The Science & Treatment of Bipolar Disorder

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。

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

今天，我们将讨论双相情感障碍，通常称为双相抑郁症。

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

双相抑郁症是一种人们的能量、感知和情绪发生巨大变化的疾病。

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

然而，值得注意的是，这些情绪、能量和感知的变化都是适应不良的。

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

它们常常会给双相情感障碍患者以及他们生活中的人造成巨大的伤害。

Today, we're going to parse the biology that leads to these shifts in mood, energy, and perception, and we are going to talk about the various treatments that exist.

今天，我们将解析导致情绪、能量和感知这些变化的生物学原理，并且我们将讨论现有的各种治疗方法。

Some of those treatments have been around for a very long time, and indeed one of those treatments, lithium, has an incredible backstory about its discovery, and in understanding how lithium works and some of the ways in which it does not work well, it reveals a tremendous amount about how the brain works normally in all individuals.

其中一些治疗方法已经存在很长时间了，事实上，其中一种治疗方法，锂，有一个令人难以置信的发现背景故事，在了解锂的工作原理以及它不能很好地工作的一些方式时，它揭示了大量关于所有个体的大脑如何正常工作的信息。

So that's a miraculous story that I look forward to sharing with you.

这是一个神奇的故事，我期待与您分享。

As we go forward in this discussion about bipolar disorder, I want everyone to keep in mind that it is a very severe condition.

当我们继续讨论双相情感障碍时，我希望每个人都记住，这是一种非常严重的疾病。

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

事实上，患有双相情感障碍的人自杀的风险要高出 20 到 30 倍。

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

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

However, for those of you that might know people or who themselves suffer from major depression, we will also be talking about important treatment developments for major depression.

然而，对于那些可能认识重度抑郁症患者或自己患有重度抑郁症的人来说，我们还将讨论重度抑郁症的重要治疗进展。

Major depression is a very common thing for many people.

重度抑郁症对许多人来说是很常见的事情。

In fact, most people will suffer from depression of some sort at some point in their life, although not necessarily a major depressive episode, and yet major depression is very common.

事实上，大多数人在一生中的某个时刻都会遭受某种抑郁症的困扰，尽管不一定是重度抑郁症发作，但重度抑郁症却很常见。

As you'll soon learn, up to 20% of people will suffer from major depression.

您很快就会了解到，多达 20% 的人将患有重度抑郁症。

So today's discussion will encompass all of that, and it will also encompass basic brain mechanisms of neuroplasticity, the brain's ability to change in response to experience, both for good and for worse, and you'll learn a lot about the basic biology of how the brain regulates mood, energy, and perception.

所以今天的讨论将涵盖所有这些，它还将涵盖神经可塑性的基本大脑机制，大脑根据经验而改变的能力，无论是好是坏，你将学到很多关于大脑如何调节情绪、能量和感知的基本生物学知识。

Before we dive into the discussion about manic bipolar disorder, I want to highlight some recent findings in an area totally separate from mental health that I think are really important for everyone to know about.

在我们深入讨论躁狂双相情感障碍之前，我想强调一下与心理健康完全无关的领域的一些最新发现，我认为这些发现对每个人来说都非常重要。

This is a paper published in the journal Cell, which is a Cell Press journal, an excellent journal.

这是发表在Cell杂志上的论文，该杂志是Cell Press旗下的期刊，优秀期刊。

In fact, one of the three apex journals.

事实上，三大顶尖期刊之一。

So for those of you that are curious, papers published in the journal Nature, Science, and Cell are considered the sort of Super Bowl, Stanley Cup, and NBA championships of publishing.

因此，对于那些好奇的人来说，发表在《自然》、《科学》和《细胞》杂志上的论文被认为是出版界的超级碗、斯坦利杯和 NBA 冠军。

And this paper, entitled "An Inter-organ Neural Circuit for Appetite Suppression," illustrates a very important principle that I think everyone should know about, and that's the principle of so-called parallel pathways.

而这篇题为《食欲抑制的器官间神经回路》的论文阐述了一个我认为每个人都应该了解的非常重要的原理，那就是所谓的并行通路原理。

Parallel pathways, as the name suggests, are pathways that could be neural pathways or hormonal pathways or otherwise, that operate independently of one another to accomplish a common goal.

平行通路，顾名思义，是一种可以是神经通路、激素通路或其他通路，它们相互独立运作以实现共同目标。

And what this paper really shows is that there's a set of peptides in the body, and the peptide that I'm referring to today is called GLP-1, glucagon-like peptide 1, and some related peptides.

而这篇论文真正说明的是，人体内存在着一组肽，我今天所说的肽就是GLP-1，胰高血糖素样肽1，以及一些相关的肽。

I've talked about these on the podcast before for two reasons.

我之前在播客上讨论过这些，原因有两个。

First of all, I'm a big proponent and consumer of yerba mate.

首先，我是马黛茶的大力支持者和消费者。

Yerba mate is a tea that can promote the release of glucagon-like peptide 1.

马黛茶是一种能够促进胰高血糖素样肽1释放的茶。

And there are also new prescription drugs that are now hitting the market and for which there are really impressive clinical trials for diabetes and obesity that are essentially glucagon-like peptide 1 stimulators, so they stimulate the release of that, or they are in fact a synthetic version of glucagon-like peptide 1.

现在还有一些新的处方药正在上市，针对糖尿病和肥胖症进行了令人印象深刻的临床试验，这些药物本质上是胰高血糖素样肽 1 刺激剂，因此它们会刺激其释放，或者它们实际上是胰高血糖素样肽 1 的合成版本。

What is glucagon-like peptide 1?

什么是胰高血糖素样肽 1？

It is a peptide, which is a small little protein, that can dramatically suppress appetite.

它是一种肽，是一种很小的蛋白质，可以显着抑制食欲。

So that's why these drugs are being explored and are showing quite impressive results for things like treatment of type 2 diabetes and other forms of diabetes as well as obesity, so they lead to weight loss.

这就是为什么这些药物正在被探索，并且在治疗 2 型糖尿病和其他形式的糖尿病以及肥胖症等方面显示出相当令人印象深刻的结果，因此它们可以减轻体重。

Now, in terms of the yerba mate stimulation of glucagon-like peptide 1, that's going to be a much lower amount of glucagon-like peptide 1 that's released from drinking yerba mate as opposed to, say, taking a drug that stimulates GLP-1 or taking a drug that is GLP-1.

现在，就马黛茶对胰高血糖素样肽 1 的刺激而言，与服用刺激 GLP-1 的药物或服用 GLP-1 药物相比，饮用马黛茶时释放的胰高血糖素样肽 1 的量要低得多。

Nonetheless, I should also point out that yerba mate comes in a bunch of different forms.

尽管如此，我还应该指出，马黛茶有多种不同的形式。

There is some concern about certain smoky flavored forms of yerba mate being carcinogenic, so that's why I avoid those forms of yerba mate.

有人担心某些烟熏味的马黛茶会致癌，所以这就是为什么我避免使用这些形式的马黛茶。

But for me, yerba mate is one of the preferred sources of caffeine for me.

但对我来说，马黛茶是我首选的咖啡因来源之一。

I like the way it tastes.

我喜欢它的味道。

It does provide that sort of caffeine kick that I like to have early in the day for focus and for work and for exercise, and yet I actively avoid the smoked varieties of yerba mate because of the potential carcinogenic effects of the smoked varieties.

它确实提供了我喜欢在一天早些时候喝的咖啡因，以集中注意力、工作和锻炼，但我积极避免熏制的马黛茶，因为熏制的马黛茶具有潜在的致癌作用。

Glucagon-like peptide 1, as I mentioned earlier, can suppress appetite.

正如我之前提到的，胰高血糖素样肽 1 可以抑制食欲。

But what this paper shows is it does that by at least two mechanisms through parallel pathways.

但这篇论文表明，它至少通过两种平行途径的机制来做到这一点。

What this paper shows is that glucagon-like peptide 1 acts on receptors in the body in a portion of the nervous system called the enteric nervous system, E-N-T-E-R-I-C, enteric nervous system.

本文表明，胰高血糖素样肽 1 作用于体内神经系统部分（称为肠神经系统，E-N-T-E-R-I-C，肠神经系统）的受体。

This is a component of your nervous system that you don't really have control over.

这是你的神经系统的一个组成部分，你无法真正控制。

It's autonomic or automatic.

它是自主的或自动的。

GLP-1 binds to what are called intestinal fugal enteric neurons.

GLP-1 与所谓的肠道真菌肠神经元结合。

You don't need to know the name, but those neurons do two things.

你不需要知道名字，但这些神经元有两件事。

First of all, they cause some gut distension.

首先，它们会引起一些肠道扩张。

So they actually make you feel full.

所以它们实际上让你感到饱足。

This is incredible, right?

这太不可思议了，对吧？

A peptide, not actual physical food, but a peptide that stimulates neurons that cause changes in the so-called mechanoreceptors of the gut of the enteric nervous system and make people feel full.

一种肽，不是真正的物理食物，而是一种刺激神经元的肽，这些神经元会引起肠神经系统肠道的所谓机械感受器发生变化，让人产生饱腹感。

So it can lead to actually mild, or I suppose if levels of GLP-1 are very high, to major gut distension.

因此，它实际上可能会导致轻微的肠道扩张，或者我认为如果 GLP-1 水平非常高，则会导致严重的肠道扩张。

Okay?

好的？

I think that the levels of GLP-1 that would come from drinking yerba mate and hopefully from appropriate dosaging of The synthetic forms of GLP-1 or drugs that stimulate GLP-1 would cause mild, not major gut distension, because major gut distension would be uncomfortable.

我认为，饮用马黛茶所产生的 GLP-1 水平，以及适当剂量的合成形式的 GLP-1 或刺激 GLP-1 的药物，会导致轻微而非严重的肠道扩张，因为严重的肠道扩张会令人不舒服。

So GLP-1 is acting at the level of gut to increase gut distension, and by way of a pathway that goes from the gut up to the hypothalamus, this little cluster of neurons about the size of a marble that sits above the roof of your mouth, is also suppressing appetite through brain mechanisms.

因此，GLP-1 在肠道水平发挥作用，增加肠道扩张，并通过从肠道到下丘脑的通路，位于上颌上方的这一小群大理石大小的神经元，也通过大脑机制抑制食欲。

So this is really beautiful, right?

所以这真的很漂亮，对吧？

You have a peptide, a small little protein, that's released in the gut, and that release within the gut causes gut distension, which makes you feel full, and by way of neural stimulation of the hypothalamus, also activates neural pathways within the brain that trigger satiety, the feeling of having had enough food.

你有一种肽，一种很小的蛋白质，它在肠道中释放，肠道内的释放会导致肠道扩张，这会让你感到饱足，并且通过刺激下丘脑的神经通路，还会激活大脑内的神经通路，从而引发饱腹感，即吃饱的感觉。

So to me, GLP-1 is both impressive and important.

所以对我来说，GLP-1 既令人印象深刻又重要。

Why?

为什么？

Because this recent category of drugs that's now hitting the market seems to adjust obesity or can help people with weight loss in order to help their health, and it's doing so by at least two mechanisms.

因为目前上市的这一类药物似乎可以调节肥胖或可以帮助人们减肥，以促进他们的健康，而且它至少通过两种机制来实现这一点。

One is within the brain, and the other is within the gut and communication through the so-called gut-brain axis, because again, these enteric neurons are communicating to the brain, the hypothalamus, by way of this, what's called the sympathogastrosppinal reticular hypothalamic pathway.

一个在大脑内，另一个在肠道内，通过所谓的肠脑轴进行通信，因为这些肠神经元再次通过所谓的交感胃脊髓网状下丘脑通路与大脑、下丘脑进行通信。

You absolutely do not need to know all of that.

您绝对不需要知道所有这些。

That's a mouthful.

那是一口。

That's enough to make your mouth feel distended.

这足以让你的嘴感到扩张。

But at the same time, things like yerba mate, and I'm sure there are other compounds out there as well, but certainly yerba mate can stimulate the release of GLP-1.

但与此同时，马黛茶之类的东西，我确信还有其他化合物，但马黛茶肯定可以刺激 GLP-1 的释放。

So for those of you that are looking for some mild appetite suppression and want to accomplish that while also ingesting caffeine, yerba mate might be a good option for that.

因此，对于那些想要轻度抑制食欲并希望在摄入咖啡因的同时实现这一目标的人来说，马黛茶可能是一个不错的选择。

And just know that it's operating through two mechanisms, on the body through mild gut distension to make you feel full, and on the brain to increase satiety or make you feel less hungry.

只需知道它通过两种机制发挥作用，通过轻微的肠道扩张作用于身体，让您感到饱足，作用于大脑以增加饱腹感或减少饥饿感。

And then for everybody, not just those that are interested in appetite suppression, I think it's important to understand that these parallel pathways are fundamental to how we are organized.

然后，对于每个人来说，不仅仅是那些对抑制食欲感兴趣的人，我认为重要的是要了解这些平行路径对于我们的组织方式至关重要。

Another good example of this would be when we are excited by something positive or negative, so it could be stressful or we're positively aroused, there is a parallel activation of epinephrine, adrenaline, both from your adrenals and from an area in the brain called the locus coeruleus.

另一个很好的例子是，当我们对积极或消极的事物感到兴奋时，这可能会带来压力，或者我们被积极地激发，肾上腺素会同时激活，肾上腺素来自肾上腺和大脑中称为蓝斑的区域。

So again and again, we see this in biology and in neuroscience, that your brain and your body are acting in concert.

因此，我们在生物学和神经科学中一次又一次地看到，你的大脑和你的身体在协调行动。

They're acting together through mechanisms that either are independent, so separately in the brain and separately in the body, but directed towards a common goal, or through communication between brain and body, and almost always, that communication is going to be bidirectional, body to brain and brain to body.

它们通过独立的机制一起行动，在大脑中是分开的，在身体中是分开的，但指向一个共同的目标，或者通过大脑和身体之间的沟通，而且几乎总是，这种沟通是双向的，身体到大脑和大脑到身体。

So I think these results are really interesting and really important for sake of weight loss, for sake of appetite suppression, and just generally for the way that they illustrate this very important theme of the way that we are constructed at a biological level, which is parallel pathways.

所以我认为这些结果非常有趣，对于减肥、抑制食欲来说非常重要，而且一般来说，它们说明了我们在生物学水平上构建方式的这个非常重要的主题，即平行路径。

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, I'd like to thank the sponsors of today's podcast.

为了与这个主题保持一致，我要感谢今天播客的赞助商。

Let's talk about bipolar disorder, and today I'm going to refer to bipolar disorder interchangeably with bipolar depression, although, as you will soon learn, not everyone with bipolar disorder necessarily goes through highs and lows.

让我们来谈谈双相情感障碍，今天我将双相情感障碍与双相抑郁症互换使用，尽管您很快就会了解到，并不是每个患有双相情感障碍的人都一定会经历高潮和低谷。

There is a subset of people who suffer from bipolar disorder who experience the manic phases, the highly elevated mood and energy, and then drop down to so-called baseline.

有一部分患有双相情感障碍的人会经历躁狂阶段、情绪和精力高度升高，然后下降到所谓的基线。

So they don't necessarily go down into a depressive state.

所以他们不一定会陷入抑郁状态。

They often will return to a somewhat normal state.

他们通常会恢复到某种正常状态。

In fact, we will talk about the percentage of time that people with bipolar disorder tend to be symptom-free, manic, or depressed in the context of the different categories of bipolar disorder.

事实上，我们将讨论不同类别的双相情感障碍患者无症状、躁狂或抑郁的时间百分比。

But as we wade into this topic, that is bipolar disorder, I just want to give you a little bit of the background statistics to anchor us in just how serious and prevalent bipolar disorder is.

但当我们深入探讨双相情感障碍这个话题时，我只想向您提供一些背景统计数据，让我们了解双相情感障碍的严重性和普遍性。

So bipolar disorder impacts about 1% of people.

因此，双相情感障碍影响了大约 1% 的人。

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

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

And as I mentioned earlier in the introduction, bipolar disorder is very serious.

正如我在前面的介绍中提到的，双相情感障碍非常严重。

It has a 20% to 30% greater incidence of suicide than the general population, which is, first of all, extremely tragic and extremely concerning.

它的自杀发生率比一般人群高出20%到30%，这首先是极其悲惨且极其令人担忧的。

So anyone that thinks they might have bipolar disorder or who knows someone with bipolar disorder should be especially vigilant about this, and we'll talk about some of the signs and risk factors, age of onset, et cetera, as we move forward.

因此，任何认为自己可能患有双相情感障碍或认识患有双相情感障碍的人都应该对此特别警惕，随着我们的进展，我们将讨论一些体征和风险因素、发病年龄等。

So 1% of people have bipolar disorder.

所以1%的人患有双相情感障碍。

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

典型的发病年龄为 20 至 25 岁，但也可能更早。

And the earlier the onset of a bipolar episode, which we will define in a few minutes, the earlier the onset of that episode, the higher likelihood that the bipolar disorder is going to be a stable feature of that person's psychology going forward.

双相情感障碍发作越早（我们将在几分钟内定义），该发作发生得越早，双相情感障碍成为该人未来心理的稳定特征的可能性就越大。

And yet, I also want to point out that there are some very good treatments for bipolar disorder that those people could still benefit from.

然而，我还想指出，对于双相情感障碍有一些非常好的治疗方法，这些人仍然可以从中受益。

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

双相情感障碍基本上有两种类型，称为双相 I 型和双相 II 型。

So let's just talk about bipolar I first.

那么我们先来谈谈双相I型。

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

I型双相情感障碍的特点是相当长的一段时间的躁狂。

What is mania?

什么是躁狂症？

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

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

But this manic episode is extreme.

但这次狂躁的发作是极端的。

This is a condition in which the energy lift, the mood lift, and the sort of impulsivity and actions and words of the person suffering from manic bipolar disorder are very noticeable and very extreme.

在这种情况下，躁狂双相情感障碍患者的能量提升、情绪提升以及冲动、行为和言语都非常明显且非常极端。

Now, a key thing, however, is that it's not always noticeable to the person suffering from it that they are in this mode.

然而，现在关键的事情是，患有这种疾病的人并不总是注意到他们处于这种模式。

Sometimes they recognize that, sometimes they don't, but it's always highly recognizable to other people that The person suffering from manic bipolar disorder is not like other people.

有时他们认识到这一点，有时他们不认识到这一点，但其他人总是高度认可患有躁郁症的人与其他人不同。

So let's talk about bipolar I in a little bit more depth.

让我们更深入地讨论一下 I 型双相情感障碍。

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

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

That turns out to be very key.

事实证明这是非常关键的。

The stability of that manic episode for seven days or more turns out to be very important.

躁狂发作持续 7 天或更长时间的稳定性非常重要。

And for those seven days, the person is in an elevated mood, expansive thought, all day, every day, for those seven days.

在那七天里，这个人整天、每一天都处于一种高涨的情绪、广阔的思想之中。

Now, there are a lot of reasons why somebody could be in a manic mode.

现在，有很多原因可以导致某人处于躁狂状态。

It doesn't necessarily mean that somebody has bipolar disorder.

这并不一定意味着某人患有双相情感障碍。

In fact, someone could be in a manic mode for seven days or more and still not be diagnosed with bipolar disorder.

事实上，某人可能处于躁狂状态 7 天或更长时间，但仍然没有被诊断为躁郁症。

Why?

