以我想说，我们仍然可以根据大约 1,000 毫克的 EPA 来计算或编号，但不用担心您会获得大约 300、400 毫克的 DHA，这可能对您来说更好。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to take a quick break and acknowledge one of our sponsors, Matina.
我想稍微休息一下，并向我们的赞助商之一马蒂娜表示感谢。
Matina makes loose leaf and ready-to-drink yerba mate.
Matina 生产活叶和即饮马黛茶。
Now, I've often discussed yerba mate's benefits, such as regulating blood sugar, its high antioxidant content, the ways it can improve digestion, and its possible neuroprotective effects.
现在，我经常讨论马黛茶的好处，例如调节血糖、其高抗氧化剂含量、改善消化的方式以及可能的神经保护作用。
It's for all those reasons that yerba mate is my preferred source of caffeine.
出于所有这些原因，马黛茶是我首选的咖啡因来源。
I also drink yerba mate because I simply love the taste.
我也喝马黛茶，因为我就是喜欢它的味道。
And while there are a lot of different choices out there of yerba mate drinks, my personal favorite far and away is Matina.
虽然马黛茶饮料有很多不同的选择，但我个人最喜欢的是 Matina。
It's made of the highest quality ingredients, which gives it a really rich but also a really clean taste, so none of that tannic aftertaste.
它采用最优质的原料制成，味道非常浓郁，但味道也非常干净，所以没有单宁的余味。
In fact, given how absolutely amazing Matina tastes and their commitment to quality, I decided to become a part owner in the company last year.
事实上，鉴于 Matina 的品味绝对令人惊叹以及他们对质量的承诺，我去年决定成为该公司的股东。
In particular, I love the taste of Matina's canned zero sugar cold brew yerba mate, which I personally helped develop.
我特别喜欢马蒂纳罐装零糖冷萃马黛茶的味道，这是我亲自帮助开发的。
I drink at least three cans of those a day now.
我现在每天至少喝三罐。
I also love their loose leaf Matina, which I drink every morning from the gourd.
我也喜欢他们的散叶马蒂娜，我每天早上从葫芦里喝。
So I add hot water and sip on that thing, and I'll have some cold brews throughout the morning and early afternoon.
所以我加了热水，喝了一口，整个早上和下午早些时候我都会喝一些冷萃咖啡。
I find it gives me terrific energy all day long, and I'm able to fall asleep perfectly well at night, no problems.
我发现它一整天都给我带来巨大的能量，而且我晚上能够睡得很好，没有任何问题。
If you'd like to try Matina, you can go to drinkmatina.com/huberman.
如果您想尝试 Matina，可以访问 Drinkmatina.com/huberman。
Right now, Matina is offering a free one-pound bag of loose leaf yerba mate tea and free shipping with the purchase of two cases of their cold brew yerba mate.
目前，Matina 提供一袋免费的一磅散叶马黛茶，购买两箱冷泡马黛茶可免运费。
Again, that's drinkmatina.com/huberman to get a free bag of yerba mate loose leaf tea and free shipping.
再次强调，访问 Drinkmatina.com/huberman 可免费获得一袋马黛茶散叶茶并免运费。
You're one of the first people that I ever heard discuss the gut microbiome and ADHD.
你是我听到的第一批讨论肠道微生物组和多动症的人之一。
This is me giving you credit for being way ahead of your time.
这是我对你远远领先于时代的赞扬。
I don't know how you are at receiving praise, especially on camera and with microphones, but I just want to say that it was over a decade ago that I heard from you about EPA and fish oil for depression and other things, about circadian rhythms, an area that I'm familiar with, and just the critical importance of circadian health for everything that we're talking about today and more, and on and on.
我不知道你如何接受赞扬，尤其是在镜头和麦克风上，但我只想说，十多年前，我从你那里听到关于EPA和鱼油治疗抑郁症等的事情，关于昼夜节律，这是我熟悉的领域，以及昼夜节律健康对于我们今天讨论的一切以及更多内容的至关重要性。
And so, again, thank you for raising these points, even if they turn out to be minor effects.
因此，再次感谢您提出这些观点，即使它们最终证明只是轻微的影响。
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
I think nowadays we hear about the gut microbiome.
我想现在我们听说过肠道微生物组。
I may have actually heard the words gut microbiome first from you.
我实际上可能首先从你那里听到了“肠道微生物组”这个词。
Gosh, yeah, that would be well over almost 20 years ago.
天哪，是的，那已经是二十多年前的事了。
Remarkable.
卓越。
So gut microbiome, what do we know about the gut microbiome and supporting it in ADHD?
那么肠道微生物组，我们对肠道微生物组及其在 ADHD 中的支持作用了解多少？
Dr. John Kruse:
约翰·克鲁斯博士：
I'm going to kind of pass on that by just saying it's complicated and probably important and so many variables that it's hard to know what's really valuable in a day-to-day real human living perspective.
我想转述一下这一点，只是说它很复杂，而且可能很重要，而且变量如此之多，以至于很难知道从日常生活的真实人类生活角度来看什么是真正有价值的。
Andrew Huberman:
安德鲁·休伯曼：
Do you do anything to support your gut microbiome?
您是否采取任何措施来支持您的肠道微生物组？
Just with your knowledge of the relationship between gut and mental health, does it impact your behavior at all in terms of choices?
仅凭您对肠道与心理健康之间关系的了解，它是否会影响您在选择方面的行为？
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah, only to the extent of trying to have a varied diet and eating at somewhat regular intervals, but not more specifically.
是的，只是尝试多样化的饮食和定期进食，但没有更具体的。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
If that's where we're at, well, that's where we're at.
如果这就是我们所处的位置，那么，那就是我们所处的位置。
Before we go back to some drugs, I wanted to ask about behavioral tools for ADHD.
在我们回到一些药物之前，我想问一下治疗多动症的行为工具。
I've seen some of the literature claiming that certain video games might actually be useful for training focus.
我看过一些文献声称某些视频游戏实际上可能有助于训练注意力。
I've managed to find a few papers that talk about focus and meditation tasks that kids in particular-
我设法找到了几篇关于专注力和冥想任务的论文，尤其是孩子们——
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
but adults may be able to get better at.
但成年人也许能够做得更好。
Are any of these brain-training games to get people better at focusing, are any of them known to be worthwhile according to real data or clinical observation?
这些大脑训练游戏是否可以让人们更好地集中注意力？根据真实数据或临床观察，这些游戏是否值得？
Dr. John Kruse:
约翰·克鲁斯博士：
So I'll start first by stepping back a little bit and broadening it.
因此，我将首先退一步并扩大范围。
I'll get to the video game things.
我会谈谈视频游戏的事情。
But one of the effective approaches that helps with symptomatic reduction with ADHD is cognitive behavioral therapy.
但有助于减轻多动症症状的有效方法之一是认知行为疗法。
So that's a form of talking therapy, and my quick overview of it is that it focuses on actions, thoughts, and feelings, and that humans can have direct control of their actions and thoughts, not too much over their feelings, but all three are affecting each other.
这是谈话疗法的一种形式，我对它的快速概述是，它侧重于行动、思想和感受，人类可以直接控制自己的行为和思想，而不是过多地控制自己的感受，但这三者都是相互影响的。
And the traditional CBT was developed by Aaron Beck to treat depression probably 50 years ago.
传统的 CBT 大约是 50 年前由 Aaron Beck 发明的，用于治疗抑郁症。
Maybe longer, '60s, I think, late '60s.
也许更长，60 年代，我想，60 年代后期。
Anyway, on the surface, it's a horrible match for ADHD because we know it requires lots of repetitive, boring homework, doing the same thing over.
不管怎样，从表面上看，这对于多动症来说是一个可怕的匹配，因为我们知道它需要大量重复、无聊的作业，重复做同样的事情。
It involves introspection of being aware of what you're doing already, looking at those patterns, looking at what the triggers, to see if you can see triggers for them, and then doing lots and lots of repetitive homework.
它涉及内省，了解你已经在做什么，查看这些模式，查看触发因素，看看你是否可以看到它们的触发因素，然后做很多很多重复的作业。
And when it's successful for depression or PTSD or other venues, we know it actually changes brain wiring and brain chemistry.
当它成功治疗抑郁症、创伤后应激障碍或其他疾病时，我们知道它实际上会改变大脑线路和大脑化学物质。
So lots of people still think talking therapies are sort of up here doing something, and chemicals and medications are really changing the brain.
因此，很多人仍然认为谈话疗法只是在做一些事情，而化学物质和药物确实在改变大脑。
If your thoughts are changing, if your behavior's changing, your brain has changed.
如果你的想法在改变，如果你的行为在改变，你的大脑就会改变。
That's the only place that thoughts and behaviors come from.
这是思想和行为的唯一来源。
But there have been at least two groups, Mary Solanto's in New York and a Harvard group by, I'm blanking on his first, Safran, and some other, Ramsey at Pennsylvania, developed approaches using CBT techniques specifically designed for people with ADHD to help overcome some of those hurdles and barriers.
但至少有两个小组，纽约的玛丽·索兰托（Mary Solanto）小组和哈佛小组（我对他的第一个小组是空白的），萨夫兰（Safran）和宾夕法尼亚州的拉姆齐（Ramsey）的其他小组开发了使用专为多动症患者设计的 CBT 技术的方法，以帮助克服其中一些障碍和障碍。
And both of them encourage actually the use of medications in combination with it, because many people with ADHD are too unfocused, too unable to sit down and do it.