为什么？

Well, there are other things that can create manic episodes.

嗯，还有其他一些事情可以造成躁狂发作。

Things like traumatic brain injury, things like seizure, things like various prescription drugs or illicit drugs, things like amphetamine and cocaine.

诸如创伤性脑损伤、癫痫发作、各种处方药或非法药物、安非他明和可卡因等。

That is not the same as bipolar disorder, even though from a symptomology perspective, they might look even identical.

这与躁郁症不同，尽管从症状学的角度来看，它们可能看起来完全相同。

So let's think about these symptoms and the diagnostic criteria that a psychiatrist would use in order to ask whether or not someone is manic because they have manic bipolar disorder, or whether or not that person is manic for some other reason, such as traumatic brain injury, illicit drugs, et cetera.

因此，让我们考虑一下这些症状以及精神科医生会使用的诊断标准，以询问某人是否因为患有躁狂双相情感障碍而躁狂，或者该人是否因其他原因（例如创伤性脑损伤、非法药物等）而躁狂。

So typically, a person would be brought into a clinic, or a person would bring themselves to a clinic or meet with a psychiatrist.

通常，一个人会被带到诊所，或者一个人会自己去诊所或会见精神科医生。

It seems more likely that they would be directed toward a psychiatrist, because oftentimes, people who are in a manic episode just simply won't have the perspective or the foresight to bring themselves into the clinic.

他们似乎更有可能被导向精神科医生，因为很多时候，处于躁狂发作状态的人只是没有远见或远见来让自己去诊所。

And the psychiatrist is going to start to evaluate for a couple of different things.

精神科医生将开始评估一些不同的事情。

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

但首先，他们要尝试弄清楚该人是否至少有以下三种症状。

The first symptom is distractibility.

第一个症状是注意力分散。

Is the person distractible?

这个人是否容易分心？

Are they going from one thing to the next?

他们会从一件事转到另一件事吗？

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

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

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

但他们也很容易受到房间内的任何刺激。

Meaning, a bell could go off or there could be a sound out in the hallway, and they'll orient to that, and then they'll orient to the clinician, and then they'll orient to something in their pocket.

这意味着，铃声可能会响起，或者走廊里可能有声音，他们会定向到那个声音，然后他们会定向到临床医生，然后他们会定向到口袋里的东西。

So they're all over the place.

所以他们到处都是。

You could think of this a little bit like ADHD or attention deficit disorder, but it's very extreme.

你可能会认为这有点像多动症或注意力缺陷障碍，但它非常极端。

So highly distractible, highly impulsive.

非常容易分心，非常容易冲动。

Impulsivity relates to actions.

冲动与行动有关。

So the person might be fidgeting with something, and then they might try and leave the room, or the person might, if they were out in the real world, somebody might notice that the person is going and purchasing multiples of something that would be unusual for someone to purchase.

因此，这个人可能正在摆弄某件事，然后他们可能会尝试离开房间，或者，如果他们在现实世界中，有人可能会注意到这个人正在去购买多件对某人来说不寻常的东西。

So for instance, I happen to know someone whose ex-spouse had bipolar disorder, and their ex-spouse went out and bought 10-plus air fryers.

举个例子，我碰巧认识一个人，他的前配偶患有躁郁症，他们的前配偶出去买了10多个空气炸锅。

I think unless you're a restaurant that's using a lot of air fryers, the idea that you would need more than one or two air fryers might just seem a little bit out of the norm.

我认为除非您是一家使用大量空气炸锅的餐厅，否则您需要超过一两个空气炸锅的想法可能看起来有点不正常。

And so that impulsivity can be at purchasing, it can be other things as well.

因此，冲动可能是在购买时，也可能是在其他事情上。

It could be booking 12 international trips in one afternoon or going and buying three cars, et cetera.

它可以在一个下午预订 12 次国际旅行，或者去购买三辆车，等等。

So impulsivity.

所以冲动。

The other is grandiosity.

另一个是宏大。

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

患有躁狂双相情感障碍的人在躁狂发作时经常会表现出夸张的言语或行为。

And keep in mind, these are not lies in the sense that the person isn't lying in order to try and pull one over on anybody.

请记住，这些并不是谎言，因为这个人撒谎并不是为了试图欺骗任何人。

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

这些是人们对自己在世界上的宏伟地位或在世界上的宏伟机会或潜力的真实信念。

Typical forms of grandiosity in manic episodes would be that the person suddenly decides that they are going to win a Pulitzer Prize, they are the person selected to win a Pulitzer Prize.

躁狂发作中浮夸的典型形式是，这个人突然决定他们将赢得普利策奖，他们是被选中赢得普利策奖的人。

They're going to write a novel that afternoon, and they're going to win a Pulitzer Prize that year, which is more or less a delusion of grandeur, right?

那天下午他们要写一本小说，那一年他们要获得普利策奖，这或多或少是一种宏伟的幻想，对吧？

The idea that someone could do that in one afternoon, I suppose it is possible in the realm of all possibilities, but it's extremely unlikely.

有人可以在一个下午做到这一点的想法，我认为在所有可能性的范围内都是可能的，但这是极不可能的。

Other forms of grandiosity that often present themselves in people suffering from a manic episode will be that they're going to run for president, or that they are the person that they believe is selected by the citizens of a given country or by the universe to be the president of that country or to be president of the universe.

患有躁狂症的人经常表现出的其他形式的浮夸是他们要竞选总统，或者他们相信某个国家的公民或宇宙选择了他们的人作为该国的总统或宇宙的总统。

It sounds ridiculous, but those sorts of delusions of grandiosity are one condition that often presents itself, or one set of symptoms that presents itself.

这听起来很荒谬，但这种浮夸的妄想是经常出现的一种情况，或者是一组自行出现的症状。

Flight of ideas are also typical of manic episodes.

想法的飞扬也是躁狂发作的典型特征。

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

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

It would be as if I was doing this podcast talking about manic bipolar disorder and then suddenly switching to OCD and then to deliberate cold exposure and then to the role of sugar and its impact on the brain, et cetera.

就好像我正在做这个播客，谈论躁狂双相情感障碍，然后突然转向强迫症，然后故意暴露在寒冷中，然后转向糖的作用及其对大脑的影响，等等。

So essentially, a random selection of the different topics that exist in science, all of which I happen to be very interested in and curious about.

所以本质上，是随机选择科学中存在的不同主题，所有这些主题都是我碰巧非常感兴趣和好奇的。

But just as we have episodes of the podcast that are about one or two topics and we focus on those in a fairly narrow trench of discussion, somebody who has a flight of ideas would be jumping between categories and topics in a kind of pseudo-random way.

但是，就像我们有关于一两个主题的播客剧集，并且我们专注于相当狭窄的讨论范围中的内容一样，拥有大量想法的人会以一种伪随机的方式在类别和主题之间跳跃。

So they might take off down a path of one thing and then switch to another without any transition or with transitions that don't have any logical structure to them.

因此，他们可能会沿着一件事的路径出发，然后切换到另一件事，而无需任何转换或没有任何逻辑结构的转换。

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

躁狂躁郁症的另一个方面经常出现在躁狂发作中，那就是躁动。

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

人们感觉身体极度烦躁，因此经常摇晃和移动。

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

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

And then another condition is no sleep.

还有一个条件就是不睡觉。

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

当我说不睡觉时，我的意思是不睡觉或睡眠很少。

As Incredible as it sounds, people who are in a manic episode can often go seven days or more with zero sleep, and a key feature of this zero sleep is that they're not troubled by it.

尽管听起来令人难以置信，但躁狂发作的人通常可以连续 7 天或更长时间处于零睡眠状态，而这种零睡眠的一个关键特征是他们不会因此而烦恼。

They're not thinking, "Oh, I'm suffering from insomnia and I really, really want to sleep."

他们不会想：“哦，我失眠了，我真的真的很想睡觉。”

Sometimes that's the case, but more often than not, they are simply not sleeping.

有时确实如此，但更多时候，他们只是没有睡觉。

They're staying up 24 hours, then another 24 hours.

他们熬夜24小时，然后又熬夜24小时。

It just continues for an entire week.

它只会持续整整一周。

Again, inconceivable to those of us that don't suffer from manic episodes.

再说一遍，这对于我们这些没有经历过躁狂发作的人来说是不可思议的。

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

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

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

精神科医生正在评估并查看它们是否出现的最后一类症状是快速、有压力的言语。

The rapid, pressured speech is something that when you hear it, you recognize it.

快速、有压力的讲话是当你听到它时你就能认出来的。

This is somebody that almost seems to be hitting you with speech like machine gun fire.

这是一个几乎用机关枪扫射般的言语攻击你的人。

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

它向你袭来，向你袭来，向你袭来，实在没有说话的余地。

They're not offering any opportunity for a back and forth, or if there is a back and forth, they might ask you how you feel about something, and then you start, "Well, I think," and then they'll come and then they're going to hit you with another barrage or a paragraph of information or of just speech that's pseudo-random.

他们不会提供任何来回的机会，或者如果有来回，他们可能会问你对某件事的感觉如何，然后你开始说，“好吧，我想，”然后他们就会过来，然后他们会用另一段弹幕、一段信息或只是伪随机的言论来打击你。

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

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

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

对于被诊断为躁狂发作的人来说，他们不必表现出所有这些症状。

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

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

It could be longer, but at least seven days.

可以更长，但至少七天。

Now, this seems pretty straightforward, right?

现在，这看起来很简单，对吧？

At one level, the way that I describe this and the way that it exists in the clinical literature, you could think, "Well, this should be pretty easy to diagnose." And yet there's a complication there or a challenge there because the psychiatrist, again, has to determine that these manic episodes are not due to something other than bipolar disorder.

在某种程度上，我描述这一点的方式以及它在临床文献中存在的方式，你可能会想，“嗯，这应该很容易诊断。”然而，那里存在一个并发症或一个挑战，因为精神科医生必须再次确定这些躁狂发作不是由躁郁症以外的原因引起的。

For instance, again, it could be TBI, traumatic brain injury, it could be seizures or meds or other sorts of drugs.

例如，它可能是创伤性脑损伤、创伤性脑损伤，也可能是癫痫发作、药物或其他类型的药物。

Corticosteroids, which are often prescribed for a number of immune conditions or for wound healing, can also cause manic episodes.

皮质类固醇通常用于治疗多种免疫疾病或伤口愈合，也可能引起躁狂发作。

So they have to determine that everything that's happening meets the criteria I described before, three out of seven of these symptom categories for seven days or more, and that it can't be better explained by something else going on in that person's life or immediate medical history.

因此，他们必须确定所发生的一切都符合我之前描述的标准，这些症状类别中的七分之三持续了 7 天或更长时间，并且不能用该人生活中发生的其他事情或直接病史更好地解释它。

That's very important.

这非常重要。

Now, the other challenge, and this is something that's going to come up again and again today, not just in the description of the biology of bipolar disorder, but also in the description of different treatments and treatment approaches, is that typically when somebody is sitting in front of a psychiatrist, in particular for the first time those two people are interacting, the psychiatrist is just getting one snapshot of the person at that moment, right?

现在，另一个挑战，这是今天会一次又一次出现的问题，不仅在双相情感障碍的生物学描述中，而且在不同治疗和治疗方法的描述中，通常是当一个人坐在精神科医生面前时，特别是两个人第一次互动时，精神科医生只是在那一刻拍到这个人的一张快照，对吗？

So the person could be on day one of a manic episode, the person might be on day six of a manic episode.

因此，这个人可能处于躁狂发作的第一天，也可能处于躁狂发作的第六天。

The person could be transitioning out of a manic episode, or the person could be suffering from a combination of manic episode where, because of the impulsivity of bipolar disorder, they went out and used illicit drugs.

该人可能正在摆脱躁狂发作，或者该人可能患有躁狂发作的组合，由于双相情感障碍的冲动，他们出去使用非法药物。

They also used cocaine.

他们还使用可卡因。

So the psychiatrist has a serious challenge.

因此，精神科医生面临着严峻的挑战。

The psychiatrist has to determine, based on a conversation, right?

精神科医生必须根据谈话来确定，对吗？

This isn't a blood test.

这不是验血。

This isn't a measurement that you can take on a scale or with a biomarker.

这不是可以通过秤或生物标记进行的测量。

They have to use language, a conversation with somebody who by all accounts is pretty impaired at conversation, to determine whether or not they are suffering from a manic episode that is the consequence of bipolar disorder.

他们必须使用语言，与一个据说在谈话中受到严重损害的人进行对话，以确定他们是否患有躁郁症的躁狂发作。

You can imagine this in the real world as somebody says, "Well, how long has it been since you slept?" And the person starts to answer, "Oh, well, the other day I went down to the basement.

你可以想象在现实世界中有人说：“好吧，你有多久没睡觉了？”那人开始回答：“哦，好吧，有一天我去了地下室。

I was going to get something out of the refrigerator, and I thought I might take a nap." And then all of a sudden, they're talking about something completely different.

我要去冰箱里拿点东西，我想我可以小睡一下。”然后突然之间，他们谈论的是完全不同的事情。

So they might not even have an answer.

所以他们甚至可能没有答案。

So the psychiatrist has to be a really good detective, a benevolent detective, but a detective nonetheless, in determining whether or not these symptoms have existed for seven days or more and whether or not they meet at least three, could be more, but at least three of the criteria of symptom categories I talked about before.

因此，精神科医生必须是一位真正优秀的侦探，一位仁慈的侦探，但在确定这些症状是否已经存在了7天或更长时间以及它们是否满足至少三个（可能更多，但至少是我之前谈到的症状类别标准中的三个）时，仍然是一个侦探。

Now, assuming that they do, assuming that the patient meets those criteria, they are likely to be diagnosed with bipolar I.

现在，假设他们这样做，假设患者符合这些标准，他们很可能被诊断为 I 型双相情感障碍。

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

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

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

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

Many of them do, but many of them do not.

他们中的许多人这样做，但也有许多人不这样做。

So somebody can truly be diagnosed accurately with bipolar I even though they're only experiencing manic episodes and then dropping down to baseline.

因此，即使某人只是经历了躁狂发作，然后降至基线，也可以真正准确地诊断出患有 I 型双相情感障碍。

Manic episode, then dropping down to baseline.

躁狂发作，然后降至基线。

That's very important to understand.

理解这一点非常重要。

Now, the second category of bipolar disorder is bipolar II.

现在，双相情感障碍的第二类是双相情感障碍II。

So BPII, or bipolar disorder II, is somewhat different than bipolar disorder I.

因此，BPII 或双相情感障碍 II 与双相情感障碍 I 有所不同。

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

首先，其最常见的特征是同时存在躁狂发作、躁狂和抑郁发作，或所谓的轻躁狂。

Now, anytime in biology or in medicine you hear hypo, it's the opposite of hyper, okay?

现在，在生物学或医学中，任何时候你听到的hypo都是hyper的反义词，好吗？

So we've got normal, hyper, and hypo.

所以我们有正常、高和低。

Hypomania is a somewhat suppressed level of mania, so this is not going to be as extreme as the mania that we typically think of.

轻躁狂是躁狂的某种程度的抑制，因此它不会像我们通常想象的那样极端。

And yet the hypo can be due to the duration, not the intensity, of mania.

然而，低血压可能是由于躁狂的持续时间而不是强度造成的。

That's right.

这是正确的。

Hypomania can mean a lessened intensity of mania, but it can also be used to refer to a shorter duration of mania.

轻躁狂可以指躁狂强度减弱，但也可以用来指躁狂持续时间较短。

And in fact, that's one of the key criteria for bipolar II.

事实上，这是 II 型双相情感障碍的关键标准之一。

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

II型双相情感障碍通常是根据持续四天甚至更短的躁狂发作来诊断的。

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

因此，患有 BP2 的人可能会进行四天的这种精力充沛、目标导向的活动。

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

他们烦躁、欣快、睡不着等等，但这种情况只持续大约四天。

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

或者他们可能有更长的躁狂期，但它们是轻躁狂发作。

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

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

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

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

So people are going from manic episodes for four days or less, then they're dropping into a depression, going back to normal, manic again.

因此，人们会在四天或更短的时间内从躁狂发作中恢复过来，然后他们就会陷入抑郁，然后又恢复正常，变得躁狂。

I do want to point out, however, that people who have bipolar I can indeed go from manic episodes to severe, what we call major depression, so they can oscillate like a sine wave, really high highs, really low lows.

然而，我确实想指出，双相情感障碍患者确实可以从躁狂发作转为严重抑郁症，即我们所说的重度抑郁症，因此他们可以像正弦波一样振荡，非常高的高点，非常低的低点。

And very important to understand in terms of understanding both bipolar I and bipolar II, is that it's not always a sine wave.

在理解双极 I 和双极 II 方面，非常重要的是，它并不总是正弦波。

This is really important, and it's something that, frankly, I did not know until I started researching this episode and talking to some psychiatrists.

这非常重要，坦率地说，直到我开始研究这一集并与一些精神科医生交谈之前我才知道这一点。

I should mention, I've talked to several board-certified psychiatrists in preparation for this episode.

我应该提到，为了准备这一集，我已经与几位经过委员会认证的精神科医生进行了交谈。

I'll give some references to them, and in fact, some of them are going to be coming on the podcast as guests in the future for a more in-depth discussion about bipolar and other psychiatric disorders.

我会给他们一些参考，事实上，他们中的一些人将来将会作为嘉宾出现在播客上，对双相情感障碍和其他精神疾病进行更深入的讨论。

But all the psychiatrists I spoke to confirmed what the other was saying, which was that the way that bipolar disorder can present can vary tremendously between individuals.

但我采访过的所有精神科医生都证实了对方的说法，即双相情感障碍的表现方式在个体之间可能存在巨大差异。

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

一个人可能会从持续 7 天或更长时间的极高情绪转为极低情绪，即持续两周或更长时间的严重抑郁症。

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

其他人则快速循环三天躁狂，三天正常，三天躁狂，然后陷入三天抑郁。

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

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

It can take a lot of different forms.

它可以采取多种不同的形式。

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

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

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

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

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

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

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

由于这些极端的高潮和低谷，从非常狂躁到深度的抑郁发作更容易识别。

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

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

There are a couple other key features about bipolar I and bipolar II that can allow us to get better insight into whether or not somebody has bipolar I or bipolar II, and that's the percentage of time that people with bipolar I versus bipolar II spend in a manic state, a depressed state, or a symptom-free state.

关于双相 I 型和双相 II 型还有其他几个关键特征，可以让我们更好地了解某人是否患有双相 I 型或双相 II 型，即双相 I 型患者与双相 II 型患者处于躁狂状态、抑郁状态或无症状状态的时间百分比。

And this is also important to discuss because it turns out that people with genuine diagnosed bipolar I or bipolar II are often symptom-free.

讨论这一点也很重要，因为事实证明，真正诊断为 I 型双相情感障碍或 II 型双相情感障碍的人通常没有症状。

Which, again, can make it difficult for us as people that know them, or for people that are treating people with bipolar disorder, to identify whether or not somebody is in a manic episode or a depressive episode, or whether or not they are headed into a manic or depressive episode.

这又会让我们作为了解他们的人，或者治疗躁郁症患者的人，很难确定某人是否处于躁狂发作或抑郁发作，或者他们是否正在陷入躁狂或抑郁发作。

So the numbers on this have been studied.

因此，我们对这方面的数字进行了研究。

It's from a paper, actually two papers, first author Judd, J-U-D-D, et al., published some years ago, 20 years ago, but the data hold up really nicely over time.

它来自一篇论文，实际上是两篇论文，第一作者 Judd、J-U-D-D 等人发表于几年前，20 年前，但随着时间的推移，数据确实保持得很好。

These were both published in Journal of American Medical Association Psychiatry, so JAMA Psychiatry is a superb journal.

这些都发表在《美国医学会精神病学杂志》上，所以《JAMA Psychiatry》是一本很棒的杂志。

And basically, people who have bipolar I, on average, spend about 50%, it's actually 53% was the number that was eventually converged upon, but about 50% of their time symptom-free.

基本上，患有 I 型双相情感障碍的人平均花费大约 50%（实际上是最终收敛的数字 53%），但大约 50% 的时间没有症状。

That's interesting, right?

这很有趣，对吧？

Somebody who has genuine bipolar I disorder can spend as much as half of their life symptom-free, sleeping normally, speaking normally, et cetera.

患有真正的 I 型双相情感障碍的人可能有一半的时间没有任何症状，睡眠正常，说话正常，等等。

About 32% of the time depressed, and when we say depressed, we mean major depression.

大约有 32% 的人感到抑郁，当我们说抑郁时，我们指的是重度抑郁症。

So severe challenges with waking up at 2:00 or 3:00 in the morning and having trouble falling back asleep.

凌晨 2:00 或 3:00 醒来并难以重新入睡是一个严峻的挑战。

That's one of the defining characteristics of depression.

这是抑郁症的定义特征之一。

Or sleeping far too much, having a hard time getting out of bed in the morning, suppressed appetite, suppressed libido, suppressed motivation, all the general symptoms of major depression, which we'll talk about a little bit more later and in an upcoming episode about major depression in particular.

或者睡得太多，早上起床困难，抑制食欲，抑制性欲，抑制动机，所有重度抑郁症的一般症状，我们稍后会详细讨论，在即将到来的关于重度抑郁症的剧集中将特别讨论。

And then about 15% of their time in this kind of manic state or mixed manic state, where they are showing long, again, seven days or more, bouts of sleeplessness, irritability, pressured speech, grandiosity, et cetera.

然后他们大约有15%的时间处于这种躁狂状态或混合躁狂状态，在这种状态下，他们会再次表现出长时间、7天或更长时间的失眠、烦躁、言语压力、浮夸等等。

Contrast that with people who have bipolar II disorder, who are spending about half of their time in a depressed state.

相比之下，患有 II 型双相情感障碍的人大约有一半的时间处于抑郁状态。

So that's interesting.

这很有趣。

People with bipolar II disorder, while not always displaying depressed states or oscillations between mania or hypomania and depressed states, they tend to be in a depressed state more often.

患有 II 型双相情感障碍的人虽然并不总是表现出抑郁状态或在躁狂或轻躁狂与抑郁状态之间振荡，但他们往往更频繁地处于抑郁状态。

And again, this is major depression.

再说一遍，这是重度抑郁症。

This isn't just a little bit of a low, this is a serious depression of their nervous system, their mood, and as we say, their affect, their outlook on life.

这不仅仅是一点点的低落，这是他们的神经系统、他们的情绪，以及我们所说的，他们的情感、他们的人生观的严重抑郁。

And that's one of the key distinguishing features of major depression, is that people's outlook on life becomes very diminished in the sense that they don't see a future.

这是重度抑郁症的主要显着特征之一，那就是人们的生活观变得非常黯淡，因为他们看不到未来。

You ask them about, "How's work going?

你问他们：“工作进展得怎么样？

How are relationships?" And it's not just that they feel that that's going poorly, they really feel as if there's no opportunity for those things to improve.

关系怎么样？”他们不仅觉得事情进展得很糟糕，而且真的觉得这些事情没有机会改进。

Those people with bipolar II tend to be symptom-free about 45% of the time.

患有 II 型双相情感障碍的人在大约 45% 的时间里往往没有任何症状。

Again, these are averages, so about 45% of the time.

同样，这些是平均值，所以大约 45% 的时间。

That's a considerable amount of the time.

这是相当长的时间。

And they tend to be in these hypomanic states only about 4% or 5% of the time.

他们只有大约 4% 或 5% 的时间处于轻度躁狂状态。

Again, the criteria for BP2, bipolar II, is these four days or less of mania or hypomania, but only 4% of the time or 5% of the time is a small enough sliver of the pie that is these people's existence, that you could imagine why it would be easy for them or other people to overlook the fact that they have bipolar disorder and not major depression.

同样，BP2（双相情感障碍 II）的标准是四天或更短的躁狂或轻躁狂，但只有 4% 或 5% 的时间是这些人存在的一小部分，你可以想象为什么他们或其他人很容易忽视他们患有双相情感障碍而不是重度抑郁症的事实。

Think about it.

想一想。

This is a person who, or I should say, a collection of people who are spending about half of their time depressed, close to half, 45% of their time symptom-free, and then about 5% of their time in a hypomanic state, so either shortened bouts of high-intensity mania or hypomania that is of reduced intensity.

这个人，或者我应该说，是一群人，他们大约有一半的时间处于抑郁状态，接近一半（45%）的时间没有症状，然后大约 5% 的时间处于轻躁狂状态，因此要么是高强度躁狂的发作时间缩短，要么是强度降低的轻躁狂。

One of the reasons that I mention these percentages of time spent in a symptom-free, depressed, manic, or hypomanic state is because one of my major goals for today's episode is that it will increase awareness of whether or not you or somebody you know, could be a coworker, could be a family member, et cetera, might be suffering from bipolar I or bipolar II.

我提到这些处于无症状、抑郁、躁狂或轻躁狂状态的时间百分比的原因之一是因为我今天这一集的主要目标之一是它会提高人们对你或你认识的人、可能是同事、可能是家庭成员等是否可能患有双相I或双相II的认识。

I think it's fair to say that if somebody's suffering from bipolar I, that is likely to be revealed or to reveal itself before too long because of the fact that people have these extended periods of mania, and mania is such an extreme state, not just for the person who's experiencing it, but the way that it presents is just so extreme and out of the ordinary.

我认为可以公平地说，如果有人患有双相情感障碍 I，那么这种情况很可能会在很长一段时间内暴露出来，因为人们会经历长时间的躁狂，而躁狂是一种极端的状态，不仅对于正在经历它的人来说，而且它呈现的方式是如此极端和不寻常。

But bipolar II, you can imagine, could really duck under the radar of our awareness, and you could imagine that we might just think somebody is low or depressed, especially if that person tends to self-medicate with alcohol or other substances.

但你可以想象，双相情感障碍II可能真的会躲在我们意识的雷达之下，你可以想象，我们可能只是认为某人情绪低落或抑郁，特别是如果这个人倾向于用酒精或其他物质进行自我治疗。

We might think, oh, well, they're drinking more than usual, or they're spending more time alone and isolating.

我们可能会想，哦，好吧，他们比平时喝得更多，或者他们花更多的时间独处和隔离。

But then when they're in their hypomanic state, that might actually present as normal to us because they were in such a depressed state before.

但当他们处于轻躁狂状态时，这对我们来说可能实际上是正常的，因为他们之前处于如此抑郁的状态。

So it's very important that we dial up our awareness, that we tune our antennae to the possibility that people out there who might appear depressed or that we haven't heard from in a while might actually be suffering from bipolar II disorder.

因此，非常重要的是，我们要提高意识，调整我们的触角，以了解那些可能看起来很沮丧或我们已经有一段时间没有收到消息的人实际上可能患有 II 型双相情感障碍。

Before we move into an in-depth discussion about the different kinds of treatments for bipolar disorder, I'd like to touch on just a few additional aspects of what bipolar disorder can do in terms of its negative consequences, and also talk about some of the inherited risk, that is the genetic factors, and the environmental factors that can contribute to bipolar disorder.

在我们深入讨论双相情感障碍的不同治疗方法之前，我想先谈谈双相情感障碍在其负面后果方面的一些其他方面，并讨论一些遗传风险，即遗传因素和可能导致双相情感障碍的环境因素。

In terms of the burden, the very real emotional and occupational and educational burden that can occur for somebody with bipolar disorder, that's actually been studied.

就负担而言，双相情感障碍患者可能出现的非常真实的情感、职业和教育负担，实际上已经被研究过。

There's a measure of this, it's called global burden, which is defined as the years lost in engaging in normal life due to some disability.

有一个衡量标准，称为“全球负担”，其定义为由于某种残疾而无法正常生活的年数。

So that disability could be cancer, that disability in this case is bipolar disorder, and basically, the way this sort of study is done is that through questionnaires, I should say quite in-depth questionnaires, there's a probing for whether or not somebody has lost two consecutive weeks or more of interest in normal activities.

因此，残疾可能是癌症，这种情况下的残疾是双相情感障碍，基本上，这种研究的方式是通过问卷调查，我应该说是相当深入的问卷调查，调查某人是否连续两周或更长时间失去了对正常活动的兴趣。

Now, for people who have depression, that's a kind of straightforward thing to address, right?

现在，对于患有抑郁症的人来说，这是一件很容易解决的事情，对吧？

You ask somebody, "When was the last time you ate?" Or, "When was the last time that you went a few days without food or lost interest in relationships or work or sex or things of that sort?" And they answer, and you can figure out the amount of time that you've essentially been withdrawn from normal levels of activity for them.

你问某人：“你最后一次吃饭是什么时候？”或者，“你最后一次几天不吃东西或者对人际关系、工作、性或诸如此类的事情失去兴趣是什么时候？”他们会回答，您可以计算出您基本上从他们的正常活动水平中退出的时间。

With bipolar disorder, what it turns out is that the global burden of having bipolar I, and even bipolar II, is massive.

对于双相情感障碍，事实证明，患有 I 型双相情感障碍甚至 II 型双相情感障碍的全球负担是巨大的。

In fact, having bipolar disorder sits as one of the highest risk factors for being in the top 10 of all categories of disabilities leading to global burden.

事实上，双相情感障碍是导致全球负担的所有类别残疾中排名前十的最高风险因素之一。

Put in plain English, what that means is having bipolar I or bipolar II disorder is extremely debilitating.

简而言之，这意味着患有 I 型双相情感障碍或 II 型双相情感障碍会让人极度虚弱。

It really slows down one's life trajectory unless it's treated properly.

除非得到适当的对待，否则它确实会减慢一个人的生活轨迹。

Now, the other aspect of bipolar disorder is its heritability, and this gets into a little bit of some tricky science related to heritability versus the genetic contribution of a given disease.

现在，双相情感障碍的另一个方面是它的遗传性，这涉及到一些与遗传性与特定疾病的遗传贡献相关的棘手科学。

So that might sound like the same thing.

所以这听起来可能是同一件事。

You think, okay, genes relate to heritability, heritability relates to genes.

你想，好吧，基因与遗传力有关，遗传力与基因有关。

But of course, everything about the way that our nervous system works and functions and expresses itself, healthy or otherwise, is an interaction between our genes and our environment.

当然，我们的神经系统的工作、功能和表达方式，无论健康与否，都是基因与环境之间的相互作用。

And so typically, the way these studies are done is you address what is the risk of somebody having a given condition in the general population?

通常，这些研究的完成方式是解决一般人群中患有某种特定疾病的人的风险有多大？

We talked about that before.

我们之前谈过这个。

Bipolar disorder is a 1% of the world's population.

双相情感障碍占世界人口的 1%。

Compare that to people who have only major depression, so this would be repeated bouts of two weeks or more of serious depression, not just low mood or something due to a life loss, but major depression, which is 10% to 17% of people have major depression, okay?

与只有重度抑郁症的人相比，这将是两周或更长时间的严重抑郁症的反复发作，不仅仅是情绪低落或由于失去生命而导致的其他原因，而是重度抑郁症，即 10% 到 17% 的人患有重度抑郁症，好吗？

They suffer from major depressive disorder compared to bipolar disorder, which again, is 1%.

与双相情感障碍相比，他们患有重度抑郁症，双相情感障碍的比例为 1%。

Now, you can address how much of the 1% of bipolar disorder that exists is due to genes versus environment in a somewhat exact way.

现在，您可以以某种精确的方式解决 1% 的双相情感障碍中有多少是由于基因与环境造成的。

This is never an exact science, and the way that this is typically done is to look at concordance, that is, the likelihood that two identical twins will both have a given condition as opposed to two fraternal twins, which have more different genes than identical twins, of course, and then two siblings who have similar genes, of course, but less similar than identical or fraternal twins, and so on and so forth.

这从来都不是一门精确的科学，通常这样做的方法是查看一致性，即两个同卵双胞胎都具有给定条件的可能性，而不是两个异卵双胞胎，当然，异卵双胞胎比同卵双胞胎有更多不同的基因，然后是两个具有相似基因的兄弟姐妹，当然，但比同卵双胞胎或异卵双胞胎不太相似，等等。

So what you basically do is you evaluate the probability that two people in the general population who are completely unrelated will have the same condition, versus two people in the general population who are very related, identical twins.

所以你基本上要做的就是评估一般人群中两个完全不相关的人与一般人群中两个非常相关的同卵双胞胎患有相同病症的概率。

And what you find is that in identical twins, if one identical twin has true major depression or major depressive disorder, there's a 20% to 45% chance that their identical twin will also have major depressive disorder.

你会发现，在同卵双胞胎中，如果其中一个患有真正的重度抑郁症或重度抑郁症，那么他们的同卵双胞胎有 20% 到 45% 的可能性也会患有重度抑郁症。

Now, that tells you right there that it can't all be genes, that it's not a gene for major depression per se, or if it is a gene or a collection of genes, that those genes are also subject to environmental influences, either prenatal within the womb or after children are born.

现在，这告诉你，它不可能都是基因，它本身不是重度抑郁症的基因，或者如果它是一个基因或基因集合，那么这些基因也会受到环境影响，无论是在子宫内还是在孩子出生后。

Now, the large range there of 20% to 45% could be due to any number of things.

现在，20% 到 45% 的大范围可能是由于多种原因造成的。

It could be experimental, meaning the techniques that were used in experiments.

它可以是实验性的，意味着实验中使用的技术。

It could be due to regional differences, one part of the world versus another.

这可能是由于地区差异，世界的一个地区与另一个地区之间的差异。

There are a lot of different factors.

有很多不同的因素。

Right now, we probably shouldn't delve into all that.

现在，我们可能不应该深入研究所有这些。

At some point, we'll probably do an episode all about the genetics of nervous system heritability and heritability of features and mental health, et cetera.

在某个时候，我们可能会制作一集关于神经系统遗传性、特征遗传性和心理健康等的遗传学内容。

But we can compare major depression and the heritability or the genetic concordance between identical twins in major depression and bipolar disorder and ask if one twin of an identical twin pair has bipolar depression, what is the likelihood that the other twin will have it?

但是我们可以比较重度抑郁症以及重度抑郁症和双相情感障碍同卵双胞胎之间的遗传性或遗传一致性，并询问同卵双胞胎中的一个双胞胎是否患有双相抑郁症，另一个双胞胎患有双相抑郁症的可能性有多大？

And it turns out that number is much higher.

事实证明这个数字要高得多。

It's 40% to 70% likelihood or probability that if one twin has bipolar disorder, that their identical twin will also have bipolar disorder.

如果双胞胎中的一个患有双相情感障碍，那么他们的同卵双胞胎也将有 40% 到 70% 的可能性或概率患有双相情感障碍。

So again, the total incidence of bipolar disorder in the general population is much lower than it is for major depression.

同样，一般人群中双相情感障碍的总发病率远低于重度抑郁症的总发病率。

It's 1% for bipolar versus 10% to 17% for major depression, but the genetic component is much higher, 40% to 70% for bipolar disorder versus 20% to 45% for major depression.

双相情感障碍的患病率为 1%，而重度抑郁症的患病率为 10% 至 17%，但遗传因素要高得多，双相情感障碍的患病率为 40% 至 70%，而重度抑郁症的患病率为 20% 至 45%。

I know I'm throwing a lot of numbers out there, but basically what this means is that researchers have been able to take those numbers and filter them through a number of different risk factors that are related to early development.

我知道我抛出了很多数字，但这基本上意味着研究人员已经能够获取这些数字并通过与早期发育相关的许多不同风险因素来过滤它们。

Ask questions like if two twins were raised separately or together, or in one part of the world versus another, or had a two-parent household versus one-parent household.

提出一些问题，例如两个双胞胎是分开抚养还是一起抚养，或者在世界的一个地方与另一个地方长大，或者是双亲家庭还是单亲家庭。

Evaluate a lot of different variables.

评估许多不同的变量。

What they were able to discover, and this has been shown again and again, is that the genetic contribution to bipolar disorder is very, very high.

他们发现，并且这一点已经被一次又一次地证明，遗传因素对双相情感障碍的影响非常非常大。

That is, the heritability of bipolar disorder is 85%.

也就是说，双相情感障碍的遗传率为85%。

Okay?

好的？

So again, I want to be really clear what this means.

再次强调，我想弄清楚这意味着什么。

The total occurrence in the general population, fairly low.

一般人群中的总发生率相当低。

Still serious, 1%, but fairly low compared to other things like major depression.

仍然很严重，1%，但与重度抑郁症等其他疾病相比相当低。

However, if someone has bipolar disorder, it's very likely that they inherited some gene or sets of genes, or more accurately, a susceptibility within their genes to environmental influences that can trigger bipolar disorder.

然而，如果某人患有双相情感障碍，他们很可能继承了某些基因或一组基因，或者更准确地说，他们的基因对环境影响的敏感性可能引发双相情感障碍。

There are a lot of different ways to discuss and to conceptualize heritability, so I want to be very careful with the way that I'm wording this.

有很多不同的方法来讨论和概念化遗传性，所以我要非常小心我的措辞方式。

What this means is that people with bipolar disorder very likely have a gene, or more typically it's going to be a set of genes, that creates a susceptibility for bipolar disorder to present itself.

这意味着患有双相情感障碍的人很可能有一个基因，或者更典型的是一组基因，使双相情感障碍容易出现。

Now, what environmental factors trigger or increase that susceptibility is not entirely clear.

现在，哪些环境因素触发或增加这种易感性尚不完全清楚。

This always seems to center back onto the same sets of things like early life stress, trauma, et cetera.

这似乎总是集中在同样的事情上，比如早年的生活压力、创伤等等。

Certainly, those are going to exacerbate the likelihood that someone who has a genetic propensity for bipolar disorder will express that bipolar disorder in its full array of symptomology.

当然，这些都会加剧具有双相情感障碍遗传倾向的人表现出双相情感障碍的全部症状的可能性。

But 85%, while very, very high, is not 100%.

但 85% 虽然非常非常高，但并不是 100%。

Again, 85%, while a very high number for heritability, is not 100%.

同样，85% 虽然对于遗传力来说是一个非常高的数字，但并不是 100%。

What that means is that there is no single gene or identified gene cluster for bipolar disorder.

这意味着没有单个基因或已识别的双相情感障碍基因簇。

The reason I keep drilling into this over and over is that I think we can confidently say that if someone has bipolar disorder, that there was something in their genetic lineage that led to that, or that very likely led to that.

我不断深入研究这个问题的原因是，我认为我们可以自信地说，如果某人患有双相情感障碍，那么他们的遗传谱系中存在某些东西导致了这种情况，或者很可能导致了这种情况。

And yet it's not like eye color or some other physical feature which we can actually do the direct, it's called Mendelian genetics, and figure out whether or not somebody directly inherited that gene from one parent or the other parent.