他们俩实际上都鼓励结合使用药物，因为许多患有多动症的人注意力不集中，无法坐下来这样做。
But these are approaches, and both approaches are amazingly similar, although devised completely independently.
但这些都是方法，尽管完全独立设计，但两种方法惊人地相似。
At the core of both of those approaches is having a system of scheduling each day.
这两种方法的核心都是建立一个每天的日程安排系统。
That doesn't mean micromanaging each minute, but it's having the essentials in place, having blocks of time that you know what you're going to do, and having a task list in combination with that, and ways of learning to prioritize and move things up or down.
这并不意味着每一分钟都要进行微观管理，而是要具备必要的要素，有明确的时间段让你知道自己要做什么，并有一个与之相结合的任务列表，以及学习确定优先级和上下移动事情的方法。
And again, with ADHD being interest-driven rather than importance-driven, you may have a task-- You probably have 17 task lists.
再说一次，由于 ADHD 是兴趣驱动的而不是重要性驱动的，你可能有一个任务——你可能有 17 个任务列表。
One's to do your coffee, one's at the grocery store.
一个是去煮咖啡，一个是去杂货店。
One, it's having one consolidated list, because if it's everywhere, then it's nowhere.
第一，它有一个综合列表，因为如果它无处不在，那么它就无处可去。
And two is the simplest triaging or organizing approach is having the things that are both urgent and important.
第二个最简单的分类或组织方法是处理既紧急又重要的事情。
So, if they have to happen today, those get in the A category.
因此，如果它们今天必须发生，那么它们就属于 A 类。
The things that are important but aren't as urgent are the B category, and all the other things are the C.
重要但不那么紧急的事情是 B 类，所有其他事情都是 C 类。
And one of the temptations that people with ADHD have is, "It's fun to go buy shoelaces, and that's on my list, so I'll go to buy shoelaces because then I can cross something off my list." But I didn't move the car, I didn't do my taxes, I haven't done my homework, and all the important things remain undone.
患有多动症的人面临的诱惑之一是，“去买鞋带很有趣，这在我的清单上，所以我会去买鞋带，因为这样我就可以从清单上划掉一些东西。”但我没有动车，没有报税，没有做作业，所有重要的事情都还没有完成。
So it's a system for getting done what's really needed to be done.
所以这是一个完成真正需要做的事情的系统。
And eventually, if your shoes don't work, the shoelaces will move up to that A category.
最终，如果你的鞋子不起作用，鞋带就会升级到 A 类。
But for most people, they're not really there, and it's not a good use of your time to do them first.
但对于大多数人来说，这些事情并不真正存在，而且先做这些事情并不是一个很好的利用时间的方法。
And there's much more to it so that CBT approach can work with decreasing procrastination.
CBT 方法还可以帮助减少拖延症。
It can help with structuring your own workspace, given that you probably have much more trouble doing that and not doing it spontaneously.
它可以帮助您构建自己的工作空间，因为您可能会在这样做而不是自发地这样做时遇到更多困难。
It's how to eliminate distractions and modules on even extending your concentration time.
这是如何消除干扰和模块，甚至延长你的注意力时间。
So the answer with the video games, there is one product that's actually been FDA-approved for use in ADHD, and the really important thing to remember there is the FDA's system for addressing medications is much more rigorous, much more thorough.
因此，视频游戏的答案是，有一种产品实际上已获得 FDA 批准用于治疗多动症，真正重要的是要记住 FDA 处理药物的系统更加严格、更加彻底。
You have to demonstrate it really works and does something.
你必须证明它确实有效并且确实有所作为。
When the FDA approves devices, basically, they're saying it's not going to kill anyone, it might help.
当 FDA 批准设备时，基本上，他们说它不会杀死任何人，它可能会有所帮助。
I mean, it might help tremendously, but having the FDA imprimatur for that doesn't guarantee that or mean that at all.
我的意思是，这可能会有很大帮助，但获得 FDA 认可并不能保证这一点，也不能保证这一点。
Andrew Huberman:
安德鲁·休伯曼：
Do you recall if the study of that device, or the study of that video game has a conflict of interest?
您还记得对该设备的研究或对该视频游戏的研究是否存在利益冲突吗？
Was it run by the company?
是公司经营的吗？
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Okay.
好的。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
So almost all of them have been run by the company.
所以几乎全部都是由公司经营的。
It's good people at UCSF who are at least partly involved in it.
加州大学旧金山分校的优秀人才至少部分参与了其中。
Andrew Huberman:
安德鲁·休伯曼：
Oh, is this Adam Gazzaley's group?
哦，这是 Adam Gazzaley 的团队吗？
Dr. John Kruse:
约翰·克鲁斯博士：
I think so.
我想是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I should just say that I've followed his work for some years.
我应该说我已经关注他的工作很多年了。
He's a neuroscientist.
他是一位神经科学家。
I know people who have been in his lab.
我认识去过他实验室的人。
He's known for doing very high quality and stringent work.
他以高质量和严格的工作而闻名。
Dr. John Kruse:
约翰·克鲁斯博士：
Their product and some of the others can clearly show you get better at their product, and you get better at tests that look exactly like their product.
他们的产品和其他一些产品可以清楚地表明您在他们的产品上变得更好，并且您在与他们的产品完全相同的测试中变得更好。
But in terms of real world, how much is this really helping ADHD symptoms on a day-to-day basis?
但就现实世界而言，这对日常多动症症状真正有多大帮助？
Not a lot of data at all.
根本没有很多数据。
So again, that doesn't mean it doesn't work.
再说一次，这并不意味着它不起作用。
And I'm going to go sideways in talking about neurofeedback, because there's lots and lots of neurofeedback companies across the country that are making lots and lots of money.
我要从侧面谈谈神经反馈，因为全国各地有很多很多的神经反馈公司正在赚很多很多钱。
And there was an article in the "American Journal of Psychiatry" in the last year.
去年《美国精神病学杂志》上有一篇文章。
I'm not remembering which group did it.
我不记得是哪个小组做的了。
And it was another failure to find a significant impact from neurofeedback.
这又是一次未能发现神经反馈产生重大影响的失败。
And again, I'm not saying it doesn't have an effect, but I've had lots of people writing me, "Should I keep spending hundreds of dollars each week because my insurance isn't covering this?" And the doctor is saying, "Oh, maybe 20 more episodes will retrain your brain." So this gets back to a topic you brought up earlier, how much are we retraining our brains with immersion in social media?
再说一次，我并不是说它没有效果，但有很多人写信给我，“我应该继续每周花费数百美元，因为我的保险不承保这个费用吗？”医生说：“哦，也许再看 20 集就能重新训练你的大脑。”那么这又回到了你之前提到的一个话题，我们在多大程度上通过沉浸在社交媒体中来重新训练我们的大脑？
And the evidence is we are rewiring our brains.
证据是我们正在重新连接我们的大脑。
So maybe anything pushing in an opposite direction, or maybe this is reinforcing some of the bad things we don't want.
因此，也许有任何事情朝相反的方向推进，或者这可能会强化一些我们不想要的坏事情。
We're in a messy world without clear answers yet.
我们正处于一个混乱的世界，还没有明确的答案。
Andrew Huberman:
安德鲁·休伯曼：
I've made it a point to put social media on an old phone.
我特别强调要在旧手机上安装社交媒体。
So those apps are only on that phone.
所以这些应用程序只能在该手机上使用。
I don't even know the number to that phone.
我什至不知道那个电话号码。
If I need to post something, I AirDrop it onto that phone, and this has helped tremendously in segregating that activity and limiting it.
如果我需要发布某些内容，我会将其通过 AirDrop 发送到该手机上，这对于隔离并限制该活动有很大帮助。
It also means that if people send me something, which would otherwise direct me to social media, it's much more difficult for me to go look it up.
这也意味着，如果人们给我发送一些东西，否则我会被引导到社交媒体，那么我去查找它就会变得更加困难。
It's helped tremendously.
这有很大帮助。
I just pass that on because it's one of the things that's really allowed me to restrict my social media time, and yet still be in keeping with the fact that I think social media has its uses, I post there, et cetera.
我只是传递这一点，因为它是真正允许我限制我的社交媒体时间的事情之一，但仍然符合我认为社交媒体有其用途的事实，我在那里发帖，等等。
Dr. John Kruse:
约翰·克鲁斯博士：
Yes.
是的。
So getting back to the scheduling, what I recommend to people, and one of my weak-- I don't know the specific apps, but there are apps that will help shut you out of Facebook or Discord or TikTok or whatever it is.
回到日程安排，我向人们推荐的内容，也是我的弱点之一——我不知道具体的应用程序，但有些应用程序可以帮助你远离 Facebook、Discord、TikTok 或其他任何东西。
If you can't exert your own willpower, which again, is harder to do if you have ADHD, and if the app approach doesn't work, the next level up is there are All sorts of companies making lockboxes and physical devices where you can lock yourself out of your device for certain hours of the day, and I think that's a good idea for lots of people.
如果你不能发挥自己的意志力，如果你患有注意力缺陷多动症，这就更难做到，如果应用程序方法不起作用，那么下一个层次就是有各种各样的公司制造密码箱和物理设备，你可以在一天中的某些时间将自己锁在设备之外，我认为这对很多人来说是个好主意。
Andrew Huberman:
安德鲁·休伯曼：
I do too, and I think it also helps, at least in my experience, to do things that are very different than social media as well, but still consuming content.
我也是这样做的，而且我认为至少以我的经验来看，做一些与社交媒体非常不同但仍然消费内容的事情也很有帮助。
So I make it a point to read from an actual physical book a bit each day or night.
因此，我每天晚上都会读一点实体书。
Also because I was raised doing that and writing by hand is just sort of in keeping with the way that my brain was wired.
也因为我从小就是这样做的，而手写正好符合我大脑的连接方式。
So maybe that's more specific to me and my generation.
所以也许这对我和我这一代人来说更具体。
But I find that when I'm doing those other activities, when I go onto social media, it feels more like a departure from the rest of life-
但我发现，当我做其他活动时，当我上社交媒体时，感觉更像是与生活的其他部分背道而驰——
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
as opposed to the other way around.
而不是相反。
But in any event-
但无论如何——
Dr. John Kruse:
约翰·克鲁斯博士：
That's a good sign for preserving
这是保存的好兆头
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I'd like to talk about some compounds that are not so typical.
我想谈谈一些不那么典型的化合物。
Meaning, some people may have heard of these, but most people probably haven't, and they are somewhat novel to me.
意思是，有些人可能听说过这些，但大多数人可能没有，而且对我来说有些新奇。
The first one is guanfacine.
第一个是胍法辛。
What is guanfacine, and why is it sometimes used for ADHD?
什么是胍法辛？为什么它有时用于治疗多动症？
Dr. John Kruse:
约翰·克鲁斯博士：
So guanfacine and a related drug called clonidine, which can be confused with Klonopin and others.
因此，胍法辛和一种称为可乐定的相关药物可能会与可乐平等药物混淆。
So clonidine and guanfacine are both alpha-2 agonists, so they work on a subset of the norepinephrine system.
因此可乐定和胍法辛都是 α-2 激动剂，因此它们作用于去甲肾上腺素系统的一个子集。
They're both originally antihypertensive for lowering blood pressure.
它们最初都是用于降低血压的抗高血压药物。
And it was actually studies first in clonidine that suggested this could be helpful with people with ADHD, and I think it was just a serendipitous initial discovery.
实际上，首先对可乐定的研究表明这可能对多动症患者有帮助，我认为这只是一个偶然的初步发现。
It wasn't seeking out its mode of action to see if that really worked.
它并不是在寻找其行动模式来看看是否真的有效。
One difference between the two of them is clonidine jumps off the norepinephrine alpha-2 receptor really quickly, and for people who skip a dose for their blood pressure medication or stop abruptly, it's not uncommon to have rebound hypertension, and not just mild, but way higher than what you're being originally treated for, to dangerous levels.
两者之间的一个区别是可乐定会很快脱离去甲肾上腺素 α-2 受体，对于跳过一剂降血压药物或突然停药的人来说，高血压反弹并不罕见，而且不仅仅是轻微的，而是远远高于您最初接受治疗的水平，达到危险水平。
Guanfacine leaves the receptors more slowly, and there have been formal studies trying to see if this is a problem or issue there.
胍法辛离开受体的速度较慢，并且已经有正式研究试图确定这是否是一个问题或问题。
And particularly given that people with ADHD forget their medication or run out and don't fill it in time or just don't remember to take it, the rebound hypertension does not seem to be nearly as common with guanfacine, and that's part of why the research has moved more towards the guanfacine.
特别是考虑到患有多动症的人忘记服药或用完药物而没有及时服药或只是不记得服药，反弹性高血压似乎在使用胍法辛时并不常见，这就是为什么研究更多地转向胍法辛的部分原因。
So there's extensive work by, I'm going to blank on her last-- Amy Arden?
所以有大量的工作，我要在她的最后一个上空白——艾米·阿登（Amy Arden）？
She's at Yale.
她在耶鲁大学。
Andrew Huberman:
安德鲁·休伯曼：
Oh, Arnsten.
哦，阿恩斯坦。
Dr. John Kruse:
约翰·克鲁斯博士：
Arnsten.
阿恩斯滕.
Thank you.
谢谢。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
And her lab and related labs have shown that guanfacine's effects seem to deal with strengthening synaptic connections in prefrontal circuitry.
她的实验室和相关实验室已经表明，胍法辛的作用似乎可以增强前额叶回路中的突触连接。
So unlike most of our drugs which are just boosting norepinephrine and/or dopamine and work quickly, and I'll throw in this because we didn't really touch this, most of the ADHD experts still say stimulants, amphetamine, and Ritalin work quickly, immediately because they boost dopamine right away.
因此，与我们的大多数药物不同，它们只是增加去甲肾上腺素和/或多巴胺并快速起效，我会加上这一点，因为我们没有真正接触过这一点，大多数多动症专家仍然说兴奋剂、安非他明和利他林很快、立即起效，因为它们立即增加多巴胺。
And are drugs like Strattera, which is atomoxetine, or Cymbalta or Wellbutrin work slowly for ADHD because they're antidepressants, and antidepressants work slowly.
像 Strattera（阿托莫西汀）、Cymbalta 或 Wellbutrin 这样的药物治疗多动症的效果很慢，因为它们是抗抑郁药，而抗抑郁药起效很慢。
There's still people saying this, and for 25 years, I've been saying, "This is just wrong from, one, a basic neuroscience point of view, and wrong from don't you ever talk or listen to patients." So neuroscience view, how quickly does dopamine reuptake get blocked by Wellbutrin or by atomoxetine, Strattera, or by Cymbalta within minutes to hours of taking it?
仍然有人这么说，25 年来，我一直在说，“从基本神经科学的角度来看，这是错误的，而且从不与病人交谈或倾听病人的意见来看，这是错误的。”因此，神经科学认为，在服用维布特林、阿托莫西汀、Strattera 或 Cymbalta 后的几分钟到几小时内，多巴胺再摄取被阻断的速度有多快？
So you would expect if you're boosting norepinephrine or dopamine availability right away, you should see effects right away.
因此，如果您立即提高去甲肾上腺素或多巴胺的可用性，您应该会立即看到效果。
And if you ask patients who these drugs work for, and they don't work for anybody, all the ones I've worked with say, "It worked just like a stimulant.
如果你问病人这些药物对谁有效，而它们对任何人都不起作用，所有与我一起工作过的人都会说：“它就像兴奋剂一样起作用。
I could tell.
我看得出来。
I took it, and I walked out of your office." And one guy I have who loves Cymbalta said, "I took it in your office, and I wasn't sure it was working, and I got downtown to work 15, 20, maybe a half hour later, and there was this guy coming at me on a skateboard on the sidewalk.
我拿着它，走出了你的办公室。”我认识的一个喜欢 Cymbalta 的人说：“我在你的办公室拿了它，我不确定它是否有效，然后我在 15 点、20 点、也许半小时后到市中心工作，有人在人行道上踩着滑板向我走来。
And I know in my normal ADD state, I would have just been flooded and not be able to process, and I could just step out of the way." So it worked that quickly and dramatically.
我知道，在我正常的ADD状态下，我会被淹没而无法处理，我可以走开。”所以它的效果如此迅速和显着。
So that's the aside.
这就是旁白。
So jumping back, guanfacine seems to work slowly, so the synaptic strengthening building, and it seems to be the alpha-2 receptors that are on neurons that receive glutamate as their primary input.
回过头来看，胍法辛似乎发挥作用很慢，所以突触强化的建立，似乎是神经元上接收谷氨酸作为主要输入的 α-2 受体。
The alpha-2 receptor is modulating how glutamate is actually working, and it's actually the NMDA glutamate receptors, not the more common in the brain AMPA glutamate receptors.
α-2 受体正在调节谷氨酸的实际工作方式，它实际上是 NMDA 谷氨酸受体，而不是大脑中更常见的 AMPA 谷氨酸受体。
Andrew Huberman:
安德鲁·休伯曼：
No, that's an important point.
不，这是很重要的一点。
I'll just quickly throw in, if I may, that the NMDA, the N-methyl-D-aspartate glutamate receptors, are the ones that typically are associated with synaptic plasticity.
如果可以的话，我会快速指出 NMDA（N-甲基-D-天冬氨酸谷氨酸受体）通常与突触可塑性相关。
Although, the AMPA receptors can do that, too.
不过，AMPA 受体也可以做到这一点。
But what Dr. Kruse is referring to is the fact that guanfacine indirectly modulates those pathways, so the longer duration to get the effect, it sounds like could be at least partially explained by a real change in neural wiring as opposed to with, you used Cymbalta and Wellbutrin as examples of fast changes in neurotransmitters and neuromodulators that led to this very quick effect in this patient that left your office, got downtown, and was already experiencing effect.
但 Kruse 博士指的是胍法辛间接调节这些通路的事实，因此获得效果的持续时间较长，听起来至少可以部分地通过神经线路的真正变化来解释，而不是你用 Cymbalta 和 Wellbutrin 作为神经递质和神经调节剂快速变化的例子，导致这位离开你的办公室、到市中心并已经体验到效果的患者迅速产生效果。
Put differently, sounds like guanfacine and clonidine Not to be confused with Klonopin.