然而，它不像眼睛颜色或其他一些身体特征，我们实际上可以直接做到这一点，它被称为孟德尔遗传学，并确定某人是否直接从父母之一或另一方遗传了该基因。

So the takeaway here is that if you have certainly an identical twin or a fraternal twin or a sibling or a parent, or even a cousin or an uncle that has bipolar disorder, in particular bipolar 1, well, then you need to be on the lookout for bipolar disorder, perhaps in yourself and for the family members of that person.

因此，这里的要点是，如果您确实有同卵双胞胎、异卵双胞胎、兄弟姐妹、父母、甚至堂兄弟姐妹或叔叔患有躁郁症，特别是躁郁症 1，那么您需要警惕躁郁症，也许是您自己以及该人的家庭成员。

My goal within this episode up until now has been to provide a clear and detailed picture of bipolar disorder and its various forms.

到目前为止，我在这一集中的目标是提供双相情感障碍及其各种形式的清晰详细的描述。

Before we start to talk about treatments for bipolar disorder and some of the neural circuit basis for bipolar disorder, I want to make sure that I distinguish bipolar disorder from borderline personality disorder.

在我们开始谈论双相情感障碍的治疗方法和双相情感障碍的一些神经回路基础之前，我想确保区分双相情感障碍和边缘性人格障碍。

We will do an entire episode, or maybe even several episodes, about borderline personality disorder.

我们将制作一整集，甚至几集，讲述边缘型人格障碍。

Borderline personality disorder can indeed present itself in ways that resemble bipolar disorder and vice versa, but there are some key distinctions that need to be made because it turns out that bipolar disorder and borderline personality disorder are quite distinct in terms of their defining criteria.

边缘性人格障碍确实可以以类似于双相情感障碍的方式表现出来，反之亦然，但需要做出一些关键的区别，因为事实证明，双相情感障碍和边缘性人格障碍在定义标准方面是截然不同的。

The key distinction between somebody with borderline personality disorder and bipolar disorder is that in borderline personality disorder, there can be episodes that can resemble mania or hypomania.

边缘性人格障碍和双相情感障碍之间的主要区别在于，边缘性人格障碍可能会出现类似于躁狂或轻躁狂的发作。

So periods of flights of ideas or where people are spending money excessively or are sexually promiscuous in ways that seem manic or could even be a little bit manic or a lot manic.

因此，在思想飞扬的时期，或者人们过度花钱或性混乱的时期，看起来很狂躁，甚至可能有点狂躁或非常狂躁。

And yet, more often than not, there is an environmental trigger for those manic episodes.

然而，这些躁狂发作往往是由环境触发的。

That is distinctly different from bipolar disorder, where the person will have manic episodes without any need for a trigger.

这与双相情感障碍明显不同，双相情感障碍患者无需任何触发因素就会出现躁狂发作。

There doesn't need to be a call from someone saying, "Hey, let's go on a vacation together," or, "There's something coming up this Friday that's really exciting," or, "Let's enter a relationship together of one form or another." The person with bipolar disorder will have episodes of mania or episodes of major depression without any need for an external stimulus or environmental trigger.

不需要有人打来电话说：“嘿，我们一起去度假吧”，或者“这个星期五将会发生一些非常令人兴奋的事情”，或者“让我们一起建立一种或另一种形式的关系”。双相情感障碍患者会在不需要任何外部刺激或环境触发的情况下出现躁狂发作或重度抑郁发作。

But the person with borderline personality disorder, almost always, again, there's never an always in biology and psychiatry, but almost always is going to exhibit flights of mania or depressive episodes or other types of mood shifts that are dramatic and maladaptive in response to things that are coming in through the external environment or relationships of some kind.

但患有边缘性人格障碍的人，几乎总是，生物学和精神病学上从来没有永远，但几乎总是会表现出躁狂或抑郁发作或其他类型的情绪变化，这些变化是对通过外部环境或某种关系进入的事物做出戏剧性和适应不良的反应。

In fact, one of the defining characteristics of borderline personality disorder is this thing that's referred to as splitting.

事实上，边缘型人格障碍的定义特征之一就是所谓的分裂。

A good example of splitting in a person with borderline personality disorder is that they will feel that they absolutely adore you and want to spend all their time with you and just think the world of you.

边缘型人格障碍患者分裂的一个很好的例子是，他们会觉得自己绝对崇拜你，想和你一起度过所有的时间，只想着你的世界。

You can do no wrong.

你不能做错事。

And in fact, they genuinely can feel that way and can genuinely think that way about you.

事实上，他们真的能有这样的感觉，也能真诚地这样想你。

And then for whatever reason, it could be a perception of something that you did or something that you said or suspicion that you're thinking something about them, they can suddenly shift or split their emotions and what's called move you from a good object or a can-do-no-wrong object to a bad object.

然后，无论出于什么原因，这可能是对你所做的事情或你所说的事情的感知，或者怀疑你正在思考他们的某些事情，他们可能会突然转移或分裂他们的情绪，这就是所谓的将你从一个好对象或一个不能做错的对象转移到一个坏对象。

They'll suddenly decide that you are cheating on them, or that you are being mean to them, or that you're insulting them, or that something that you're doing is in violation to their self-worth, their wellbeing, et cetera.

他们会突然认为你在欺骗他们，或者你对他们很刻薄，或者你在侮辱他们，或者你正在做的事情侵犯了他们的自我价值、他们的福祉等等。

And that can send them down a pathway of being very angry, very depressed, et cetera.

这会让他们变得非常愤怒、非常沮丧等等。

As I describe the contour of a person with borderline personality disorder, as somebody who splits very suddenly in response to some environmental trigger, real or perceived, there's the risk, of course, that it makes the person with borderline personality disorder sound like a bad person, that they're very volatile.

当我描述边缘性人格障碍患者的轮廓时，因为某人因某种环境触发因素（无论是真实的还是感知的）而突然分裂，当然存在这样的风险：这会让边缘性人格障碍的人听起来像个坏人，他们非常不稳定。

And while they can be volatile, I want to be very careful to point out that the person with borderline personality disorder is also suffering in this context.

虽然它们可能不稳定，但我想非常小心地指出，边缘性人格障碍患者也在这种情况下遭受痛苦。

So while those sorts of relationships with people with borderline personality disorder, whether or not they're romantic relationships or familial or coworkers, et cetera, can be very challenged, can be very high friction because of the good object, bad object shifts, et cetera, it's bidirectional, meaning the person with borderline personality disorder, as you can imagine, is also going through a lot of suffering.

因此，虽然与边缘性人格障碍患者的关系，无论是浪漫关系、家庭关系还是同事关系等，都可能会面临很大的挑战，可能会因为好的客体、坏客体的转移等而产生很大的摩擦，但它是双向的，这意味着边缘性人格障碍的人，正如你可以想象的那样，也正在经历很多痛苦。

At one moment, they feel as if someone is wonderful and can do no wrong to them, and they want to be so strongly affiliated with them.

某一时刻，他们觉得某人很棒，不会对他们做错事，他们希望与他们有如此强烈的联系。

And then in the next moment, they feel as if that person is attacking them through their actions or even through their non-actions.

然后在下一刻，他们感觉好像那个人正在通过他们的行动甚至不行动来攻击他们。

So again, we will return to borderline personality disorder in a separate episode.

因此，我们将在单独的一集中再次讨论边缘型人格障碍。

It's a serious disorder, both for the person that has it and for people around them.

对于患有该病的人和周围的人来说，这是一种严重的疾病。

Fortunately, there are some emerging treatments that are showing promise, and it's a fairly common disorder.

幸运的是，有一些新兴的治疗方法显示出了希望，而且这是一种相当常见的疾病。

But it's important that we distinguish borderline personality disorder from bipolar disorder, mostly on the basis of this need for a trigger.

但重要的是，我们将边缘性人格障碍与双相情感障碍区分开来，主要是基于对触发因素的需求。

Again, in bipolar disorder, there is no need for a trigger to create a manic episode or a major depressive episode.

同样，在双相情感障碍中，不需要触发因素来产生躁狂发作或重度抑郁发作。

They just happen, or they can just happen.

它们就这样发生了，或者它们可能就发生了。

Whereas in borderline personality disorder, almost always, there's an external trigger or a perception that something happened in the environment or that somebody is behaving a certain way that dramatically shifts the person with borderline personality disorder from one mode to the next.

而在边缘型人格障碍中，几乎总是存在外部触发因素或感知，即环境中发生了某些事情，或者某人的某种行为方式戏剧性地将边缘型人格障碍患者从一种模式转变为另一种模式。

As we move into our discussion about the treatments for and neural circuits underlying bipolar disorder, I want to just nail down one more key point.

当我们开始讨论双相情感障碍的治疗方法和潜在的神经回路时，我想再明确一个关键点。

This is a very brief point, but it's perhaps the most important point, which is the highs and lows, or we should say the highs, these manic episodes, and sometimes lows, because again, not everybody with bipolar disorder one or two suffers from depressive episodes.

这是一个非常简短的观点，但它可能是最重要的一点，即高潮和低谷，或者我们应该说高潮，这些躁狂发作，有时还有低谷，因为同样，并不是每个患有一两次双相情感障碍的人都会遭受抑郁发作。

Sometimes yes, sometimes no. In particular, in bipolar two, yes, but people with bipolar one can have extreme manic episodes and then just return to normal, as you recall.

有时是，有时不是。特别是对于双相情感障碍二型患者，是的，但是双相情感障碍一型患者可能会出现极度躁狂发作，然后就恢复正常，正如您所记得的那样。

Well, those extreme lows and/or extreme highs of people with bipolar disorder impact their lives in very negative ways.

嗯，躁郁症患者的极度低落和/或极度兴奋会对他们的生活产生非常负面的影响。

This is essential, and it's something that we're going to return to a little bit later when we talk about the relationship between bipolar disorder and creativity, because it turns out that there's a quite strong association there, one that would almost lead you to believe that being bipolar can be beneficial in certain contexts, and yet, on whole, having bipolar disorder is extremely detrimental and challenging to the person suffering from it.

这是至关重要的，当我们稍后讨论双相情感障碍和创造力之间的关系时，我们将回到这一点，因为事实证明，两者之间存在着相当强的关联，这种联系几乎会让你相信双相情感障碍在某些情况下可能是有益的，但总的来说，患有双相情感障碍对患有双相情感障碍的人来说是极其有害和具有挑战性的。

And it's something that we want to keep in mind as we think about treatments and the underlying biology.

当我们考虑治疗方法和潜在的生物学原理时，我们要牢记这一点。

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

现在我想谈谈双相情感障碍的一些治疗方法。

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

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

And in the description of the discovery of this treatment for bipolar disorder, it also reveals to us that sometimes treatments come to the profession of medicine and through science in ways that precede the discovery of the underlying biology.

在描述这种双相情感障碍治疗方法的发现时，它还向我们揭示，有时治疗方法会以先于潜在生物学发现的方式通过科学进入医学专业。

That's right.

这是正确的。

Every once in a while, someone will discover a treatment for a disease without any understanding about the underlying biological basis of that disease.

每隔一段时间，就会有人发现一种疾病的治疗方法，但对该疾病的生物学基础没有任何了解。

And in fact, that is the case for bipolar disorder.

事实上，双相情感障碍就是这种情况。

And the treatment that we are referring to is lithium.

我们指的治疗方法是锂。

Lithium, as some of you know, is on the periodic table of elements.

正如你们中的一些人所知，锂位于元素周期表中。

It is indeed a naturally occurring substance.

它确实是一种天然存在的物质。

It actually arrived on Earth by way of stardust.

它实际上是通过星尘到达地球的。

Yes, we are talking about stardust on this podcast.

是的，我们在这个播客上谈论星尘。

But if you'd like to learn more about the origins of lithium and how lithium arrived here on Earth for its discovery and applications in psychiatry, there's a beautiful talk that exists on YouTube, and we'll provide a link to this in the show note captions That describes the history of lithium in terms of its interplanetary travels and arrival on Earth.

但是，如果您想了解更多有关锂的起源以及锂如何到达地球并在精神病学中发现和应用的信息，YouTube 上有一个精彩的演讲，我们将在节目注释标题中提供指向此内容的链接，该链接描述了锂的星际旅行和抵达地球的历史。

This is a talk delivered by a physicist who's expert in quantum mechanics and is expert in lithium, and it's a just wonderful talk that I can refer you to.

这是一位物理学家的演讲，他是量子力学方面的专家，也是锂方面的专家，这是一个非常精彩的演讲，我可以推荐给你。

Less on the biology in that talk, but certainly a lot about lithium as an element.

演讲中关于生物学的内容较少，但肯定有很多关于锂作为一种元素的内容。

So for those of you nerds like me that love to know how things came to be here on the planet in one form or another, I'll encourage you to take a brief listen to that talk.

因此，对于像我这样喜欢了解事物如何以某种形式出现在地球上的书呆子，我鼓励您简短地听一下这个演讲。

We are going to discuss lithium in the context of its applications for treatment of bipolar disorder, and the discovery of lithium as a treatment for bipolar disorder is truly a miraculous story that I think everyone should know.

我们将在锂治疗双相情感障碍的应用中讨论锂，发现锂可以治疗双相情感障碍确实是一个神奇的故事，我认为每个人都应该知道。

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

这个故事的关键人物是一位姓凯德的医生。

He was an Australian physician, and Cade has a very interesting story in his own right.

凯德是一位澳大利亚医生，他自己也有一个非常有趣的故事。

Cade was an Australian psychiatrist, or Australian psychiatrist, who also was a soldier.

凯德是一位澳大利亚精神病学家，或者说澳大利亚精神病学家，同时也是一名军人。

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

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

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

所以他有一些时间进行观察，在监禁期间，他观察到一些狱友在情绪和精力上经历了相当剧烈的波动，基本上是从躁狂发作到抑郁发作，或者从躁狂发作到正常发作。

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

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

In other words, Cade hypothesized that there's a buildup of a chemical in certain people's brains that makes them manic, and they urinate that chemical out.

换句话说，凯德假设某些人的大脑中积聚了一种化学物质，使他们变得躁狂，然后他们将这种化学物质排出体外。

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

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

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

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

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

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

Right?

正确的？

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

他对这些豚鼠采取的具体措施尚不清楚。

This is at a time or an era in science when you could just sort of report things a little bit more subjectively.

在科学的一个时代或一个时代，你可以更主观地报告事情。

Although there were still numbers and statistics, it was a little bit more of case studies and descriptions.

虽然仍然有数字和统计数据，但更多的是案例研究和描述。

But it turns out that even though that all seems a little bit loose, it led to some incredible and still important discoveries for psychiatric health.

但事实证明，尽管这一切看起来有点松散，但它为精神健康带来了一些令人难以置信且仍然重要的发现。

So what he figured out was that the urine from manic patients seemed to be more toxic for these guinea pigs.

所以他发现，躁狂症患者的尿液似乎对这些豚鼠的毒性更大。

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

而且他还知道，尿液中有两种有毒物质，尿素和尿酸。

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

因此，他能够将躁狂症患者和没有躁狂症患者的尿素和尿酸区分开来，并且他发现这些精神病躁狂患者和非躁狂患者的尿素是相同的。

So it did not seem that urea was the compound that was creating these manic episodes or related to manic episodes or held the toxicity.

因此，尿素似乎并不是造成这些躁狂发作或与躁狂发作相关或具有毒性的化合物。

So instead, he focused on the uric acid.

因此，他转而关注尿酸。

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

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

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

碰巧的是，你们化学家会熟悉这一点，但有些事情并不容易解决。

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

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

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

它实际上不会变成可以注射的透明液体。

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

因此为了尝试注射不同浓度的尿酸，他最终使用锂来辅助稀释，锂起了作用。

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

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

Okay?

好的？

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

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

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

他还发现尿酸锂对这些豚鼠具有总体镇静作用。

So now we're really off in crazy territory.

所以现在我们真的陷入了疯狂的境地。

Right?

正确的？

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

我们谈论的是分离出尿素和尿酸的患者尿液。

We're adding lithium to the uric acid.

我们在尿酸中添加锂。

We're injecting this into guinea pigs.

我们正在将其注射到豚鼠体内。

This is getting pretty wild and pretty weird.

这变得非常疯狂和奇怪。

But this is medicine, and from time to time, this is medicine and science.

但这就是医学，有时，这是医学和科学。

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

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

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

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

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

因此，他非常恰当地问道，也许锂本身就能对这些豚鼠产生镇静作用。

And indeed, that was the case.

事实确实如此。

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

当他做了适当的对照实验并只给这些豚鼠注射锂溶液时，它们平静了下来。

From there He in sort of 1940s style medicine, this would not happen now.

从那时起，他按照 20 世纪 40 年代风格的医学，现在不会发生这种情况。

He very quickly moved from that animal model into human patients and started injecting human patients with lithium or providing lithium orally to those patients.

他很快从该动物模型转移到人类患者身上，并开始为人类患者注射锂或为这些患者口服锂。

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

你瞧，我们发现锂在减轻躁狂症状方面具有绝对深远和积极的作用。

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

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

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

这是 1949 年 9 月 3 日发表在《澳大利亚医学杂志》上的一篇论文。

We will provide a link to this study, it is now a classic study in the field of psychiatry.

我们将提供这项研究的链接，它现在是精神病学领域的一项经典研究。

It's a really wonderful paper to read, and actually, I encourage people, even if you're not a scientist or a clinician, to just take a quick look at the second page in this paper that we've made available to you, where he describes each of the various case studies or the individuals that he looked at.

这是一篇非常精彩的论文，实际上，我鼓励人们，即使您不是科学家或临床医生，也可以快速浏览一下我们为您提供的本文的第二页，其中他描述了每个不同的案例研究或他所研究的个人。

I'm not going to read these in detail now because it would take a lot of unnecessary time.

我现在不打算详细阅读这些内容，因为这会花费很多不必要的时间。

But things like Case seven, MC, aged 40 years old, suffering from manic recurrent mania.

但事情就像案例七，MC，40岁，患有躁狂症，反复发作。

In this episode, he'd been excited, restless, and violent for over two months and was interfering so often that he had to be confined to a single room during the day.

在这一集中，他两个多月以来一直处于兴奋、不安和暴力状态，并且经常干涉，以至于白天不得不被限制在一个房间里。

Right?

正确的？

So this is very debilitating, what we now know to be bipolar depression.

所以这是非常令人衰弱的，我们现在知道这就是躁郁症。

He commenced taking lithium citrate 20 grains, that's a measure of the amount of lithium, three times a day.

他开始每天服用 3 次柠檬酸锂，每次 20 粒（这是锂含量的衡量标准）。

In four days, he was distinctly quieter, and by February 13th, 1949, appeared practically normal.

四天内，他明显变得更加安静，到 1949 年 2 月 13 日，他看起来几乎恢复正常。

He continued well, and on February 20th, 1949, the dose of citrate was reduced to 10 grains, et cetera.

他继续坚持下去，1949年2月20日，柠檬酸盐的剂量减少到10粒，等等。

He left the hospital.

他离开了医院。

There are numerous descriptions of this sort within this paper, including some descriptions of patients that did not see such success and including some descriptions of patients that suffered from some negative side effects.

本文中有许多此类描述，包括一些对没有取得如此成功的患者的描述，以及一些对遭受某些负面副作用的患者的描述。

So that's important to point out as well.