换句话说，听起来像胍法辛和可乐定，不要与 Klonopin 混淆。
Clonidine could help ADHD, but might take longer for the effects to manifest than the other drugs that-
可乐定可以帮助治疗多动症，但与其他药物相比，效果可能需要更长的时间才能显现出来：
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
we typically hear about.
我们通常听说过。
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah.
是的。
So most often it takes two, three, four weeks.
所以大多数情况下需要两、三、四个星期。
With the stimulants, you see effects right away.
使用兴奋剂，您会立即看到效果。
It's reinforcing and stimulants often, in addition to having effects on concentration, attention, do boost energy for most people, do boost mood for most people.
它通常是增强剂和兴奋剂，除了对集中力、注意力有影响外，还可以为大多数人增强能量，为大多数人增强情绪。
Andrew Huberman:
安德鲁·休伯曼：
And can improve sleep if they're not taken too close to sleep, yeah.
如果他们不离睡觉太近的话，可以改善睡眠，是的。
Dr. John Kruse:
约翰·克鲁斯博士：
Guanfacine's most common side effect tends to be sedating, so most people take it at nighttime, which is, why are you taking a sedating nighttime medication for your ADHD?
胍法辛最常见的副作用是镇静作用，因此大多数人在夜间服用，也就是说，为什么您要服用夜间镇静药物来治疗多动症？
It's because it helps, it works slowly, indirectly.
因为它有帮助，它的作用缓慢，间接。
So Intuniv, the brand name extended-release guanfacine, was approved in kids, because again, most of the research on ADHD is still on kids, for treating ADHD as a solo agent.
因此，缓释胍法辛品牌 Intuniv 被批准用于儿童，因为大多数关于 ADHD 的研究仍然针对儿童，作为治疗 ADHD 的单一药物。
It clearly works in adults as well, and even before Intuniv was approved, there were a handful of studies with either immediate-release guanfacine or extended-release guanfacine.
它显然也适用于成人，甚至在 Intuniv 获得批准之前，就有一些关于速释胍法辛或缓释胍法辛的研究。
In the studies so far, the results aren't distinguishable.
迄今为止的研究中，结果还无法区分。
They both seem to work.
他们似乎都工作。
So clinically, because it's much cheaper, I actually use immediately release form and all at bedtime.
所以在临床上，因为它便宜得多，我实际上使用立即释放形式并且全部在睡前使用。
And again, because it's my impression, and I probably don't have an N that's big enough to do a rigorous study, is the sedating effects are relegated to the nighttime and people are feeling okay during the daytime.
再说一次，因为这是我的印象，而且我可能没有足够大的 N 来进行严格的研究，镇静作用被降级到夜间，人们在白天感觉良好。
Some of the rationale with the extended release is you're sort of smearing it over a longer time, so it should be less sedating.
延长释放的一些理由是你涂抹它的时间较长，所以它的镇静作用应该较少。
But depending on the time curve and how it works, you could actually wind up with being more uniformly sedated day and night with the extended release.
但根据时间曲线及其工作原理，通过延长释放时间，您实际上可能会在白天和晚上得到更均匀的镇静效果。
So I've seen good results in some people.
所以我在一些人身上看到了很好的结果。
I've had many who either didn't work or they didn't perceive result, because again, some part for some people, the stimulant benefit is, "I can feel it.
我有很多人要么没有工作，要么没有意识到结果，因为对于某些人来说，刺激性的好处是，“我能感觉到它。
I know it's working." So the majority, at least in terms of prescription searches and what clinics tend to be, it looks like most people who are on guanfacine are on it in combination with either a stimulant or a norepinephrine or dopamine-promoting agent.
我知道它正在发挥作用。”因此，大多数人，至少在处方搜索和诊所往往是什么方面，看起来大多数服用胍法辛的人都将其与兴奋剂、去甲肾上腺素或多巴胺促进剂结合使用。
Andrew Huberman:
安德鲁·休伯曼：
Let's talk about modafinil and armodafinil by extension.
让我们进一步谈谈莫达非尼和阿莫达非尼。
We hear about modafinil a lot in communities like the tech community and communities where people are trying to, quote-unquote, "cognitively enhance." What is modafinil?
我们在科技社区和人们试图“增强认知”的社区中经常听到莫达非尼。什么是莫达非尼？
What does it do?
它有什么作用？
What doesn't it do?
它没有什么作用？
How might it be useful for ADHD?
它对多动症有何用处？
Dr. John Kruse:
约翰·克鲁斯博士：
So we're going to jump back to your issue with the recency in science and how to incorporate things.
因此，我们将回到您的问题，即科学的最新进展以及如何整合事物。
So modafinil was a drug developed by a French company and approved there and used for decades, for maybe a decade before it came to the US 25, maybe 35 years ago.
所以莫达非尼是一种由一家法国公司开发的药物，在法国获得批准并使用了几十年，也许是十年，然后它在 25 甚至 35 年前进入美国。
And at the time, all the research showed that it was an orexin receptor antagonist.
而当时所有的研究都表明它是一种食欲素受体拮抗剂。
Right, antagonist/agonist works on the orexins.
是的，拮抗剂/激动剂作用于食欲素。
Andrew Huberman:
安德鲁·休伯曼：
The hypocretin/orexin system, right.
下丘脑分泌素/食欲素系统，对。
Yeah.
是的。
Dr. John Kruse:
约翰·克鲁斯博士：
So boosting activity, but not working like all of our stimulant alerting drugs, which are working on primarily norepinephrine systems.
因此可以促进活动，但不像我们所有的兴奋剂警报药物那样起作用，这些药物主要作用于去甲肾上腺素系统。
So it was called the non-stimulant stimulant.
因此被称为非兴奋剂兴奋剂。
Now most of the pharmacology literature refers to it as a dopamine acting drug, and some people are debating whether it's orexin that it's working via or dopamine.
现在大多数药理学文献都将其称为多巴胺作用药物，有些人正在争论它是通过食欲素还是通过多巴胺起作用。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. John Kruse:
约翰·克鲁斯博士：
I haven't seen anything that to me gives a clear consensus.
我还没有看到任何对我来说给出明确共识的东西。
So I stick with the orexin because that's where I was taught.
所以我坚持使用食欲素，因为那是我被教导的。
So orexin, getting back to the sleep-wake in the brain and arousal, as I describe it, there's two ways to wake up in the morning.
因此，食欲素，回到大脑中的睡眠觉醒和唤醒，正如我所描述的，早上有两种醒来的方式。
One way is the normal way that you just wake up, and the other is being alarmed by an alarm clock, your neighbor starting their lawnmower, someone snoring, an earthquake if you're in LA or Hawaii, being startled out of sleep.
一种是你刚刚醒来的正常方式，另一种是被闹钟叫醒、你的邻居启动割草机、有人打鼾、地震（如果你在洛杉矶或夏威夷）、从睡梦中惊醒。
That wakefulness system is the sympathetic nervous system.
那个觉醒系统就是交感神经系统。
The orexin system is the more natural, normal waking system, and it isn't arousing you.
食欲素系统是更自然、更正常的清醒系统，它不会唤醒你。
It's waking you, but it's not agitating you.
它会叫醒你，但不会让你不安。
Again, the claims originally was that this is how modafinil worked.
同样，最初的说法是莫达非尼就是这样起作用的。
It was waking you up, but not over-stimulating, over-revving you.
它会叫醒你，但不会过度刺激、让你过度兴奋。
So other than being developed by this French company, the entity that spent most research funds looking into what this does or doesn't do was the US military because they have a big investment in wanting people to be alert and ready to kill 24/7, but not being hyperactive, trigger-happy, jittery like stimulants can do.
因此，除了这家法国公司开发的产品之外，花费大部分研究资金来研究它能做什么或不能做什么的实体是美国军方，因为他们投入了大量资金，希望人们保持警惕并做好24/7全天候杀戮的准备，但又不像兴奋剂那样过度活跃、好动、紧张。
And particularly in the early days, this is really dating me, of the Afghan War, we dropped bombs on Canadian troops by accident in our friendly fire scenario things, and the investigation, the pilot and the crew there blamed their trigger happiness on being revved up by methylphenidate.
特别是在早期，这真的是我的约会，阿富汗战争，我们在友军交火场景中意外向加拿大军队投掷了炸弹，调查后，飞行员和机组人员将他们触发的快乐归咎于哌醋甲酯的刺激。
So for years, the military has relied on traditional stimulants to keep people able to fight around the clock, and they wanted an agent that would keep you alert, awake, but not revved up, not agitated.
因此，多年来，军方一直依靠传统的兴奋剂来让人们能够全天候作战，他们想要一种能够让你保持警觉、清醒，但不兴奋、不焦躁的药剂。
And I'd say there's some good evidence that that's really sort of how modafinil works or performs.
我想说，有一些充分的证据表明，这确实是莫达非尼的作用或表现。
So modafinil was called Provigil for pro-vigilance, and then when they were losing their US patent- Like many drugs, the Provigil is a racemic mixture of left-handed and right-handed versions of the same modafinil molecule.
因此，莫达非尼被称为 Provigil，以提高警惕，然后当他们失去美国专利时 - 与许多药物一样，Provigil 是同一莫达非尼分子的左旋和右旋版本的外消旋混合物。
They found that the armodafinil, the right-handed version, was the one that's doing most of the good stuff and has a longer half-life than the combined version.
他们发现阿莫达非尼（右手版本）发挥了大部分作用，并且比组合版本的半衰期更长。
So they got a new patent for armodafinil, which is Nuvigil.
于是他们获得了armodafinil的新专利，也就是Nuvigil。
So that's the only difference between the two.
所以这是两者之间的唯一区别。
They're the same active ingredients as far as we can tell.
据我们所知，它们的活性成分相同。
And when it got approval in the US, it was approved for narcolepsy, where people are falling abruptly asleep during the day, so it keeps them alert and awake there.
当它在美国获得批准时，它被批准用于治疗嗜睡症，即人们在白天突然入睡，因此它可以让他们保持警觉和清醒。
It also got approval for circadian sleep shift work disorder, where because you're on a shift schedule, you're sleeping weirdly.
它还获得了治疗昼夜节律睡眠轮班工作障碍的批准，因为你在轮班时间表上，所以你的睡眠很奇怪。
And it got approval for daytime sleepiness from sleep apnea.
它还获得了治疗睡眠呼吸暂停引起的白天嗜睡的批准。
But even at that time when it was approved, there were dozens of studies that showed, regardless of why you're sleepy, whether it was sedating medication, whether you had lupus or MS, whether you had some other condition, it works pretty well for keeping people alert and awake.
但即使在它被批准的时候，仍有数十项研究表明，无论你为什么困，是否服用镇静药物，是否患有狼疮或多发性硬化症，无论你是否患有其他疾病，它对于保持人们的警觉和清醒都非常有效。
So more than keeping alert and awake, there does seem to be evidence that it helps with some of the executive functions of attention, concentration.
因此，似乎有证据表明，它不仅有助于保持警觉和清醒，还有助于提高注意力和专注力等执行功能。
My clinical experience with it, it tends to be, again, with the amphetamine on top, many fewer people describe it as being helpful or as helpful.
根据我的临床经验，它往往是再次使用安非他明，很少有人将其描述为有帮助或有帮助。
On the other hand, there's one study, and I'm forgetting the principal investigators, it was at Brown University, where they used some very clever, sophisticated approach to try to sort out motivation versus pure cognitive functioning.
另一方面，有一项研究，我忘记了主要研究人员，它是在布朗大学进行的，他们使用了一些非常聪明、复杂的方法来试图区分动机与纯粹的认知功能。
And their claim, and it was a very well-done study, they were comparing it directly to an amphetamine product.
他们声称，这是一项非常出色的研究，他们将其直接与安非他明产品进行比较。
Their claim was that modafinil was the one that was actually boosting cognitive functions and not just boosting motivation, whereas that most of amphetamine's benefit for ADHD, when we say, "It helps me concentrate, it helps me sustain focus, it makes me less distracted," their feeling, their analysis was that the stimulant was mostly working on motivation.
他们声称，莫达非尼实际上可以增强认知功能，而不仅仅是增强动力，而安非他明对注意力缺陷多动症的大部分益处，当我们说“它帮助我集中注意力，它帮助我保持注意力，它让我不那么分心”时，他们的感觉和分析是，兴奋剂主要对动机起作用。
It's a controlled substance, but not the same schedule as amphetamine and Ritalin, so it's easier for some prescribers to prescribe.
它是一种受控物质，但与安非他明和利他林的时间表不同，因此一些处方者更容易开处方。
Even though it's the non-stimulant stimulant, and I'd say most people do experience, "I feel more alert or awake or better, but I don't feel revved up," about 10% to 15% of people that I've worked with, and others have written about it, so I don't think it's unique, will feel revved up when they take it the first few times.
尽管它是非兴奋剂兴奋剂，我想说大多数人确实经历过，“我感觉更警觉、更清醒或更好，但我没有感到兴奋”，与我共事过的人中大约有 10% 到 15%，其他人也写过有关它的文章，所以我不认为它是独一无二的，当他们服用前几次时会感到兴奋。
And invariably, the people I've worked with have said, "This feels like bad speed," including people who never even took speed.
和我共事过的人总是说，“这感觉速度很糟糕”，其中包括那些从未加速过的人。
So I don't know why they came up.
所以我不知道他们为什么会出现。
It's just weird that people come up with the same terms.
人们提出相同的术语，这很奇怪。
But my interpretation is that for some people, this novel substance primarily may be tapping into the orexin system, is serving as a signal, kind of like a panic attack does, that there's something weird, something different, we're being revved up, and that it's, I think, secondarily triggering the sympathetic system.
但我的解释是，对于某些人来说，这种新物质可能主要进入食欲素系统，作为一种信号，有点像恐慌发作，表明有一些奇怪的东西，一些不同的东西，我们正在加速，我认为，它其次触发了交感系统。
Because for most of those people within a few trials, within a few days, they no longer had that over-revved effect.
因为对于大多数人来说，经过几次试验，几天之内，他们就不再有那种过度兴奋的效果了。
And again, the important piece for alerting people to that is if they're expecting taking this, I'm not going to feel over-aroused and over-agitated, and they do, then they're even less prepared and more freaked out.
再说一次，提醒人们这一点的重要一点是，如果他们期待接受这个，我就不会感到过度兴奋和过度激动，而他们确实如此，那么他们甚至更没有准备，更害怕。
Andrew Huberman:
安德鲁·休伯曼：
Even though I've never tried modafinil, Provigil, that people that I know who have, and I know one who has for treatment of real narcolepsy, so he's narcoleptic, but others who take it for ADHD and for work focus and cognitive enhancement, people who take modafinil and armodafinil really like it.
尽管我从未尝试过莫达非尼、普罗维吉尔，我认识的人都曾尝试过莫达非尼，而且我认识一个人，他是为了治疗真正的发作性睡病，所以他是发作性睡病患者，但其他服用莫达非尼治疗多动症、工作注意力和认知增强的人，服用莫达非尼和阿莫达非尼的人真的很喜欢它。
I don't know if it has any reinforcing property, but today is the first that I've heard that it has this dopaminergic aspect.
我不知道它是否有任何增强作用，但今天是我第一次听说它具有多巴胺能方面。
But they seem to really like it and rely on it.
但他们似乎真的很喜欢它并依赖它。
Have you seen a kind of a dependence form?
你见过一种依赖形式吗？
Dr. John Kruse:
约翰·克鲁斯博士：
It is a controlled substance because some people are worried about the potential, and there was a woman, an Olympic athlete, 20, 15 years ago, who had Modaf and said she had narcolepsy.
它是一种受控物质，因为有些人担心其潜力，20、15 年前有一位女性，一位奥林匹克运动员，她患有莫达夫，并说她患有嗜睡症。
I don't know the ver- but was disqualified from the Olympics because of it.
我不知道具体原因，但因此被取消了奥运会资格。
Whether it has any real performance-enhancing effects is not clear.
它是否具有任何真正的性能增强效果尚不清楚。
It was available in France for a decade, at least, before it came to the US, and they didn't see any rates of substance abuse or problems.
在进入美国之前，它在法国已经上市了至少十年，而且他们没有看到任何药物滥用率或问题。
It clearly does not have, on any tests or animal studies, the propensity that the amphetamines do, and I'd say it's, to me, not a concluded subject whether there's any potential for addiction with it.
在任何测试或动物研究中，它显然不具有安非他明所具有的倾向，而且我想说，对我来说，它是否有成瘾的可能性还不是一个结论性的话题。
Andrew Huberman:
安德鲁·休伯曼：
What about within the category of Adderall, Vyvanse, and the stimulant-type treatments for ADHD, I don't want to say what are your go-to favorites because that makes it sound very non-clinical, but what are the general trends that you've observed and that others have observed clinically or in any studies about preference for long-acting drugs versus shorter-acting drugs?
那么在 Adderall、Vyvanse 和 ADHD 兴奋剂类治疗方法中，我不想说您最喜欢什么，因为这听起来非常不临床，但是您观察到的以及其他人在临床上或在任何关于长效药物与短效药物的偏好的研究中观察到的总体趋势是什么？
And maybe this is also a good opportunity for you to be able to chime in about drug holidays, taking weekends off, and things of that sort.
也许这对你来说也是一个很好的机会，可以参与毒品假期、周末休息等类似的事情。
Dr. John Kruse:
约翰·克鲁斯博士：
Maybe I'll start with that.
也许我会从那开始。
So for decades, particularly starting with kids, the dogma has been taking breaks from stimulants is a good idea because it will decrease the likelihood of developing addictions.
因此，几十年来，尤其是从孩子开始，人们一直认为戒掉兴奋剂是个好主意，因为这会降低上瘾的可能性。
It will decrease tolerance.
它会降低耐受性。
And not a lot of rigorous research, but one of the known side effects of stimulants for kids is growth suppression.
虽然没有大量严格的研究，但兴奋剂对儿童的已知副作用之一是生长抑制。
So height winds up being about two centimeters, not big, but measurably and consistently found there for kids who are routinely on the stimulants for their growth years.