所以指出这一点也很重要。

But it's an absolutely wonderful paper and it's an absolutely wonderful voyage into the history of psychiatry, right down to the discussion where in just three short paragraphs, Cade really lays out the case for why lithium is such an important discovery in the treatment of what at that time they were calling psychotic excitement and what we now know to be manic bipolar depression.

但这绝对是一篇精彩的论文，也是对精神病学历史的一次精彩的旅程，直到讨论，凯德在短短的三个段落中真正阐述了为什么锂在治疗当时他们所说的精神病性兴奋和我们现在所知的躁狂双相抑郁症方面是一个如此重要的发现。

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

我应该提到，锂具有许多重要的特性，但也有一些需要考虑的重要副作用。

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

首先，它确实具有一定的毒性，因此需要非常仔细地监测血液中锂的含量。

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

因此，这并不是那种人们只要服用给定剂量就能让每个患者产生相同反应的药物。

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

需要进行大量的监督和大量的血液检查，尤其是在锂治疗的前三个月。

I should mention that lithium treatment is still used to some great degree of success in many, not all, people suffering from bipolar depression or bipolar disorder rather.

我应该提到的是，对于许多（不是全部）患有双相抑郁或双相情感障碍的人来说，锂盐治疗仍然取得了一定程度的成功。

But there are a number of important things that happened between 1949 and present day that prevented lithium from reaching patients that really needed it, and that all can be summarized in two or three short sentences.

但从 1949 年至今，发生了许多重要的事情，导致锂无法到达真正需要它的患者手中，所有这些都可以用两三个简短的句子来概括。

Basically, by virtue of the fact that lithium is a naturally occurring element, it could not be patented, and as a consequence of that, there wasn't a lot of potential profit for drug companies to produce lithium.

基本上，由于锂是一种天然存在的元素，它无法获得专利，因此，制药公司生产锂的潜在利润并不多。

In fact, still to this day, it's very low cost, and still to this day, no one really owns the patent for lithium in its purest form.

事实上，直到今天，它的成本仍然非常低，而且直到今天，仍然没有人真正拥有最纯粹形式的锂的专利。

So that made it unattractive.

所以这使得它没有吸引力。

It turns out that the FDA in the United States didn't allow lithium to be used as a treatment for manic bipolar disorder until 1970.

事实证明，美国FDA直到1970年才允许锂用于治疗躁郁症。

So we're talking about a full 21 years from the publication of this paper by Cade in the Medical Journal of Australia, showing quite beautifully the great potential and use of lithium for quelling the symptoms of bipolar disorder until the first patients in the United States were starting to access lithium regularly.

因此，我们谈论的是从 Cade 在《澳大利亚医学杂志》上发表这篇论文到美国第一批患者开始定期服用锂为止的整整 21 年，该论文完美地展示了锂在缓解双相情感障碍症状方面的巨大潜力和用途。

And nowadays, of course, lithium is available, but still not able to be patented because it's element number three on the periodic table.

当然，如今锂已经可用，但仍然无法申请专利，因为它是元素周期表上的第三号元素。

It's naturally occurring.

这是自然发生的。

It's not literally falling down from the stars as stardust and going into pill form, but rather it can be synthesized in laboratories.

它并不是真正以星尘的形式从恒星上落下并变成药丸的形式，而是可以在实验室中合成。

But it is available.

但它是可用的。

It does show not only great potential in many patients, but great application in many patients despite its side effects.

它不仅在许多患者中显示出巨大的潜力，而且尽管有副作用，但在许多患者中具有巨大的应用价值。

So lithium really stands as this kind of golden example of a treatment that works, at least in many individuals, prior to an understanding of the biological basis of the disease for which that treatment is needed.

因此，在了解需要治疗的疾病的生物学基础之前，锂确实是这种治疗方法的黄金范例，至少对许多人来说是有效的。

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

话虽如此，科学家和临床医生一直在非常严格地尝试了解锂的作用原理和原理，以便了解双相情感障碍的原因和作用。

This is the way that proper medicine and science is done.

这就是正确的医学和科学的运作方式。

Even if there's an excellent treatment for something, it's important to understand why that treatment works because first of all, not everyone responds to that treatment.

即使对某件事有很好的治疗方法，了解这种治疗方法为何有效也很重要，因为首先，并不是每个人都对这种治疗方法有反应。

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

其次，科学家和医生明白，仅仅因为我们有一种有效的治疗方法，如果它有任何副作用，就有可能有更好的治疗方法。

So it's not just about trying to bypass a drug that doesn't make much money for drug companies.

因此，这不仅仅是试图绕过一种对制药公司来说赚不了多少钱的药物。

I know a lot of people think in those terms.

我知道很多人都这么想。

They think, "Oh, well, there's this continued search for better treatments for bipolar disorder, even though lithium works because lithium doesn't allow drug companies to make much money."

他们认为，“哦，好吧，尽管锂有效，但人们仍在继续寻找更好的双相情感障碍治疗方法，因为锂不允许制药公司赚很多钱。”

That's not really the case.

事实并非如此。

The fact of the matter is, is that the toxicity, some of the other issues that are created with lithium, the fact that people need the ongoing blood testing, et cetera, really stimulates the need, really an urgent need for new and better treatments for bipolar disorder.

事实是，锂的毒性、锂引起的其他一些问题、人们需要持续进行血液检测等事实确实刺激了这种需求，确实迫切需要新的、更好的双相情感障碍治疗方法。

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

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

If you were to do a literature search on The actions and mechanisms of lithium in terms of how it can calm people down and reduce their manic episodes, you would find an enormous array of papers, literally thousands of scientific studies in animals and in humans, which, for instance, will tell you that lithium treatment will increase so-called BDNF, brain-derived neurotrophic factor.

如果你要对锂的作用和机制进行文献检索，了解它如何让人们平静下来并减少躁狂发作，你会发现大量论文，实际上是数以千计的动物和人类科学研究，例如，这些研究会告诉你，锂治疗会增加所谓的 BDNF（脑源性神经营养因子）。

BDNF is often talked about in the context of neuroplasticity, the brain and nervous system's ability to change in response to experience, and indeed, it does seem that ingesting lithium increases BDNF.

BDNF 经常在神经可塑性、大脑和神经系统响应经验而变化的能力的背景下被谈论，事实上，摄入锂似乎确实会增加 BDNF。

BDNF is what we call permissive for neuroplasticity.

BDNF 就是我们所说的神经可塑性的允许性。

It doesn't create specific changes in the brain, meaning it's not going to make your memory better or your coordination better or your emotional state better per se.

它不会在大脑中产生特定的变化，这意味着它不会让你的记忆力更好，你的协调性更好，或者你的情绪状态本身更好。

What BDNF does is it permits the neurons, the nerve cells, and their connections in the brain to be more likely to change if the proper environmental conditions are met.

BDNF 的作用是，如果满足适当的环境条件，它允许神经元、神经细胞及其在大脑中的连接更有可能发生变化。

That is, BDNF creates a kind of buoyancy to neuroplasticity.

也就是说，BDNF 为神经可塑性创造了一种浮力。

It opens the gates to neuroplasticity.

它打开了神经可塑性的大门。

So lithium does increase BDNF.

所以锂确实会增加 BDNF。

We'll talk about why that's important in the context of the neural circuits involved with bipolar disorder in a few minutes.

几分钟后我们将讨论为什么这对于涉及双相情感障碍的神经回路很重要。

It also seems to be a potent anti-inflammatory.

它似乎也是一种有效的抗炎剂。

Now, inflammation is one of those words that's thrown around extensively nowadays, especially on social media, and especially as it relates to any health condition.

现在，炎症是当今广泛使用的词语之一，尤其是在社交媒体上，尤其是因为它与任何健康状况有关。

It's like inflammation, inflammation, inflammation always seems to be discussed in the context of inflammation being bad.

就像炎症，炎症，炎症似乎总是在炎症不好的背景下讨论。

But I do want to point out that inflammation is a natural adaptive response to physical injury to a cell or organ or tissue of any kind.

但我确实想指出，炎症是对任何类型的细胞、器官或组织的物理损伤的自然适应性反应。

Inflammation is the basis by which adaptations occur to exercise.

炎症是运动适应的基础。

So for instance, you were to weight train and use a heavier than normal weight and do a set to failure or create some little micro tears in the muscle that are healthy in the sense that they would create adaptations and make that muscle stronger, maybe even grow that muscle.

举例来说，你要进行重量训练，使用比正常重量更重的重量，做一组直到力竭，或者在肌肉中产生一些微小的微小撕裂，这些撕裂是​​健康的，因为它们会产生适应并使肌肉更强壮，甚至可能会生长肌肉。

There's an inflammatory response associated with that, that is critical to the positive adaptation.

与此相关的炎症反应对于积极适应至关重要。

So inflammation isn't always bad, although excessive or, as we say, runaway inflammation is bad.

因此，炎症并不总是有害的，尽管过度的炎症或正如我们所说的失控的炎症是有害的。

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

锂似乎能够抑制炎症，重要的是，它可以抑制神经组织，特别是大脑内的炎症。

That is important, and we will return to that and why it's important in a little bit.

这很重要，我们稍后会回顾这一点以及为什么它很重要。

The other thing about lithium is that lithium is neuroprotective.

关于锂的另一件事是锂具有神经保护作用。

That is, it can prevent neurons from dying under certain conditions.

也就是说，它可以防止神经元在某些条件下死亡。

Why would neurons die?

为什么神经元会死亡？

Well, there are a lot of reasons why neurons can die.

神经元死亡的原因有很多。

There can be a physical insult to the neurons.

神经元可能受到物理伤害。

You can get hit really hard in the head.

你的头部可能会受到重击。

A bullet, God forbid, can enter the skull and kill neurons.

上帝保佑，子弹可以进入头骨并杀死神经元。

There are a lot of reasons why neurons can die.

神经元死亡的原因有很多。

Neuroprotection is a situation in which a neuron is given some sort of chemical or physical resiliency that allows it to suffer an insult and yet bounce back.

神经保护是一种情况，其中神经元被赋予某种化学或物理弹性，使其能够承受伤害并恢复。

So it's very similar to the way that we think about psychological resiliency.

所以这与我们思考心理弹性的方式非常相似。

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

神经保护是神经元更好地处理不同类型的压力，特别是兴奋性毒性的能力。

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

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

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

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

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

因此，锂似乎可以预防某些神经毒性。

Now, this turns out to be particularly important for this discussion about bipolar disorder and the neural circuit basis of bipolar disorder because if we are to take a step back and ask what's different in the brains of people with bipolar disorder, there are some very interesting answers that start to emerge.

现在，事实证明，这对于关于双相情感障碍和双相情感障碍的神经回路基础的讨论特别重要，因为如果我们退后一步，问问双相情感障碍患者的大脑有什么不同，就会开始出现一些非常有趣的答案。

There are basically two main neural circuits that are present in normal individuals.

正常人基本上存在两种主要的神经回路。

And when I say normal, I say that respectfully to the people with bipolar disorder by referring to people who do not suffer from manic episodes or from manic depression.

当我说“正常”时，我是指那些没有患有躁狂发作或躁狂抑郁症的人，这是对双相情感障碍患者的尊重。

There are circuits that are present in people with bipolar disorder and in people that do not suffer from bipolar disorder.

双相情感障碍患者和未患有双相情感障碍的人体内都存在一些回路。

Both of those circuits do the same thing in both sets of individuals, and yet in people with bipolar disorder, there seems to be an atrophy or a removal of certain neural connections over time that leads to a situation in which people with bipolar disorder become very poor at registering their own internal state, in particular their emotional states and their somatic states.

这两种回路在两组个体中都做同样的事情，但在双相情感障碍患者中，随着时间的推移，某些神经连接似乎会萎缩或消失，导致双相情感障碍患者变得非常不善于记录自己的内部状态，特别是他们的情绪状态和躯体状态。

What we're referring to here is something called interoception.

我们在这里指的是所谓的内感受。

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

我之前在 Huberman 实验室播客上谈过这个问题，但有两种感知模式。

Perception, of course, is attention to something that's happening in our environment or to us on or within our body.

当然，感知是对我们环境中或我们身体上或体内发生的事情的关注。

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

外感受实际上是对我们皮肤范围之外发生的事情的关注。

So seeing that person's face over there, or seeing that color of leaf over there, or hearing a sound over to my left.

所以看到那边那个人的脸，或者看到那边树叶的颜色，或者听到我左边的声音。

That is exteroception, perception of things beyond the confines of one's skin.

这就是外感，即对超出皮肤范围的事物的感知。

Then there's interoception, which is perception of things that are happening internally, like how full does my gut feel?

然后是内感受，这是对内部发生的事情的感知，比如我的肠道感觉有多饱？

How fast is my heart beating?

我的心跳有多快？

Some people can measure that quite accurately just by thinking about it.

有些人只需思考一下就可以相当准确地衡量这一点。

Other people can't.

其他人不能。

How happy am I?

我有多幸福？

How sad am I?

我有多悲伤？

How energetic am I?

我的精力有多充沛？

How lethargic am I?

我有多昏昏欲睡？

Et cetera, et cetera.

等等等等。

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

所以我们总是处于外感受和内感受之间的平衡。

But as it turns out, people with bipolar disorder over time, and especially into the second and third decade of having bipolar disorder, seem to have progressively diminished levels of interoception, and that very likely is important in their inability to register, for instance, that, wow, they are talking at an excessive rate, or they haven't slept in five or even 10 days, or they haven't eaten in a long period of time.

但事实证明，随着时间的推移，患有双相情感障碍的人，尤其是在患有双相情感障碍的第二个和第三个十年里，内感受水平似乎逐渐下降，这很可能对他们无法记录，例如，哇，他们说话的速度太快，或者他们已经五天甚至十天没有睡觉，或者他们已经很长一段时间没有吃东西了很重要。

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

这种内感受神经回路的萎缩开始成为双相情感障碍的神经回路特征或基础之一。

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

现在，我从以下说法过渡到有关神经回路的对话：锂可以防止神经回路非常活跃而产生的一些神经毒性作用。

Now, this can get a little bit complicated, but I promise I'm going to make it clear for any of you that are watching and/or listening.

现在，这可能会变得有点复杂，但我保证我会向正在观看和/或收听的人讲清楚。

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

现实情况是，患有双相抑郁症的人很可能患有多动症，即在疾病表达的早期，大脑内某些回路的活动水平增加，正如我之前提到的，这种情况通常发生在 20 岁出头左右，尽管有时甚至可能更早，比如十几岁等等。

But that hyperactivity, we think, leads to a toxicity, an excitotoxicity of certain elements of the neural circuits that are responsible for interoception.

但我们认为，这种过度活跃会导致毒性，即负责内感受的神经回路某些元件的兴奋性毒性。

In other words, the overuse of certain circuits can lead to a diminishing, an atrophy, or even a death of certain elements within those circuits, and it appears that lithium, through its anti-inflammatory and neuroprotective effects and through its ability to increase BDNF, very likely protects us against some of that atrophy of those circuits for interoception.

换句话说，某些回路的过度使用会导致这些回路中某些元素的减少、萎缩，甚至死亡，而锂似乎通过其抗炎和神经保护作用，以及通过其增加 BDNF 的能力，很可能保护我们免受内感受回路的某些萎缩。

So this isn't a case in which people with bipolar have a neural circuit or lack a neural circuit, and people without bipolar are the opposite.

因此，这并不是双相情感障碍患者有神经回路或缺乏神经回路的情况，而没有双相情感障碍的人则相反。

This is a case in which everyone more or less starts out the same, but it seems that there's a hyperactivity of certain neural circuits in people with bipolar disorder that over time actually causes those circuits to diminish.

在这种情况下，每个人的开始或多或少都是一样的，但双相情感障碍患者的某些神经回路似乎过度活跃，随着时间的推移，实际上会导致这些回路减弱。

Now, this is very important because some of the more recent longitudinal studies doing brain imaging on people with bipolar disorder and those without, and doing that over time in patients starting as early as their teens but into their 20s and 30s, reveals just that, that there can be hyperactivity of circuits early on, but then hypo, reduced activity of those very same circuits at a time five or 10 years later.

现在，这一点非常重要，因为最近的一些纵向研究对双相情感障碍患者和非双相情感障碍患者进行了脑成像，并且随着时间的推移，对从十几岁开始一直到20多岁和30多岁的患者进行了这项研究，结果表明，早期的脑回路可能会过度活跃，但随后会在五年或十年后出现低活动，这些相同的脑回路的活动会减少。

Again, this speaks to the complicated nature of bipolar disorder and the complicated nature of psychiatry and linking specific psychiatric disorders to neural circuits in general.

这再次说明了双相情感障碍的复杂性和精神病学的复杂性，以及将特定的精神疾病与一般神经回路联系起来。

Because if you have a situation in which, in one disease, let's just hypothesize here for a second that, for instance, in certain forms of schizophrenia, there's elevated dopamine, and were we to just reduce the amount of dopamine, that they would receive relief from those schizophrenic symptoms.

因为如果你遇到一种情况，在一种疾病中，让我们假设一下，例如，在某些形式的精神分裂症中，多巴胺含量升高，如果我们减少多巴胺的含量，他们的精神分裂症症状就会得到缓解。

Well, that's all pretty straightforward on the face of it.

嗯，从表面上看这一切都非常简单。

But in this situation with bipolar disorder, what we're talking about is hyperactivity, too much activity, leading to hypoactivity through death of those very circuits.

但在双相情感障碍的情况下，我们谈论的是多动症，过多的活动，通过这些回路的死亡导致活动减退。

And so now you can especially appreciate why when the patient shows up to the psychiatrist or when the psychiatrist shows up to the patient in the total course of their disease is going to be very important, and then layer on top of that the complexity of the fact that the very defining characteristic of bipolar disorder is that there are oscillations in mood.

所以现在你可以特别理解为什么当病人去看精神科医生时或当精神科医生在病人的整个疾病过程中去看病人时会非常重要，然后再考虑到事实的复杂性，即双相情感障碍的明确特征是情绪波动。

So now we need to think about treatments not just for the manic episodes, but also treatments for the depressive episodes, and that's in fact what psychiatrists do.

所以现在我们不仅需要考虑治疗躁狂发作，还要考虑治疗抑郁发作，而这实际上就是精神病学家所做的。

Turns out that they apply different treatments or combinations of treatments for patients that are in manic episodes versus depressive episodes, and they have to infer all that from discussions.

事实证明，他们对躁狂发作和抑郁发作的患者采用不同的治疗或治疗组合，并且他们必须从讨论中推断出所有这些。

Again, just exchange of words, depending on when that person walked into their office, where they are in terms of manic episodes, no symptomology, or depressive symptomology, and whether or not they've had that symptomology for an extended period of time.

再说一遍，只是交换意见，具体取决于那个人何时走进他们的办公室，他们在躁狂发作、无症状或抑郁症状方面处于什么位置，以及他们是否已经长期患有这种症状。

And then just to make the situation even more complicated, the very circuits that atrophy, that start to wane and disappear in people with bipolar disorder, are the circuits for interoception, for understanding of what's going on in one's own body.

然后，让情况变得更加复杂的是，双相情感障碍患者中开始萎缩和消失的回路正是内感受回路，用于了解自己体内正在发生的事情。

So you can imagine if you sit down and ask somebody, "Well, how long has it been since you slept?"

所以你可以想象一下，如果你坐下来问某人：“你有多久没睡觉了？”

That person may genuinely not know.

那个人可能真的不知道。

Or if you ask the very depressed person, "How depressed are you?" That person may not be able to articulate that.

或者，如果你问非常抑郁的人：“你有多抑郁？”那个人可能无法清楚地表达这一点。

So fortunately, there are solutions to this, and the solution is that more often than not, the accurate understanding of whether or not someone has bipolar depression or not, and what stage of the illness they might be in or not, is going to depend on the reports of people around them and not the patient themselves.

幸运的是，这个问题是有解决方案的，而且解决方案是，准确了解某人是否患有双相抑郁症，以及他们可能处于疾病的哪个阶段，将取决于周围人的报告，而不是患者自己。

Hence, the importance of having a rather detailed and admittedly, a rather intense discussion about the symptomology of bipolar disorder so that you can have an understanding of the people around you and have an eye and an ear to whether or not those people might be suffering from bipolar, and if so, at what stage of the disease they might happen to be at.

因此，对双相情感障碍的症状进行相当详细和激烈的讨论非常重要，这样您就可以了解周围的人，并密切关注这些人是否可能患有双相情感障碍，如果是，他们可能处于疾病的哪个阶段。

Now I'd like to talk a little bit more about what is known about the neural circuits that lead to the manic states, as well as the depressive states, but mainly the manic states of bipolar disorder.

现在我想多谈谈关于导致躁狂状态和抑郁状态的神经回路的已知信息，但主要是双相情感障碍的躁狂状态。

We already discussed the fact that interoception, registering of one's own internal emotions and bodily states, is diminished in people with bipolar disorder.

我们已经讨论过这样一个事实，即双相情感障碍患者的内感受（记录自己的内部情绪和身体状态）会减弱。

But we haven't really talked about the neural circuits that are responsible for that lack of recognition.

但我们还没有真正讨论导致缺乏识别的神经回路。

For that reason, I'd like to point out a paper.

因此，我想指出一篇论文。

This is a fairly recent paper, just came out this year, but it's an excellent one, looking at the changes over time in neural circuitry in people with high genetic risk for bipolar disorder, and in particular in young people.

这是一篇相当新的论文，今年刚刚发表，但它是一篇出色的论文，研究了双相情感障碍高遗传风险人群，特别是年轻人的神经回路随时间的变化。

And studies of this sort are rare, but are exceedingly important because of the fact that they track individuals over time.

这类研究很少见，但却极其重要，因为它们随着时间的推移跟踪个体。

The title of this paper is "Longitudinal Changes in Structural Connectivity in Young People at High Genetic Risk for Bipolar Disorder." We will provide a link to this study in the show note captions.

这篇论文的标题是“双相情感障碍高遗传风险年轻人结构连通性的纵向变化”。我们将在节目注释标题中提供本研究的链接。

There are a lot of data in this paper, in particular neuroimaging data, and it's quite extensive in terms of analyzing the so-called connectomics.

这篇论文有很多数据，特别是神经影像数据，在分析所谓的连接组学方面相当广泛。

You've probably heard of genomics, which is the analysis of genes and their display in different individuals or different animals, et cetera.

您可能听说过基因组学，它是对基因及其在不同个体或不同动物等中的表现进行分析。

You have proteomics, which is The display of, or the existence of different proteins.

蛋白质组学是不同蛋白质的展示或存在。

So omics is a big thing now in science.

所以组学现在是科学界的一件大事。

You kind of throw omics behind anything and it becomes its own Wikipedia page, which means it becomes its own thing, so to speak.

你把组学放在任何东西后面，它就会成为自己的维基百科页面，这意味着它成为自己的东西，可以这么说。

I say that only partially in jest.

我这样说只是部分地开玩笑。

Nonetheless, connectomics is the analysis of connections between different neurons and neural circuit elements.

尽管如此，连接组学是对不同神经元和神经回路元件之间连接的分析。

And what this paper really showed by analyzing the connectomics of neural circuits in the brains of many different people with different categories of, and onset of, and severity of bipolar disorder, as well as controls in different age groups, et cetera, is that people who are of particularly high risk for having bipolar disorder or that have full-blown bipolar disorder have deficits and actually reductions in the amount of connectivity between what are called the parietal brain regions and the limbic system.

通过分析患有不同类别、不同发作和严重程度的双相情感障碍的许多不同人以及不同年龄组等的对照者的大脑中的神经回路连接组学，这篇论文真正表明的是，双相情感障碍风险特别高或患有完全双相情感障碍的人的顶叶脑区域和边缘系统之间的连接量存在缺陷，实际上减少了。

Now, the limbic system I've talked about before on this podcast.

现在，我之前在这个播客上讨论过边缘系统。

If you're not familiar with it, I'll explain what it is in a moment.

如果您不熟悉它，我稍后会解释它是什么。

It's simply a collection of brain structures, not one brain structure, but a collection of brain structures that generally are responsible for shifting the overall state that we're in from states of more relaxed and calm to states of more alert and focused.

它只是大脑结构的集合，不是一个大脑结构，而是一组大脑结构的集合，这些结构通常负责将我们所处的整体状态从更放松和平静的状态转变为更警觉和专注的状态。

The limbic system is intimately related to the so-called autonomic nervous system, which regulates our sleep-wake cycles and a number of other things like our digestion, et cetera, our level of hunger, and on and on.

边缘系统与所谓的自主神经系统密切相关，自主神经系统调节我们的睡眠-觉醒周期以及许多其他事物，例如我们的消化等等，我们的饥饿程度等等。

So the limbic system is really kind of like a volume control, or as nerd scientists like to say, a kind of gain control on the overall level or amplitude of alertness or calmness.

所以边缘系统实际上有点像音量控制，或者像书呆子科学家喜欢说的那样，是一种对警觉或平静的整体水平或幅度的增益控制。

In fact, if we're very, very calm, we are asleep, or even more calm, we can be in a coma.

事实上，如果我们非常非常平静，我们就睡着了，或者更加平静，我们可能会处于昏迷状态。

If we are very alert, we can be wide awake and ready to work and run, et cetera.

如果我们非常警觉，我们就能完全清醒并准备好工作和跑步等等。

Or if we are very, very, very alert by way of limbic autonomic interactions, well, then we can be in anxiety, we can be in full-blown panic attack, or we can be in mania.

或者，如果我们通过边缘自主神经相互作用非常、非常、非常警觉，那么我们可能会陷入焦虑，我们可能会陷入全面的惊恐发作，或者我们可能会陷入躁狂。

We can have so much energy that we feel like we don't need to sleep.

我们可以拥有如此多的能量，以至于我们感觉不需要睡觉。

And in fact, disruptions in this circuitry really seems to be what's going on in people who have bipolar disorder.

事实上，躁郁症患者身上确实出现了这种回路的紊乱。

Now, if disruptions in the circuitry are present in the limbic system, that doesn't necessarily mean that the limbic system is at fault, because the way that neural circuits work is that different brain areas are talking to one another through electrical-chemical signaling, and they are regulating one another.

现在，如果边缘系统中存在回路中断，这并不一定意味着边缘系统有问题，因为神经回路的工作方式是不同的大脑区域通过电化学信号相互交流，并且它们正在相互调节。

And what this paper really tells us is that there are elements within the parietal lobe, which is a kind of a section of the brain that sits off to the side.

这篇论文真正告诉我们的是，顶叶内存在一些元素，顶叶是大脑的一部分，位于一侧。

It's not really off to the side, but in neuroanatomical nomenclature, the parietal lobe is connected in two ways bidirectionally.

它并不是真正偏向一边，但在神经解剖学命名法中，顶叶以两种方式双向连接。

So parietal lobe is connecting to limbic system and limbic system is connecting to parietal lobe.

因此，顶叶连接到边缘系统，边缘系统连接到顶叶。

And in people with bipolar disorder, it seems that the parietal lobe is able to exert less top-down control, that is less suppression of certain elements of the limbic system, which at least right now is leading researchers to hypothesize that the limbic system is sort of revving at higher levels.

在双相情感障碍患者中，顶叶似乎能够施加较少的自上而下的控制，即对边缘系统某些元素的抑制较少，这至少现在让研究人员假设边缘系统正在以更高的水平加速。

It's kind of like RPM in your car, so it kind of redlining at times and for durations that are inappropriate or at least abnormal.

它有点像汽车中的转速，因此有时会在不适当或至少不正常的持续时间内进行红线标注。

So we have two major sets of neural circuit deficits or changes in people with bipolar.

因此，双相情感障碍患者有两组主要的神经回路缺陷或变化。

Their lack of internal awareness is reduced, and that turns out to be by way of neural structures like the insula, which is a brain region that is connected in a very direct way to our somatosensory cortex, so the part of our cortex that registers how we feel, literally, sense of touch and internal state.

他们缺乏内在意识的情况减少了，而这是通过像岛叶这样的神经结构来实现的，岛叶是一个以非常直接的方式与我们的体感皮层相连的大脑区域，因此我们的皮层中记录我们感觉的部分，从字面上看，就是触觉和内部状态。

So those circuits ...

所以那些电路...

Excuse me.

对不起。

For those of you listening, I just bumped the microphone.

对于那些正在听的人，我刚刚碰了一下麦克风。

Excuse me.

打扰一下。

Those circuits are disrupted in people with bipolar and the top-down control, the kind of accelerator and brake on our overall levels of energy are also disrupted.

双相情感障碍患者的这些回路被破坏，自上而下的控制、我们整体能量水平的加速器和制动器也被破坏。

Now, that's all fine and good because, well, it's true, at least according to what the data at this point in time tell us.

现在，这一切都很好，因为，至少根据目前的数据告诉我们的是，这是真的。

There may be new discoveries to come, but that all seems to be the case.

可能会有新的发现，但一切似乎都是如此。

But it doesn't tell us how to modulate or change that circuitry.

但它没有告诉我们如何调制或改变该电路。

It also doesn't tell us how something like lithium can actually benefit a large number of patients or how a good number of the other treatments for bipolar disorder, which we'll talk about going forward, can benefit patients with bipolar.

它也没有告诉我们像锂这样的东西如何实际上使大量患者受益，或者我们将在未来讨论的许多其他双相情感障碍治疗方法如何使双相情感障碍患者受益。

So it appears that lithium is exerting its positive effects on bipolar depression treatment, at least in part, by preventing the loss of certain neural circuits, namely the neural circuits for interoception and the top-down control over the limbic system.

因此，锂似乎正在对双相抑郁症的治疗发挥积极作用，至少部分是通过防止某些神经回路的丧失，即内感受神经回路和对边缘系统自上而下的控制。

Now, it turns out that by examining lithium's effects at an even more reductionist level, we can gain really important insight into what's going on in bipolar depression and some of the other treatments for bipolar depression, including behavioral treatments, things like transcranial magnetic stimulation, and even some of the more natural or so-called nutraceutical treatments, including things like high-dose omega-3 supplementation, which we're going to talk about extensively.

现在，事实证明，通过在更简化的水平上检查锂的作用，我们可以获得真正重要的见解，了解双相抑郁症的情况以及双相抑郁症的其他一些治疗方法，包括行为治疗、经颅磁刺激等，甚至一些更自然或所谓的营养治疗方法，包括高剂量 omega-3 补充剂等，我们将广泛讨论。

Now, in order to understand what we're going to talk about next, it's important that everybody understand a key concept of neuroplasticity, and this is a key concept regardless of whether or not one is talking about bipolar depression.

现在，为了理解我们接下来要讨论的内容，每个人都必须理解神经可塑性的一个关键概念，无论是否谈论双相抑郁症，这都是一个关键概念。

In fact, it's something I think everybody, every citizen of Earth should know about, and that's called homeostatic plasticity.

事实上，我认为每个人、每个地球公民都应该了解这一点，这就是所谓的稳态可塑性。

Homeostatic plasticity is a particular form of neuroplasticity in which if a neural circuit is overactive for a period of time, there are changes that occur at the cellular level that lead to a balance or a homeostatic regulation of that circuit so that it's no longer overactive.

稳态可塑性是神经可塑性的一种特殊形式，如果神经回路在一段时间内过度活跃，细胞水平上就会发生变化，导致该回路达到平衡或稳态调节，使其不再过度活跃。

Conversely, if a neural circuit is underactive for a period of time, certain changes happen within the cells of that circuit to ramp up their activity or make them more likely to be active.

相反，如果神经回路在一段时间内不活跃，该回路的细胞内就会发生某些变化，以增强其活动或使它们更有可能活跃。

And whether or not a neural circuit and the neurons within it become more active or less active in the context of homeostatic plasticity largely depends on one mechanism, and it's a beautiful mechanism that I'll make very clear to you right now, even if you don't have a background in biology.

在稳态可塑性的背景下，神经回路及其内部的神经元是否变得更加活跃或不那么活跃，很大程度上取决于一种机制，这是一个很好的机制，我现在就会向你解释清楚，即使你没有生物学背景。

Neurons communicate with one another by releasing so-called neurotransmitters, which are just chemicals.

神经元通过释放所谓的神经递质来相互交流，这些神经递质只是化学物质。

Those neurotransmitters are vomited out.

那些神经递质会被吐出来。

They're not actually vomited, but they're spit out into the so-called synaptic cleft, often called the synapse.

它们实际上并没有被呕吐出来，而是被吐到所谓的突触间隙（通常称为突触）中。

The synapse is just a little gap between neurons.

突触只是神经元之间的一个小间隙。

And When they are released into the synapse, they don't just stay there.

当它们被释放到突触中时，它们不会只是停留在那里。

They actually park or bind to receptors on what's called the postsynaptic neuron.

它们实际上停泊或结合到所谓的突触后神经元上的受体上。

And depending on how many receptors they bind to and how many receptors are available, et cetera, they can have a greater or lesser effect on the postsynaptic neuron.

并且取决于它们结合的受体的数量以及可用的受体的数量等等，它们可以对突触后神经元产生或大或小的影响。

This scenario of neurotransmitters being released into synapses, then binding to receptors on postsynaptic neurons and influencing the electrical excitability of those postsynaptic neurons sit central to not just the treatment of bipolar disorder, but to all treatments of all psychiatric conditions, and indeed to things like neuropathic pain as well.

神经递质被释放到突触中，然后与突触后神经元上的受体结合并影响这些突触后神经元的电兴奋性，这种情况不仅是双相情感障碍的治疗的核心，也是所有精神疾病的治疗的核心，实际上也是神经性疼痛等疾病的治疗的核心。

For example, the so-called SSRIs, Prozac, Zoloft, and others, et cetera, stands for selective serotonin reuptake inhibitor.

例如，所谓的SSRIs、Prozac、Zoloft等，代表选择性5-羟色胺再摄取抑制剂。

What does that mean?

这意味着什么？

Well, serotonin is a neurotransmitter.

嗯，血清素是一种神经递质。

It's actually a neuromodulator that's released into the synapse.

它实际上是一种释放到突触中的神经调节剂。

And then the SSRI, the selective serotonin reuptake inhibitor, allows more of that serotonin to sit within the synapse for longer.

然后，选择性血清素再摄取抑制剂 SSRI 可以让更多的血清素在突触内停留更长时间。

It's a reuptake inhibitor.

它是一种再摄取抑制剂。

It prevents reuptake by the presynaptic neuron.

它可以防止突触前神经元的再摄取。

And that serotonin, therefore, can park in or dock in the receptors, as it's called, of the postsynaptic neuron in greater numbers and have a greater impact on that postsynaptic neuron.

因此，血清素可以大量驻留在或停靠在突触后神经元的受体中，并对突触后神经元产生更大的影响。

So the drugs that are used to treat depression or other things of that sort, things like SSRIs, work by changing the availability of neurotransmitter in the synapse.

因此，用于治疗抑郁症或其他类似疾病的药物（例如 SSRI）通过改变突触中神经递质的可用性来发挥作用。

Other things like MAO inhibitors, monoamine oxidase inhibitors, work a different way.

其他药物，如 MAO 抑制剂、单胺氧化酶抑制剂，则以不同的方式发挥作用。

They inhibit the enzyme.

它们抑制酶。

Anytime you hear ASE in biology, it's very likely an enzyme which breaks things down.

每当您在生物学中听到 ASE 时，它很可能是一种分解物质的酶。

So MAO inhibitors prevent the breakdown, not the reuptake, but the breakdown of neurotransmitter, and therefore allow more neurotransmitter to be available in the synapse and influence the postsynaptic cell.

因此，MAO 抑制剂可以防止神经递质的分解，而不是再摄取，从而允许更多的神经递质在突触中可用并影响突触后细胞。

Homeostatic plasticity is a form of neuroplasticity in which overall circuits can become much more excitable or much less excitable by the addition of more receptors in the postsynaptic neuron or by the removal of more receptors from the postsynaptic neuron.

稳态可塑性是神经可塑性的一种形式，通过在突触后神经元中添加更多受体或从突触后神经元中去除更多受体，整个回路可以变得更加兴奋或更加不兴奋。

And the way this happens is just beautiful.

这种发生的方式真是太美好了。

It was first discovered in the visual system, and the person primarily responsible for the discovery of homeostatic plasticity, although there are several, is a woman by the name of Gina Turrigiano.

它首先在视觉系统中被发现，主要负责发现稳态可塑性的人（尽管有几个）是一位名叫吉娜·图里吉亚诺（Gina Turrigiano）的女性。

She's a professor at Brandeis University.

她是布兰迪斯大学的教授。

And what the Turrigiano Laboratory showed was that, for instance, if we are in the dark for a long period of time, literally, when we're not seeing much for a long period of time, there's an increase in the number of receptors in the postsynaptic neurons, so that a smaller amount of light and excitability within the visual system can lead to greater amounts of activity in the visual system.

图里吉亚诺实验室的研究表明，如果我们长时间处于黑暗中，实际上，当我们在很长一段时间内看不到太多东西时，突触后神经元中的受体数量就会增加，因此视觉系统中较少的光量和兴奋性可以导致视觉系统中的更多活动。

Conversely, if there's an overactivity or an increase in activity in the visual system for some period of time, then a number of receptors in the postsynaptic neuron are removed from that postsynaptic neuron surface, making any neurotransmitter that's available only able to bind the receptors that are left and have less of an influence on those cells.

相反，如果视觉系统在一段时间内过度活跃或活动增加，那么突触后神经元中的许多受体就会从突触后神经元表面去除，使得任何可用的神经递质只能与留下的受体结合，对这些细胞的影响较小。

In other words, keeping a circuit in so-called homeostatic balance in a particular range of excitability.

换句话说，使电路在特定的兴奋性范围内保持所谓的稳态平衡。

Now, while that's a mouthful and an earful and a conceptful, I don't know if a conceptful is a word, but in any case, that's a lot to think about.

现在，虽然这是一个拗口、一个耳熟能详、一个概念性的概念，但我不知道概念性是否是一个词，但无论如何，这是一个值得思考的问题。

But all you need to know is that if a neural circuit is very active for a period of time, in normal individuals, there will be a reduction in the amount of activity by way of removing receptors that bind neurotransmitter.

但你需要知道的是，如果神经回路在一段时间内非常活跃，那么在正常个体中，会通过去除与神经递质结合的受体来减少活动量。

Whereas if a neural circuit is very quiet, it's not activated for a period of time.

然而，如果神经回路非常安静，它就会在一段时间内不会被激活。

Maybe your leg is in a cast, for instance, and you're not activating your quadricep and calves very much.