因此，身高最终约为两厘米，虽然不大，但对于那些在成长过程中经常服用兴奋剂的孩子来说，身高是可测量的、一致的。
And taking breaks that last for several months, like taking it off during the summer, result in overcoming that decrement in height.
持续几个月的休息，比如在夏天脱掉它，可以克服身高的下降。
I looked and I still haven't-- Whether there's any lower rate of addiction, whether there's any lower rate of developing tolerance, there's nothing that shows clinically.
我看了，还是没有——成瘾率是否降低，耐受性发展是否降低，临床上没有任何显示。
It may be true.
这可能是真的。
The other recommendation when I started out was, and this is before the internet, before constant plugged into everything, and before kids had soccer practice and violin lessons and 400 activities, is that kids should take it during the workdays and not take it during the weekends and not take it during the summers.
我开始时的另一个建议是，这是在互联网出现之前，在不断接触一切事物之前，在孩子们进行足球练习、小提琴课程和 400 项活动之前，孩子们应该在工作日学习，而不是在周末学习，也不要在夏天学习。
And now, and for many years, we've lived in a world where little Johnny has soccer practice and ballet and piano and has 42 things to get to where he's supposed to be performing and focused and behaving.
现在，多年来，我们生活在一个小约翰尼练习足球、芭蕾舞和钢琴的世界里，他有 42 件事要做，才能达到他应该表演、专注和行为的地方。
So the sort of excuse you could have downtime has diminished in many communities.
因此，在许多社区，停工的借口已经减少。
And again, whether there's actual benefits to that or not, other than for the height decrement, which again, there is evidence that taking long breaks, but probably not short breaks, mitigates that.
再说一遍，无论是否有实际的好处，除了身高降低之外，有证据表明，长时间休息（但可能不是短暂休息）可以缓解这种情况。
I haven't seen any evidence clearly showing a benefit.
我还没有看到任何证据清楚地表明它有好处。
That doesn't mean it's not there.
这并不意味着它不存在。
Nobody has really studied it rigorously.
没有人真正认真地研究过它。
Sort of related to that, you asked the question about short-acting versus long-acting, and there's differences in the realm of what's clinically helpful or useful, and then there's the issue of risks or side effects.
与此相关的是，您问了关于短效与长效的问题，在临床上有帮助或有用的领域存在差异，然后还有风险或副作用的问题。
So again, one of the claims is that part of what makes a drug more addictive is not just the level it reaches, but how quickly it's going in and out, and that the short-acting drugs may predispose someone to higher rates of addiction.
再次强调，一种说法是，药物更容易上瘾的部分原因不仅在于它达到的水平，还在于它进出的速度有多快，而且短效药物可能会使人更容易上瘾。
There are, at least occasionally, some people arguing on the other side that saturating the receptors for longer periods of time, but high doses with a long extended release version, that may actually be more of a risk.
至少偶尔，有些人会争论说，让受体饱和的时间更长，但长效缓释版本的高剂量，实际上可能风险更大。
But I'd say there's more concern, I think, in the basic science community from the immediate release.
但我想说的是，我认为基础科学界从立即发布的结果中产生了更多的担忧。
And there's a tiny bit of data, but part of it overall is that, we talked earlier about global rates of addiction to any substance.
虽然有一小部分数据，但总体而言，我们之前讨论过全球对任何物质的成瘾率。
That we have fairly good data on because the CDC tracks it.
我们有相当好的数据，因为疾病预防控制中心跟踪它。
But in terms of very specifically who gets addicted to Adderall, who gets addicted to Ritalin, there's so little data, and most people just sort the same numbers that, oh, maybe 2% to 3% of kids run into trouble, and it's not common, and that's it.
但就具体谁对阿得拉上瘾、谁对利他林上瘾而言，数据太少了，大多数人只是对相同的数字进行排序，哦，也许有 2% 到 3% 的孩子遇到麻烦，而且这种情况并不常见，仅此而已。
Or they study a much broader question, and that's the issue of misuse combined with abuse.
或者他们研究一个更广泛的问题，那就是误用和滥用的问题。
And misuse, by the research definitions, means anyone who didn't use their drug exactly as prescribed, which means if you're taking a short-acting Ritalin and it says take it one every six hours apart during the day, and you acknowledge taking it on one day eight hours difference, you're classified as a misuser by those studies.
根据研究的定义，滥用是指任何没有完全按照处方使用药物的人，这意味着如果您正在服用短效利他林，并且它说白天每六小时服用一次，并且您承认每天间隔八小时服用一次，那么您就会被这些研究归类为滥用者。
I'm being maybe a little ridiculous because most of the exceptions aren't that narrow.
我可能有点可笑，因为大多数例外情况并没有那么狭窄。
But there's a big blurring in the research, particularly coming from the people who are worried about addiction.
但这项研究存在很大的模糊性，特别是来自那些担心成瘾的人。
We should be worried about addiction, but we shouldn't be overreacting or creating, pretending it's a problem among those where that, I would say, is not addiction.
我们应该担心成瘾，但我们不应该反应过度或创造，假装这是那些我想说的不是成瘾的人的问题。
That's not abuse.
这不是虐待。
That's not using it as directed.
那不是按照指示使用它。
But people with ADHD, by their very nature, are not going to use things as directed, either because they forgot or weren't organized enough to get it on time or forgot what you said in the office, even though you wrote it down because they lost the sheet of paper it's written down on.
但患有注意力缺陷多动症的人，就其本质而言，不会按照指示使用东西，要么是因为他们忘记了，要么是因为没有足够的组织能力来按时拿到东西，要么是忘记了你在办公室说的话，即使你写下了它，因为他们丢失了写下它的纸。
So getting back to patients' experience of it.
所以回到患者的体验。
So the advantages of the immediate release is they tend to work quickly.
因此，立即发布的优点是它们往往可以快速发挥作用。
You can feel it going in.
你可以感觉到它正在进入。
Most people, there's a lot of individual variability, but let's say in the six to eight-hour range will get benefit.
对于大多数人来说，存在很大的个体差异，但假设在六到八小时的范围内就会受益。
Some shorter, some immediate release lasts all day.
有些较短，有些立即释放持续一整天。
But you know when it's on, you know when it's off.
但你知道它什么时候打开，你知道什么时候关闭。
If you forget to take your medicines in the morning, but you know you have a presentation at 3:00 that afternoon, you could take it at 2:00 and still be able to sleep that night.
如果您早上忘记服药，但您知道当天下午 3:00 有演示，您可以在 2:00 服药，并且当天晚上仍然可以睡觉。
So it allows more flexibility.
因此它允许更大的灵活性。
It allows more pinpointing of optimizing it for points of the day you want to be using it.
它可以更精确地针对您想要使用它的当天的时间点进行优化。
Some people philosophically say that in itself is wrong or bad, that you should be absolutely steady and constant because what we're trying to do is be consistent and reproducible.
有些人从哲学上说，这本身就是错误或不好的，你应该绝对稳定和恒定，因为我们试图做的是一致和可重复的。
And others would say we're trying to treat individuals who have different demands on them and have different patterns during their day.
其他人可能会说，我们正在努力对待那些对他们有不同要求并且在一天中有不同模式的人。
So there are different philosophies about what's better or worse.
因此，关于什么是好什么是坏有不同的哲学。
One of the big downsides of the immediate release, though, is not only does it go in quickly, it tends to go off quickly.
然而，立即发布的一大缺点是，它不仅进入得很快，而且往往很快就会消失。
And most people, not all, but most experience some withdrawal as it's going off.
大多数人，不是全部，但大多数人在事情发生时都会经历一些退缩。
And although when we're using this for ADHD, we focus on the cognitive executive function benefits, the focus, the attention, the concentration, and people can experience that.
尽管当我们用它来治疗多动症时，我们关注的是认知执行功能的好处，注意力，注意力，集中力，人们可以体验到这一点。
Many people who weren't even aware Of it increasing their energy, feel my energy's crashing as I go off of it, or many people who aren't aware that it was actually elevating mood to any extent feel, "Oh, my God, I'm crashing, and I'm crying and cranky and miserable now." And with the extended release versions, most of them go in more gradually, so it can be harder to detect.
许多人甚至没有意识到它增加了他们的能量，当我停止使用它时，感觉我的能量崩溃了，或者许多没有意识到它实际上在某种程度上提升了情绪的人感觉，“哦，天哪，我崩溃了，我现在哭了，脾气暴躁，痛苦不堪。”对于扩展版本，它们中的大多数会更加逐渐地进入，因此更难以检测到。
They last a longer period of the day, and most of them go out much more gradually at the end of the day.
它们在一天中持续的时间更长，并且大多数在一天结束时逐渐消失。
The one I like the most for a long-acting amphetamine product is Vyvanse.
我最喜欢的长效安非他明产品是 Vyvanse。
And Vyvanse was designed as a slow-release product.
Vyvanse 被设计为缓释产品。
It was designed specifically to be unattractive to drug abusers.
它是专门为对吸毒者没有吸引力而设计的。
So Vyvanse chemically links a dextroamphetamine molecule to lysine, one of the amino acids.
因此，Vyvanse 将右旋苯丙胺分子与氨基酸之一赖氨酸进行化学连接。
It's a basic component of proteins and 20 essential amino acids.
它是蛋白质和 20 种必需氨基酸的基本成分。
And if you snort it or inject it, you have an inactive prodrug.