例如，也许您的腿打着石膏，并且您没有充分激活股四头肌和小腿。

Well, when that cast comes off, sure, the muscle might be atrophied, but the nerves that connect to that muscle are actually in a position to influence that muscle even more once you start using that muscle or those muscles, because whatever neurotransmitter is released now has the opportunity to bind to more receptors, in that case, in muscle, or in the case of brain circuits, in postsynaptic neurons.

好吧，当石膏脱落时，当然，肌肉可能会萎缩，但一旦你开始使用那块肌肉或那些肌肉，连接到那块肌肉的神经实际上就能够更大地影响那块肌肉，因为现在释放的任何神经递质都有机会与更多的受体结合，在这种情况下，在肌肉中，或者在大脑回路的情况下，在突触后神经元中。

So homeostatic plasticity is this beautiful balancing mechanism that makes sure that neural circuits are never too active nor too quiet for too long.

因此，稳态可塑性是一种美丽的平衡机制，可确保神经回路在太长时间内不会太活跃或太安静。

And in a beautiful display of how treatments can lead to a better understanding of biology, which can lead to the discovery of even better treatments, lithium and another compound, which we'll talk about, ketamine, seem to exert their actions largely through effects on homeostatic neuroplasticity.

锂和另一种化合物（我们将要讨论的氯胺酮）完美地展示了治疗如何能够更好地理解生物学，从而发现更好的治疗方法，似乎主要是通过对稳态神经可塑性的影响来发挥作用。

There's a wonderful paper that describes all the nitty-gritty of this.

有一篇精彩的论文描述了这一切的所有细节。

Certainly, most people listening, I'm guessing, are not going to be interested in all this detail.

当然，我猜大多数听的人不会对所有这些细节感兴趣。

But for those of you that you are and you want to delve deep into this, this paper was published in Neuron, Cell Press journal, excellent journal.

但对于那些想要深入研究这个问题的人来说，这篇论文发表在《Neuron》、《Cell Press》杂志上，这是一个优秀的杂志。

It's titled "Targeting Homeostatic Plasticity for the Treatment of Mood Disorders." And there's one particular figure in this paper that I'll just describe to you in which measurements were made from neurons and the number of receptors in those neurons.

它的标题是“以稳态可塑性治疗情绪障碍”。我将在本文中向您描述一个特定的数字，其中的测量是根据神经元和这些神经元中的受体数量进行的。

It's done somewhat indirectly through a method that's detailed and neuroscientists are familiar with.

它是通过神经科学家熟悉的详细方法间接完成的。

Basically, what it measures is how excited a given neuron is, electrically excited a given neuron is, to a given amount of neurotransmitter.

基本上，它测量的是给定神经元对给定数量的神经递质的兴奋程度，即给定神经元的电兴奋程度。

So that the amount of neurotransmitter that's vomited onto a neuron is essentially kept constant, and then the response of the postsynaptic neuron is measured.

这样吐到神经元上的神经递质的量基本上保持恒定，然后测量突触后神经元的反应。

So it can be of one level or higher or lower, depending on homeostatic plasticity.

因此，它可以是一个水平或更高或更低，具体取决于稳态可塑性。

And what this paper shows, and what's been shown over and over again, is that when neurons are exposed to lithium for a period of time, there is a reduction in the excitability of the postsynaptic neuron.

这篇论文所表明的以及一再表明的事实是，当神经元暴露于锂一段时间时，突触后神经元的兴奋性会降低。

That is, neurons within the brain become less excitable Over time, if lithium is present, whereas ketamine, which is now a common FDA-approved, at least in the US, it's approved for the treatment of major depression, ketamine does the opposite.

也就是说，随着时间的推移，如果存在锂，大脑内的神经元就会变得不那么兴奋，而氯胺酮（至少在美国）是 FDA 批准的一种常见药物，至少在美国被批准用于治疗重度抑郁症，而氯胺酮则相反。

Ketamine seems to increase the number of receptors in the postsynaptic neuron and lead to greater levels of excitability and electrical activity within neural circuits to a given fixed amount of neurotransmitter.

氯胺酮似乎会增加突触后神经元中的受体数量，并在给定固定量的神经递质的情况下导致神经回路内更高水平的兴奋性和电活动。

So this is super interesting because what it means is that lithium is causing circuits to be less active.

所以这非常有趣，因为这意味着锂会导致电路不那么活跃。

Ketamine is causing circuits to be more active, and we know from excellent clinical data now that ketamine seems to be a very effective treatment for major depression and for the major depressive episodes of people that suffer from bipolar depression that includes these major depressive episodes of two weeks or longer of suppressed mood, appetite, sleep issues, et cetera.

氯胺酮使神经回路更加活跃，我们现在从出色的临床数据中得知，氯胺酮似乎是治疗重度抑郁症和双相抑郁症患者重度抑郁发作的一种非常有效的治疗方法，其中包括两周或更长时间的抑郁发作、情绪、食欲、睡眠问题等。

Now, the key thing about ketamine that's often not discussed is that while its effects are very potent, they are transient.

现在，关于氯胺酮的一个经常没有被讨论的关键问题是，虽然它的作用非常有效，但它们是短暂的。

So one major drawback to ketamine therapy for depression is that it has to be done repeatedly.

因此，氯胺酮治疗抑郁症的一个主要缺点是必须重复进行。

And how repeatedly or how often rather, depends, of course, on a discussion between the psychiatrist and the patient.

当然，重复的次数或频率取决于精神科医生和患者之间的讨论。

This is not something to cowboy on your own.

这不是牛仔自己的事情。

I know that, and many of you are probably familiar with the fact that ketamine also is abused recreationally.

我知道这一点，你们中的许多人可能都熟悉氯胺酮也被用于娱乐目的的事实。

It is a so-called NMDA, N-methyl-D-aspartate receptor antagonist, so it blocks the very receptor that's responsible for neuroplasticity, for changes in neural circuits.

它是一种所谓的 NMDA（N-甲基-D-天冬氨酸受体拮抗剂），因此它可以阻断负责神经可塑性和神经回路变化的受体。

It also changes excitability in neurons, as I just described.

正如我刚才所描述的，它还会改变神经元的兴奋性。

So ketamine is a very potent chemical that has been shown over and over again and is now FDA approved for the treatment of major depression, but its effects seem to be transient.

因此，氯胺酮是一种非常有效的化学物质，已经被反复证明，现在 FDA 批准用于治疗重度抑郁症，但其效果似乎是短暂的。

Lithium, as I described earlier, seems to reduce the manic episodes or the intensity of manic episodes and symptomology in people with bipolar disorder.

正如我之前所描述的，锂似乎可以减少双相情感障碍患者的躁狂发作或躁狂发作的强度和症状。

It's doing that through neuroprotection, so protecting neural circuits from dying away that initially are overactive and that overactivity causing excitotoxicity.

它通过神经保护来做到这一点，从而保护最初过度活跃的神经回路免于消失，而过度活跃会导致兴奋性毒性。

It sort of blocks that excitotoxicity, we believe.

我们相信，它可以阻止兴奋性毒性。

And it seems to do that in part by diminishing the amount of activity in those circuits.

它似乎在一定程度上是通过减少这些回路中的活动量来做到这一点的。

So this is a beautiful mechanistic story, and it's the sort of story that you'd love to have for a great number of psychiatric illnesses, and fortunately, we have for bipolar disorder.

所以这是一个美丽的机械故事，也是你希望看到的关于许多精神疾病的故事，幸运的是，我们有关于双相情感障碍的故事。

Overactivity of a given circuit eventually leads to neurotoxicity.

特定回路的过度活跃最终会导致神经毒性。

Excuse me.

打扰一下。

Lithium is preventing that neurotoxicity by reducing the number of receptors in certain elements within those circuits, so so-called homeostatic scaling.

锂通过减少这些回路内某些元件中的受体数量来防止神经毒性，即所谓的稳态缩放。

It's down-regulating the number of receptors, leading to less excitability and preventing, we think, excitotoxicity.

我们认为，它会下调受体的数量，从而降低兴奋性并预防兴奋性毒性。

And in that sense, you can see exactly why it's important to get lithium treatment in there early for people with bipolar disorder.

从这个意义上说，您可以确切地明白为什么对双相情感障碍患者尽早进行锂治疗很重要。

Ketamine as a treatment for major depression seems to be effective, but transient.

氯胺酮作为治疗重度抑郁症的药物似乎有效，但效果短暂。

And you can also see why it would be important not just to reduce the manic episodes for people with bipolar disorder, but to also treat the depressive episodes.

您还会明白为什么不仅减少双相情感障碍患者的躁狂发作而且治疗抑郁发作也很重要。

So this is a key feature of the treatment for bipolar depression and for bipolar disorder.

因此，这是治疗双相抑郁和双相情感障碍的一个关键特征。

There needs to be treatment both of the mania and of the depressive episodes if they're present.

如果存在躁狂症和抑郁症发作，则需要对其进行治疗。

And fortunately, there are excellent drugs to do that, and I should mention that ketamine and lithium are just two of the drugs within the kit that psychiatrists have access to.

幸运的是，有很好的药物可以做到这一点，我应该提到氯胺酮和锂只是精神科医生可以使用的试剂盒中的两种药物。

There are many things, olanzapines and a number of different things, including clozapine.

有很多东西，奥氮平和许多不同的东西，包括氯氮平。

Clozapine is an antipsychotic, which is commonly prescribed as a sedative in some cases that allows people in manic episodes to sleep.

氯氮平是一种抗精神病药，在某些情况下通常被用作镇静剂，可以让躁狂发作的人入睡。

It's classically described as so-called dopamine receptor four antagonist, although it does other things as well.

它通常被描述为所谓的多巴胺受体四拮抗剂，尽管它也有其他作用。

Clozapine has a number of side effect features related to white blood cell and things of that sort that require careful monitoring.

氯氮平具有许多与白细胞相关的副作用，需要仔细监测。

So there are an enormous number now, literally dozens and dozens of different drugs, each designed to target either the manic phase, the depressive phase, or some what we call acute sort of early phases versus ongoing treatments.

因此，现在有大量的药物，实际上有几十种不同的药物，每种药物都旨在针对躁狂期、抑郁期或我们所说的急性早期阶段与持续治疗的比较。

This is a vast galaxy of drug treatments that really should be navigated, I should say, absolutely should be navigated by a board-certified psychiatrist, and of course, in close discussion with both the person suffering from bipolar disorder, but also ideally the family members of the person suffering from bipolar disorder.

这是一个巨大的药物治疗星系，我应该说，绝对应该由经过委员会认证的精神科医生来指导，当然，与患有双相情感障碍的人密切讨论，但最好也与患有双相情感障碍的人的家人进行密切讨论。

But I think, at least up until now, we've focused on the two major pathways for treatment, lithium and ketamine, and we've talked about why lithium and ketamine work, that they're working on opposite ends of this homeostatic scaling.

但我认为，至少到目前为止，我们一直专注于两种主要的治疗途径：锂和氯胺酮，并且我们已经讨论了锂和氯胺酮为何有效，以及它们在这种稳态缩放的相反两端发挥作用。

We talked a bit about the circuits that are involved in generating what we think are the manic symptomology and the lack of interoception, why people can just persist in staying awake, awake, awake, not eating, et cetera.

我们讨论了一些涉及产生我们认为的躁狂症状和缺乏内感受的回路，以及为什么人们可以坚持保持清醒、清醒、清醒、不吃东西等等。

Now you have in mind how all that is put together, and I think you have in mind some of the well-demonstrated treatments for the different component parts of bipolar disorder, which now I'm hoping you're also well-versed in based on our early, early discussion of what constitutes bipolar I and bipolar II.

现在你已经知道了所有这些是如何组合在一起的，我想你已经知道了一些针对双相情感障碍不同组成部分的经过充分论证的治疗方法，现在我希望你也能根据我们早期对双相I和双相II的构成的讨论而熟悉这些治疗方法。

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

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

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

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

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

首先，关于药物疗法与非药物疗法或谈话疗法的一个要点。

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

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

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

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

That's just the reality of it.

这就是现实。

And contrast that with our discussion about obsessive-compulsive disorder, which we talked about a few episodes ago.

并将其与我们在几集前讨论过的关于强迫症的讨论进行对比。

If you haven't seen that episode, we have an in-depth episode all about OCD and obsessive-compulsive personality disorder.

如果您还没有看过该集，我们有一个关于强迫症和强迫性人格障碍的深入剧集。

There, it seems that drug therapies and talk therapies can be done independently or in combination.

在那里，药物疗法和谈话疗法似乎可以单独进行，也可以结合进行。

As expected, combined drug and talk therapies are more effective there than either one alone, but there are pretty impressive effects of talk therapy alone, provided that they're initiated at the right time and it's the right form of talk therapy.

正如预期的那样，药物和谈话疗法相结合比单独使用任何一种疗法都更有效，但如果在正确的时间开始并且是正确的谈话疗法形式，那么单独的谈话疗法也有相当令人印象深刻的效果。

That's OCD, but in terms of bipolar disorder, it really seems that the drug therapies are necessary, at least in most all cases.

这就是强迫症，但就双相情感障碍而言，药物治疗似乎确实是必要的，至少在大多数情况下是这样。

That said, talk therapies are a terrific augment or support for those drug therapies and sometimes can allow people to take lower doses of those drug therapies, which turns out to be important because of the side effect profiles of a lot of drug therapies and sometimes the cost as well.

也就是说，谈话疗法是对这些药物疗法的极好的增强或支持，有时可以让人们服用较低剂量的药物疗法，事实证明这一点很重要，因为许多药物疗法都有副作用，有时还包括成本。

I guess we can think of cost just as another side effect, really.

我想我们真的可以将成本视为另一个副作用。

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

再次，与双相情感障碍的药物治疗相结合，使用了既定的和更新颖的谈话疗法。

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

认知行为疗法似乎是最好的一种疗法，至少从现有的统计数据和论文来看是这样。

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

这也是人们探索最多的一种。

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

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

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

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

Now, earlier I said borderline personality disorder has all these triggers and triggered elements from the external environment, whereas bipolar disorder does not.

现在，我之前说过边缘性人格障碍具有来自外部环境的所有这些触发因素和触发因素，而双相情感障碍则没有。

And that's still true, but it is the case that somebody with bipolar can have worse symptoms if life conditions get worse or more stressful.

这仍然是事实，但事实是，如果生活条件变得更糟或压力更大，双相情感障碍患者的症状可能会更严重。

So cognitive behavioral therapy, the discussion about, and sometimes the direct exposure to anxiety-provoking elements of life, can be very helpful for adjusting the responses to those otherwise triggering events, and sometimes making the drug treatments more effective, even at lower doses.

因此，认知行为疗法，讨论，有时甚至直接接触生活中引起焦虑的因素，对于调整对那些引发事件的反应非常有帮助，有时甚至可以使药物治疗更有效，即使在较低剂量下也是如此。

There are also forms of therapy, including family-focused therapy, which is especially important in terms of bipolar disorder because family members, provided that they are not themselves in a manic episode due to the close heritability of bipolar disorder, but family members can often be excellent windows into whether or not somebody is doing well or poorly or is veering toward or is emerging from a manic or depressive episode because they understand that person.

还有一些治疗形式，包括以家庭为中心的治疗，这对于双相情感障碍尤其重要，因为家庭成员，只要他们自己没有处于躁狂发作中，因为双相情感障碍的密切遗传性，但家庭成员通常可以成为了解某人是否表现良好或不佳，或是否正在转向躁狂或抑郁发作或正在摆脱躁狂或抑郁发作的绝佳窗口，因为他们了解那个人。

They have a lot of data.

他们有很多数据。

It could be purely subjective data, but they have a lot of exposure to how long or well somebody's been sleeping or eating, et cetera.

这可能是纯粹的主观数据，但他们大量了解某人的睡眠或饮食时间或健康状况等。

So family-focused therapy involves other members of the person suffering from bipolar disorder's family, as well as conversations about family members in a way that helps patients with bipolar disorder navigate, not just through manic episodes and depressive episodes, but start to learn to predict what are the conditions, psychological, physical, and otherwise, that can trigger bipolar episodes.

因此，以家庭为中心的治疗涉及双相情感障碍患者家庭中的其他成员，以及有关家庭成员的对话，以帮助双相情感障碍患者导航，不仅可以度过躁狂发作和抑郁发作，而且开始学习预测可能引发双相情感障碍发作的心理、身体和其他情况。

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

还有一类疗法称为人际关系和社会节奏疗法。

This is deserving of its own entire episode, really.

这真的值得拥有自己的整个情节。

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

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

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

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

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

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

Just by way of example, you can imagine that if somebody is in a very healthy relationship or a very abusive relationship, that that's going to strongly impact the outcomes of manic episodes.

举例来说，您可以想象，如果某人处于非常健康的关系或非常虐待的关系中，这将强烈影响躁狂发作的结果。

You can imagine that if the financial situation is one in which people can recover from manic episodes, I didn't mention this earlier, but I should have, forgive me, that oftentimes people who are in a manic episode will go out and spend immense amounts of money that they simply cannot afford to lose.

你可以想象，如果财务状况是人们可以从躁狂发作中恢复过来的，我之前没有提到这一点，但我应该，请原谅我，处于躁狂发作中的人们常常会出去花掉大量他们根本无法承受损失的钱。

And then the depressive episodes that in many cases follow are made far worse by the financial anxiety and the financial stress that results from those manic episodes of spending, et cetera.

然后，在许多情况下，随之而来的抑郁发作会因财务焦虑和疯狂消费等造成的财务压力而变得更加严重。

And then, of course, this carries over to sexual promiscuity, where people might be dealing with unwanted pregnancy or STIs or very fractured interpersonal dynamics with existing or new relationships.

当然，这也会导致性混乱，人们可能会面临意外怀孕或性传播感染，或者现有或新关系中的人际关系非常破裂。

You can imagine how these manic episodes, as well as the depressive episodes, can really wick out into an enormous amount of destruction, which brings us back to the initial criteria of BP1 and BP2, is that these manic episodes are not a good thing.

你可以想象这些躁狂发作以及抑郁发作如何真正导致巨大的破坏，这让我们回到 BP1 和 BP2 的最初标准，即这些躁狂发作不是一件好事。

These depressive episodes are not a good thing.

这些抑郁发作并不是一件好事。

They create this sense of euphoria in the person experiencing mania, or they create this sense that anything is possible, but at the end of the day, and actually every day, these episodes are quite maladaptive.

他们在经历躁狂症的人中创造了这种欣快感，或者他们创造了一种一切皆有可能的感觉，但到了一天结束时，实际上每天，这些情节都是相当不适应的。

They really destroy people's lives, and it's not just the life of the person that's suffering from bipolar disorder.

它们确实摧毁了人们的生活，而且不仅仅是双相情感障碍患者的生活。

And so, hence, cognitive behavioral therapy, family-focused therapy, and interpersonal and social rhythm therapies are the primary three talk therapies that are most often combined with drug therapies in order to try and Really reduce the harm.

因此，认知行为疗法、以家庭为中心的疗法以及人际和社会节律疗法是最常与药物疗法结合使用的主要三种谈话疗法，以尝试并真正减少伤害。

It's really all about harm reduction from manic episodes and depressive episodes.

这实际上是为了减少躁狂发作和抑郁发作的危害。

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

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

Electric shock therapy may sound barbaric, and in fact, it tends to look barbaric, although this is done in the controlled setting of a hospital.