如果你吸食或注射它，你就会得到一种无活性的前药。
You have this dexamphetamine.
你有这种右旋安非他明。
Your red blood cells actually have an enzyme that cleaves the lysine and leaves you with the free active dextroamphetamine, and that's the slow-release mechanism, is how quickly your red blood cells can do it, and they have limited capacity to do that.
您的红细胞实际上有一种酶可以裂解赖氨酸，并留下游离的活性右旋苯丙胺，这就是缓慢释放机制，即您的红细胞能够以多快的速度完成这一任务，而它们的能力有限。
So although they designed it to be an anti-drug abuse drug, it actually turns out to be one of the most consistently, evenly entering the body.
因此，尽管他们将其设计为一种抗药物滥用药物，但实际上它是进入人体最一致、最均匀的药物之一。
For some people, it goes in so slowly that they say, "I don't feel it." And also, towards the end of the day, one of the best in terms of not falling off abruptly.
对于某些人来说，这种感觉进行得很慢，以至于他们说：“我感觉不到。”而且，在一天结束时，就不会突然掉落而言，这是最好的之一。
The potential downside is, again, that the capacity of the red blood cells is limited, so at some point, for most people, because that's a rate-limiting step, when you're adding more and more, you're actually extending the duration of time more than you're getting a bigger peak because your red blood cells just aren't cleaving it fast enough to make more dextroamphetamine available.
潜在的缺点是，红细胞的容量是有限的，所以在某些时候，对于大多数人来说，因为这是一个限速步骤，当你添加越来越多时，你实际上延长了持续时间，而不是获得更大的峰值，因为你的红细胞分裂速度不够快，无法产生更多的右旋苯丙胺。
Almost invariably, when I'll ask, "How did this compare to your Adderall XR or to a Hanseathr?" They'll say, "Smooth."
当我问“这与您的 Adderall XR 或 Hanseatr 相比如何？”时，几乎总是如此。他们会说：“顺利。”
Andrew Huberman:
安德鲁·休伯曼：
Smooth.
光滑。
Dr. John Kruse:
约翰·克鲁斯博士：
They're getting it.
他们明白了。
They're not feeling-
他们没有感觉——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. John Kruse:
约翰·克鲁斯博士：
...
...
too jarred, too revved up.
太震动，太兴奋。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, we don't really have a language for these things, right?
是的，我们真的没有语言来表达这些东西，对吧？
Hence the bad speed language before.
因此，之前的速度语言很糟糕。
Cracked out, bad speed-
破解了，速度太差了
Dr. John Kruse:
约翰·克鲁斯博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
smooth.
光滑。
Because what we're talking about here is the gestalt of the subjective experience of all these neural and chemical mechanisms.
因为我们在这里讨论的是所有这些神经和化学机制的主观体验的完形。
Very interesting.
非常有趣。
Thank you for sharing that.
感谢您分享这一点。
I know that there are a lot of listeners and viewers who have tried these things or are considering or at one point used them, and a lot has evolved in this realm of chemistry for ADHD, but that's very helpful.
我知道有很多听众和观众已经尝试过这些东西或正在考虑或曾经使用过它们，并且在多动症的化学领域已经发生了很多变化，但这非常有帮助。
Before we wrap up, I want to make sure that I ask you about something that's been on my mind a lot in general, but in particular as it relates to ADHD, which is time perception.
在我们结束之前，我想确保我问了你一些我一直在想的事情，但特别是因为它与注意力缺陷多动症（ADHD）有关，即时间感知。
And I'm basically obsessed with time perception.
我基本上沉迷于时间感知。
I've long been fascinated by the fact that we can fine slice time when our arousal is high.
长期以来，我一直着迷于这样一个事实：当我们的兴奋度很高时，我们可以细化时间。
That's what-
就是这样——
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
presumably gives people the kind of slow motion effect in very stressful environments, versus when we're relaxed, our frame rate on life goes down, and it's all very dynamic.
大概会给人们在压力很大的环境中带来一种慢动作效果，而当我们放松时，我们的生活帧率会下降，而且一切都非常动态。
It's important our brains are able to do that.
重要的是我们的大脑能够做到这一点。
But someone recently told me the following.
但最近有人告诉我以下内容。
Her partner has ADHD, and she said that the big rescue to their relationship came when they together read a book about ADHD, and something in there read something like this, that people without ADHD keep track of time, whereas people with ADHD don't, but they do know the difference between now and not now.
她的伴侣患有注意力缺陷多动症，她说，当他们一起读一本关于注意力缺陷多动症的书时，他们的关系得到了很大的拯救，里面的内容是这样的，没有注意力缺陷多动症的人会记录时间，而患有注意力缺陷多动症的人不会，但他们确实知道现在和现在之间的区别。
But they're not tracking time.
但他们没有追踪时间。
They know that what they're doing in the moment is not what they're-
他们知道他们此刻正在做的事情不是他们现在要做的——
Dr. John Kruse:
约翰·克鲁斯博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
going to be doing later or what they did in the past, but they're not tracking time the same way.
稍后将要做的事情或他们过去所做的事情，但他们并没有以相同的方式跟踪时间。
And I think this ties back to this interest-based attention system.
我认为这与基于兴趣的注意力系统有关。
What do we know about time perception in ADHD?
我们对多动症患者的时间知觉了解多少？
And by extension, do you think that these drugs are working in part to change time perception?
推而广之，您认为这些药物是否在一定程度上改变了时间观念？
Dr. John Kruse:
约翰·克鲁斯博士：
Good question.
好问题。
So I'd say there's two different angles, and I think, the one that's easier to objectively measure is putting people in a lab, and there's a simple test, a time perception test, and you interrupt them after a certain period-- Say you're going to be estimating how long you're left without interruption.
所以我想说有两个不同的角度，我认为，更容易客观测量的一个是把人们放在实验室里，有一个简单的测试，一个时间感知测试，你在一段时间后打断他们——假设你要估计你没有被打断的时间有多长。
And people with ADHD, they're inconsistently inconsistent.
而患有多动症的人，他们的表现总是不一致的。
Or consistently-
或者始终如一地——
Andrew Huberman:
安德鲁·休伯曼：
Consistently inconsistent
始终不一致
Dr. John Kruse:
约翰·克鲁斯博士：
...
...
inconsistent.
不一致。
So it's not that they perpetually underestimate or overestimate, but they are estimating incorrectly much more often than people without ADHD.
因此，并不是说他们总是低估或高估，而是他们比没有多动症的人更容易做出错误的估计。
So there's something at a basic time processing level that's aberrant there.
因此，在基本时间处理级别上存在一些异常情况。
But there's also getting the real-world aspect of not paying attention to cues or not noticing other people have left the room, or being distracted, which compounds the situation.
但现实世界中也存在不注意暗示或没有注意到其他人离开房间或分心的情况，这使情况变得更加复杂。
And it's also interesting to the extent to which many people aren't aw-- So I often ask, even though it's not one of the 18 symptoms, "Are you chronically late to--" And particularly people who show up late to my office time after time.
有趣的是，很多人都没有意识到——所以我经常问，即使这不是 18 种症状之一，“你是否长期迟到——”尤其是那些一次又一次迟到我办公室的人。
So one of my favorite quotes is this person who, the session before, we had been talking that her boss was giving her threatening notices because she had come in two hours late one day, and she had all sorts of good excuses of why she couldn't get out the door.
所以我最喜欢的引用之一是这个人，在之前的会议上，我们一直在谈论她的老板向她发出威胁通知，因为她有一天迟到了两个小时，而且她有各种各样的好借口为什么她不能出门。
And we were talking, "Are you regularly late?" "No." And I said, "Well, why was the boss so upset?" I'd say And then I ask, "Well, when is the expectation?" This is pre-COVID, pre-working from home.
我们讨论的是“你经常迟到吗？” “不。”我说：“那么，老板为什么这么生气呢？”我会说，然后我会问：“那么，预期是什么时候？”这是新冠疫情之前、在家工作之前的情况。
"When is the expectation you're there?
“你预计什么时候到？
When do you usually show up?" "Oh, well, office starts at 9:00, and I'm usually there by 9:15, 9:20.
你一般什么时候出现？” “哦，好吧，办公室是 9:00 开始的，我通常是 9:15、9:20 到的。
That's not late." In her mind, it wasn't late.
那还不算晚。”在她看来，现在还不算晚。
So when you ask a question, "Are you routinely late?" You're going to get meaningless information on your little checklist, unless you know what that means to the individual.
所以当你问“你经常迟到吗？”你会在你的小清单上得到毫无意义的信息，除非你知道这对个人意味着什么。
So the second part of the question, I'm sure it's been done, and I don't have the answer, whether stimulants or other drugs measurably improve time perception in that laboratory situation of just, can you estimate how much time has elapsed?
所以问题的第二部分，我确信它已经完成了，但我没有答案，兴奋剂或其他药物是否可以在实验室情况下显着改善时间感知，你能估计已经过去了多少时间吗？
I should know that, but I don't have that on top of my-- And the more global question of how central that's sort of the time aspect of organization of thoughts and attention is to the content of disorganization.
我应该知道这一点，但我没有把它放在我的之上——以及更全球性的问题，即思想和注意力的组织的时间方面对于解体的内容有多重要。
There are some research groups, I think it's mainly a Danish group, who's feeling that ADHD is primarily a circadian rhythm disruption, that that's the central neurologic issue at play.
有一些研究小组，我认为主要是丹麦小组，他们认为多动症主要是昼夜节律紊乱，这就是中枢神经系统问题。
And there's interesting-- I got to do work in the early '80s on bright light therapy for winter depression, which has a measurable impact as strong as medication.
有趣的是，我在 80 年代初开始从事针对冬季抑郁症的强光疗法的研究，这与药物治疗一样具有可测量的效果。
But there is one or two studies done on individuals with ADHD, without any seasonal depression, without any depression at all, and just those same bright lights, showing them a dose of bright lights early in the morning, measurably improved a broad range of ADHD symptoms.
但有一两项针对多动症患者的研究，没有任何季节性抑郁症，也没有任何抑郁症，只是同样的明亮灯光，在清晨向他们展示一剂强光，显着改善了广泛的多动症症状。
And the claim was that that was working because it was helping resynchronize internal rhythms, which are out of sync in ADHD, whether that's exactly the same thing you are getting at.
据称，这是有效的，因为它有助于重新同步内部节律，而这些节律在多动症中是不同步的，无论这是否与您所理解的完全相同。
But certainly, even though we have a sort of master clock in the suprachiasmatic nucleus, we also have clocks throughout our body, and they're talking and interacting and ostensibly synchronized and working with each other.
但当然，尽管我们的视交叉上核中有一种主时钟，但我们的身体也有时钟，它们在交谈、相互作用，表面上是同步的，彼此协作。
But it could well be that for many people they're not, and that getting that to work is essential.
但对于很多人来说，情况很可能并非如此，而让其发挥作用至关重要。
Andrew Huberman:
安德鲁·休伯曼：
Thank you for those reflections.
谢谢你的反思。
And really, I want to say thank you on behalf of myself and everyone listening and watching, for doing the work you do.
真的，我想代表我自己以及所有收听和观看的人对你们所做的工作表示感谢。
You were invited here today because you have an absolutely encyclopedic understanding and knowledge of ADHD and the clinical treatments, and I've watched your YouTube channel, and we'll provide links to all your various resources.
今天邀请您来到这里，是因为您对 ADHD 和临床治疗有绝对百科全书式的理解和知识，而且我观看了您的 YouTube 频道，我们将提供您所有各种资源的链接。
I'm looking forward to your upcoming book, "However Long It Takes." I'm sure it'll be spectacular.
我期待着你即将出版的书《无论需要多久》。我相信这将会非常精彩。
When you talk about ADHD, you're able to do it from so many different angles, behavioral, supplement-based, nutrition, life and organizational aspects, and of course, the medication, the pharmacology, the neuroscience, and the ways that those different nodes interact with one another, because of course they do.
当你谈论多动症时，你可以从很多不同的角度来讨论，行为、补充剂、营养、生活和组织方面，当然还有药物、药理学、神经科学，以及这些不同节点彼此相互作用的方式，因为它们当然是这样的。
So I just want to be absolutely clear how grateful we are for you for sharing all this knowledge.
因此，我只想明确表示，我们非常感谢您分享所有这些知识。
A lot of people struggle with attention issues, regardless of whether or not they have full-blown ADHD or not.
很多人都在与注意力问题作斗争，无论他们是否患有全面的多动症。
A lot of people have been treated for it.
很多人都因此接受了治疗。
Some people are still wondering if they should be or not.
有些人仍然想知道是否应该这样做。
And so today's discussion was nothing short of spectacular.
所以今天的讨论非常精彩。
So on behalf of everybody, I want to just thank you for doing what you do and for coming here to educate us.
因此，我谨代表大家感谢你们所做的事情以及来到这里教育我们。
Thank you so much.
太感谢了。
Dr. John Kruse:
约翰·克鲁斯博士：
Thanks.
谢谢。
I'm gobsmacked, so...
我惊呆了，所以...
Andrew Huberman:
安德鲁·休伯曼：
Thank you for joining me for today's discussion with Dr. John Kruse.
感谢您参加今天与约翰·克鲁斯博士的讨论。
To learn more about his work, please see the links in the show note captions.
要了解有关他的作品的更多信息，请参阅演出注释标题中的链接。
If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.
如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。
That's a terrific zero-cost way to support us.
这是支持我们的绝佳零成本方式。
In addition, please click follow for the podcast on both Spotify and Apple.
此外，请点击关注 Spotify 和 Apple 上的播客。
And on both Spotify and Apple, you can leave us up to a five-star review.
在 Spotify 和 Apple 上，您都可以给我们五星级的评价。
If you have questions for me or comments about the podcast or guests or topics you'd like me to consider for the Huberman Lab podcast, please put those in the comments section on YouTube.
如果您对我有疑问，或者对播客或嘉宾有意见，或者您希望我为 Huberman Lab 播客考虑的主题，请将这些内容放在 YouTube 的评论部分。
I do read all the comments.
我确实阅读了所有评论。
Please also check out the sponsors mentioned at the beginning and throughout today's episode.
另请查看今天节目开头和整个节目中提到的赞助商。
That's the best way to support this podcast.
这是支持这个播客的最佳方式。
For those of you that haven't heard, I have a new book coming out.
对于那些还没有听说过的人，我即将出版一本新书。
It's my very first book.
这是我的第一本书。
It's entitled "Protocols: An Operating Manual for the Human Body." This is a book that I've been working on for more than five years, and that's based on more than 30 years of research and experience.
它的标题是“协议：人体操作手册”。这本书是我花了五年多时间编写的，它基于 30 多年的研究和经验。
And it covers protocols for everything from sleep, to exercise, to stress control, protocols related to focus and motivation.
它涵盖了从睡眠、锻炼、压力控制、与注意力和动机相关的各个方面的协议。
And of course, I provide the scientific substantiation for the protocols that are included.
当然，我还为所包含的协议提供了科学依据。
The book is now available by presale at protocolsbook.com.
该书现已在protocolbook.com 上预售。
There you can find links to various vendors.
在那里您可以找到各个供应商的链接。
You can pick the one that you like best.
您可以选择您最喜欢的一个。
Again, the book is called "Protocols: An Operating Manual for the Human Body." If you're not already following me on social media, I am hubermanlab on all social media platforms.
同样，这本书的名字是“协议：人体操作手册”。如果您还没有在社交媒体上关注我，我是所有社交媒体平台上的 hubermanlab。
So that's Instagram, X, formerly known as Twitter, Facebook, LinkedIn, and Threads.
这就是 Instagram、X，以前称为 Twitter、Facebook、LinkedIn 和 Threads。
And on all those platforms, I discuss science and science-related tools, some of which overlaps with the content of the Huberman Lab podcast, but much of which is distinct from the content on the Huberman Lab podcast.
在所有这些平台上，我讨论科学和与科学相关的工具，其中一些与胡伯曼实验室播客的内容重叠，但其中大部分与胡伯曼实验室播客的内容不同。
Again, that's hubermanlab on all social media platforms.
再说一次，这就是所有社交媒体平台上的 hubermanlab。
And if you haven't already subscribed to our Neural Network Newsletter, the Neural Network Newsletter is a zero-cost monthly newsletter that includes podcast summaries, as well as what we call protocols in the form of one to three-page PDFs that cover everything from how to optimize your sleep, how to optimize dopamine, deliberate cold exposure.
如果您还没有订阅我们的神经网络时事通讯，神经网络时事通讯是一份零成本的月度时事通讯，其中包括播客摘要，以及我们所说的一到三页 PDF 形式的协议，涵盖从如何优化睡眠、如何优化多巴胺、故意冷暴露等所有内容。
We have a foundational fitness protocol that covers cardiovascular training and resistance training.
我们有一个基本的健身方案，涵盖心血管训练和阻力训练。
All of that is available completely zero cost.
所有这些都是完全零成本可用的。
You simply go to hubermanlab.com, go to the Menu tab in the top right corner, scroll down to Newsletter, and enter your email.
您只需访问 hubermanlab.com，转到右上角的“菜单”选项卡，向下滚动到新闻通讯，然后输入您的电子邮件即可。
And I should emphasize that we do not share your email with anybody.
我要强调的是，我们不会与任何人分享您的电子邮件。
Thank you once again for joining me for today's discussion with Dr. John Kruse.
再次感谢您参加今天与约翰·克鲁斯博士的讨论。
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。
This is US Bank's Cozy Cashformations, with your chief financial playmaker, Fernando Mendoza.
这是美国银行的 Cosy Cashformations，与您的首席金融组织者费尔南多·门多萨 (Fernando Mendoza) 一起。
Speaker 3:
演讲者3：
You are worthy of financial security.
您值得拥有财务保障。
Budgeting is not restriction, it's freedom.
预算不是限制，而是自由。
You are smart.
你很聪明。
You are capable.
你有能力。
You are giving your money a purpose.
你给你的钱一个目的。
You are learning the language of saving, of growing.
你正在学习储蓄、成长的语言。
Now streaming.
现在正在播放。
Andrew Huberman:
安德鲁·休伯曼：
Member FDIC, copyright 2026 US Bank
FDIC 成员，版权所有 2026 US Bank