电击疗法可能听起来很野蛮，事实上，它看起来也很野蛮，尽管这是在医院的受控环境中进行的。

If any of you have seen "One Flew Over the Cuckoo's Nest," I think the final scene or near final scene in that movie was Jack Nicholson with the sort of bite protector in his mouth and getting electric shock therapy, and as the name suggests, it's a kind of inducing a global seizure, either low level or grand mal-type seizure in the patient's brain and nervous system.

如果你们中有人看过《飞越疯人院》，我认为那部电影的最后一幕或接近最后一幕是杰克·尼科尔森嘴里含着某种咬合保护器并接受电击治疗，顾名思义，这是一种诱发全身性癫痫发作的方法，无论是在患者的大脑和神经系统中的低水平还是严重的癫痫发作。

You might ask, "Well, why would one want to do that?" Well, it turns out that this is a well-established and in many cases, very effective treatment for major depression.

您可能会问：“那么，为什么要这样做呢？”事实证明，这是一种行之有效的治疗重度抑郁症的方法，在许多情况下非常有效。

Electric shock therapy is generally used for treatment-resistant depression.

电击疗法通常用于治疗难治性抑郁症。

So these are people that have no positive response or ongoing positive response to drug therapies or other therapies.

因此，这些人对药物疗法或其他疗法没有积极反应或持续积极反应。

Electric shock therapy is thought to work primarily by stimulating the massive kind of indiscriminate release of things like serotonin, dopamine, acetylcholine, a huge variety of neuromodulators, as well as things like BDNF, brain-derived neurotrophic factor, which then allows neuroplasticity to take place.

电击疗法被认为主要通过刺激血清素、多巴胺、乙酰胆碱、多种神经调节剂以及 BDNF（脑源性神经营养因子）等物质的大量无差别释放来发挥作用，从而使神经可塑性发生。

Again, BDNF being permissive for neuroplasticity.

再次强调，BDNF 允许神经可塑性。

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

ECT 的问题在于它实际上只对难治性抑郁症有用。

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

它实际上并不针对躁郁症和躁郁症的躁狂方面，但在药物治疗不起作用时仍会使用。

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

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

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

这是您需要去医院的事情，并且通常在电惊厥治疗后需要一些住院护理。

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

这是一个相当高的成本，特别是对于那些没有保险的人来说。

And of course, it requires anesthesia.

当然，这需要麻醉。

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

对于大多数人来说，这不会是一个问题，但对于许多人来说，这可能是一个问题。

And there's often some associated memory loss.

而且经常会出现一些相关的记忆丧失。

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

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

Nowadays, ketamine type therapy is done repeatedly, or other treatments.

如今，重复进行氯胺酮类治疗或其他治疗。

For instance, transcranial magnetic stimulation, which is basically non-invasive.

比如经颅磁刺激，基本上是非侵入性的。

It's a coil that's placed on the outside of the skull, excuse me, and we can more accurately refer to it as repetitive or rTMS, repetitive transcranial magnetic stimulation.

这是一个放置在头骨外侧的线圈，对不起，我们可以更准确地将其称为重复性或 rTMS，即重复性经颅磁刺激。

Transcranial magnetic stimulation is a tool that allows researchers and clinicians to reduce the amount of activity in specific neural circuits, so they can actually target the magnetic field to particular neural circuits to reduce activity in those neural circuits.

经颅磁刺激是一种工具，可以让研究人员和临床医生减少特定神经回路的活动量，因此他们实际上可以将磁场瞄准特定的神经回路，以减少这些神经回路的活动。

Again, it's minimally invasive.

再次强调，它是微创的。

It has been shown to be effective in both increasing neuroplasticity in positive ways, as well as reducing depressive episodes, and in a few instances, in reducing the amplitude or the intensity of manic episodes in people with bipolar disorder.

它已被证明可以有效地以积极的方式增加神经可塑性，以及减少抑郁发作，并且在某些情况下，可以减少双相情感障碍患者躁狂发作的幅度或强度。

The problem is, it's still a very early technique.

问题是，这仍然是一项非常早期的技术。

There aren't a lot of clinics and labs doing it.

没有很多诊所和实验室这样做。

I'm starting to see more advertisements, literally commercial clinics that are advertising rTMS or TMS.

我开始看到更多的广告，实际上是商业诊所在宣传 rTMS 或 TMS。

I encourage you to approach those clinics with caution.

我鼓励您谨慎前往这些诊所。

I'm of the mind that if those clinics are not either closely or maybe even distantly associated with a research institution that's really up on the latest of rTMS, you'd be wise to at least do your research, right?

我认为，如果这些诊所与真正掌握最新 rTMS 的研究机构没有密切甚至遥远的联系，那么您至少应该进行研究，对吗？

And explore, talk to other patients who've done these treatments.

并探索、与其他接受过这些治疗的患者交谈。

But certainly in university hospitals and in clinical settings and research settings, rTMS is being used as a way to, for instance, reduce the activity of certain limbic circuitries, so that people are just overall less excitable and manic.

但可以肯定的是，在大学医院、临床环境和研究环境中，rTMS 被用作一种方法，例如减少某些边缘回路的活动，从而使人们总体上不那么兴奋和躁狂。

Or to activate, because it can also be used for activation now of certain neural circuits.

或者激活，因为它现在也可以用于激活某些神经回路。

Activate, for instance, the parietal inputs, the top-down control over the limbic system.

例如，激活顶叶输入，即对边缘系统的自上而下的控制。

This is all happening right now.

这一切正在发生。

So we have ECT, repetitive TMS or rTMS, and then as I mentioned earlier, ketamine therapies.

所以我们有 ECT、重复 TMS 或 rTMS，然后正如我之前提到的，氯胺酮疗法。

Most of those are targeted toward the depressive aspects of manic depression.

其中大多数都是针对躁狂抑郁症的抑郁方面。

So for people with bipolar disorder that doesn't include depression, those are going to be less effective.

因此，对于患有双相情感障碍（不包括抑郁症）的人来说，这些方法的效果会较差。

But overall, it's going to be the talk therapies of the sort that we discussed earlier or a moment ago, plus drug treatments.

但总的来说，这将是我们之前或刚才讨论过的那种谈话疗法，加上药物治疗。

Almost always lithium will be explored, plus some treatments for the depressive episodes, in particular, if those depressive episodes are present.

几乎总是会探索锂，加上一些针对抑郁发作的治疗方法，特别是如果存在这些抑郁发作。

Nowadays, there's a lot of excitement about psilocybin, which is a psychedelic.

如今，裸盖菇素（psilocybin）是一种致幻剂，引起了很多人的兴奋。

In the US, psilocybin is still illegal.

在美国，裸盖菇素仍然是非法的。

It is not legal, meaning you can get in a lot of trouble for possessing it, certainly for selling it, et cetera.

它是不合法的，这意味着您可能会因为拥有它而遇到很多麻烦，当然也可能因为出售它等等而陷入困境。

But psilocybin is being explored as a clinical therapy in certain laboratory settings, in particular at Johns Hopkins School of Medicine.

但裸盖菇素正在某些实验室环境中作为临床疗法进行探索，特别是在约翰霍普金斯大学医学院。

It's being explored in human patients for the treatment of major depression, for OCD, I believe, as well, but certainly for major depression and for eating disorders.

我相信它也正在人类患者中探索治疗重度抑郁症和强迫症，但肯定是治疗重度抑郁症和饮食失调。

And it seems from the initial wave of publications from that work done by the incredible Matthew Johnson, or Dr. Matthew Johnson, who was a guest on this podcast before.

从令人难以置信的马修·约翰逊（Matthew Johnson）或马修·约翰逊博士（Dr. Matthew Johnson）所做的第一波出版物来看，他之前是这个播客的嘉宾。

He's also been on the Tim Ferriss podcast.

他还参加了蒂姆·费里斯播客。

He's been on the Lex Fridman podcast.

他一直在 Lex Fridman 播客上。

Dr. Matthew Johnson came on this podcast, has talked about some of the work with psilocybin for the treatment of depression.

马修·约翰逊博士参加了这个播客，谈论了裸盖菇素治疗抑郁症的一些工作。

Very impressive results there.

那里的结果非常令人印象深刻。

And as you can imagine, very impressive results for the major depressive episodes for bipolar.

正如你可以想象的那样，双相情感障碍的重度抑郁发作的结果非常令人印象深刻。

However, at least to my knowledge, again, to my knowledge, there have not been any controlled clinical trials exploring psilocybin for the mania associated with bipolar disorder.

然而，至少据我所知，据我所知，还没有任何对照临床试验探索裸盖菇素治疗与双相情感障碍相关的躁狂症。

If someone out there is aware of those clinical trials, please let me know.

如果有人知道这些临床试验，请告诉我。

I'll do an update in a future podcast.

我将在未来的播客中进行更新。

But right now, no knowledge From me about psilocybin clinical trials for the manic component of bipolar disorder.

但现在，我不知道裸盖菇素治疗双相情感障碍躁狂成分的临床试验。

A number of people are probably also going to wonder about whether or not cannabis or medical marijuana is useful for bipolar disorder.

许多人可能还会想知道大麻或医用大麻是否对双相情感障碍有用。

To address this, I look to some previous lectures and some clinicians at Stanford Psychiatry.

为了解决这个问题，我查阅了一些以前的讲座和斯坦福大学精神病学的一些临床医生的资料。

This question was asked of them, and as it turns out, cannabis does not seem to be effective for the treatment of the manic phases of bipolar disorder or for the treatment of the major depressive component.

有人向他们提出了这个问题，事实证明，大麻似乎对治疗双相情感障碍的躁狂期或治疗重度抑郁症无效。

The only treatment perhaps, or I should say the only situation perhaps in which it might be useful, and this is what was relayed to me, is that it may help with sleep in certain people that are having trouble with insomnia.

也许唯一的治疗方法，或者我应该说它可能有用的唯一情况，这就是传达给我的内容，是它可能有助于某些患有失眠症的人的睡眠。

Although nowadays it's far more common for people in manic episodes to be prescribed things like trazodone or other benzos, benzodiazepines, in order to try and get sleep within the manic episodes.

尽管如今，对于躁狂发作的人来说，更常见的是服用曲唑酮或其他苯并二氮杂卓类药物，以便在躁狂发作期间尝试入睡。

And benzodiazepines and trazodone, et cetera, work largely through the so-called GABA system.

苯二氮卓类药物和曲唑酮等药物主要通过所谓的 GABA 系统发挥作用。

This is a neurotransmitter that causes reductions in excitability of neurons, hence why it's being used to try and calm people down and allow them to sleep during their manic episodes.

这是一种神经递质，会导致神经元兴奋性降低，因此它被用来试图让人们平静下来，让他们在躁狂发作期间入睡。

So not a lot or essentially no data supporting the use of cannabis for the treatment of bipolar disorder per se, nor data supporting the use of psilocybin for the treatment of bipolar disorder per se.

因此，没有太多或基本上没有数据支持使用大麻本身治疗双相情感障碍，也没有数据支持使用裸盖菇素本身治疗双相情感障碍。

But I realize as I say that, that there are going to be a number of people that may have had positive or negative experiences with cannabis or psilocybin as they relate to bipolar disorder.

但我意识到，当我这么说时，会有很多人可能对大麻或裸盖菇素有过积极或消极的经历，因为它们与双相情感障碍有关。

So please, if you're willing or comfortable, put that, if you're comfortable, into the comments section on YouTube.

因此，如果您愿意或愿意，请将其放入 YouTube 的评论部分。

And of course, if you are aware of any studies on cannabis or psilocybin showing positive outcomes for the treatment of bipolar disorder, please provide links or PubMed IDs to those.

当然，如果您知道任何有关大麻或裸盖菇素的研究显示出治疗双相情感障碍的积极效果，请提供这些研究的链接或 PubMed ID。

I'd love to peruse those studies.

我很想仔细阅读这些研究。

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

有两种自然疗法，或者我应该说，基于营养补充剂的双相情感障碍方法。

They get talked about a lot, and one of them shows some interesting promise or effectiveness even, in a limited context.

它们被广泛讨论，其中之一甚至在有限的背景下也表现出了一些有趣的前景或有效性。

Before marching into this description of these two compounds, in fact, before even mentioning these two compounds, I do want to emphasize what's been said and written about over and over again and what was relayed to me from expert psychiatrists.

事实上，在开始对这两种化合物进行描述之前，事实上，在提及这两种化合物之前，我确实想强调一遍又一遍地说过和写过的内容，以及精神科医生专家向我传达的内容。

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

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

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

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

I don't say this to protect me.

我这么说并不是为了保护我。

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

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

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

现在，这并不是说没有有用的生活方式干预措施可以支持躁郁症患者。

So I just briefly want to mention those.

所以我只想简单地提一下这些。

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

再说一次，我引用了斯坦福大学和其他地方的精神病学家的一些优秀在线讲座的内容，这些讲座本质上是说，当然，当然，当然，当然，当然，获得更好的睡眠，获得足够的锻炼，获得适当的营养，进行高质量、健康的社交互动，甚至在白天定期接受阳光，在晚上避免强光，所有这些都将结合在一起，以支持双相情感障碍患者的神经系统和心理。

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

但它们编织在一起以支持任何人和每个人的心理、神经化学和神经回路。

So they have generally a modulatory effect.

因此它们通常具有调节作用。

That is, they're indirectly shifting the likelihood that somebody might have an episode or the intensity of an episode, and particularly the depressive episodes.

也就是说，它们间接地改变了某人可能出现发作的可能性或发作的强度，尤其是抑郁发作。

Right?

正确的？

You can imagine how someone who's heading into a depressive episode, maybe they're on a lower amount of medication, or they haven't yet medicated for the depressive episode of bipolar, and now they're making sure, or their family is making sure that they're getting exercise, sunshine, eating correctly, social engagement, et cetera.

你可以想象一个即将陷入抑郁发作的人，也许他们正在服用较少量的药物，或者他们还没有治疗双相抑郁发作的药物，但现在他们正在确保，或者他们的家人正在确保他们得到锻炼、阳光、正确饮食、社交参与等等。

Of course, it makes perfect sense why they would have perhaps a shallower drop into depression or maybe even offset a depressive episode.

当然，这是完全有道理的，为什么他们可能会较浅地陷入抑郁症，甚至可能抵消抑郁症的发作。

That said, most all, if not all people with bipolar disorder are likely to need some sort of drug therapy intervention in order to help them.

也就是说，大多数（如果不是全部）双相情感障碍患者可能需要某种药物治疗干预来帮助他们。

So lifestyle factors are always important in all individuals, those suffering from psychiatric conditions or not.

因此，生活方式因素对于所有人来说始终很重要，无论是否患有精神疾病。

But in some conditions of the mind and body, those lifestyle interventions can have a greater effect in offsetting symptoms, whereas in bipolar disorder, I think it's naive and, in fact, wrong to say that lifestyle interventions alone are going to prevent, especially the extreme forms of mania and depression.

但在某些精神和身体状况下，这些生活方式干预措施可以在抵消症状方面发挥更大作用，而在双相情感障碍中，我认为说仅靠生活方式干预就可以预防，特别是极端形式的躁狂和抑郁症，我认为这种说法很天真，事实上也是错误的。

Again, bipolar disorder being so serious and carrying such high suicide risk, we just have to point this out again and again.

再说一遍，躁郁症如此严重，自杀风险如此之高，我们不得不一次又一次地指出这一点。

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

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

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

这两种物质就是肌醇和 omega-3 脂肪酸。

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

现在，肌醇是一种因多种原因而被服用的化合物。

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

这是我们之前在播客上讨论过的事情。

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

我个人服用肌醇，并不是因为我患有双相情感障碍。

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

事实上，我很幸运，我没有躁郁症。

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

但我每三天左右服用 900 毫克肌醇，以改善睡眠。

It's something that I've added to my sleep stack.

这是我添加到我的睡眠堆栈中的东西。

It's something that I found greatly enhances the depth and quality of my sleep.

我发现它可以极大地提高我的睡眠深度和质量。

And if I wake up in the middle of the night to use the bathroom, et cetera, it's greatly enhanced my ability to fall back asleep when I want to go back to sleep.

如果我半夜醒来去洗手间等，当我想回去睡觉时，它会大大增强我重新入睡的能力。

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

它在白天似乎也具有相当有效的抗焦虑作用。

And as I discussed in our episode about obsessive-compulsive disorder, inositol has been used at high dosages Again, I should say myo-inositol has been used at high dosages, at levels of even 10, 18 grams.

正如我在关于强迫症的一集中所讨论的，肌醇已被高剂量使用。再次，我应该说肌醇已被高剂量使用，甚至达到 10、18 克的水平。

Those are massive dosages, by the way, to deal with certain symptoms of OCD to limited success.

顺便说一句，这些剂量很大，用于治疗强迫症的某些症状，但效果有限。

And I should mention that high dosages of 10 or 18 grams of inositol can cause a lot of gastric discomfort, et cetera.

我应该提到，高剂量的 10 或 18 克肌醇会引起严重的胃部不适等。

If you want to learn more about inositol and its various uses, I encourage you to go to examine.com, where there's the so-called human effect matrix, and that human effects matrix will describe the many places in which myo-inositol and other forms of inositol have been shown to be effective in, for instance, reducing anxiety, enhancing sleep, and on and on.

如果您想了解更多有关肌醇及其各种用途的信息，我鼓励您访问 exam.com，那里有所谓的人类效应矩阵，该人类效应矩阵将描述肌醇和其他形式的肌醇已被证明在许多方面有效的地方，例如，减少焦虑、增强睡眠等等。

Myo-inositol is important because myo-inositol, and we can just say inositol, is related to so-called second messenger pathways.

肌醇很重要，因为肌醇，我们可以说肌醇，与所谓的第二信使途径有关。

I don't want to get too deep into second messenger pathways, but when certain substances bind, like neurotransmitters to a receptor on a cell surface, oftentimes those receptors themselves will open and allow the passage of ions and other things into a cell.

我不想太深入地了解第二信使通路，但是当某些物质（例如神经递质）与细胞表面的受体结合时，这些受体本身通常会打开并允许离子和其他物质进入细胞。

Oftentimes, they will engage what are called second messenger systems.

通常，他们会使用所谓的第二信使系统。

That is, they will trigger mechanisms within the cell to then go do other things.

也就是说，它们会触发细胞内的机制，然后去做其他事情。

This is probably something we should get into in real detail in a future episode for those of you that really want to nerd out on cell-cell signaling, which is a favorite topic of mine.

对于那些真正想研究细胞间信号传导的人来说，这可能是我们应该在未来的剧集中详细讨论的内容，这是我最喜欢的主题。

In any case, inositol is related to a number of so-called second messenger systems.

无论如何，肌醇与许多所谓的第二信使系统有关。

This handoff or this kind of stimulating of changes within a cell that can inspire changes in what's called membrane fluidity, can actually make the membranes of cells, the outside fence around a cell, which is made up of fatty stuff, it can change the fluidity, meaning how readily things can float around in the membrane.

这种交接或这种细胞内变化的刺激可以激发所谓的膜流动性的变化，实际上可以使细胞膜（细胞周围由脂肪物质组成的外部栅栏）改变流动性，这意味着物体在膜上漂浮的容易程度。

We think of cells as very rigid, like there's a cell, there's a neuron, or there's an immune cell.

我们认为细胞非常刚性，就像有一个细胞，有一个神经元，或者有一个免疫细胞。

But actually, those cells have a fatty outside, and particularly neurons have a fatty outside.

但实际上，这些细胞的外部有脂肪，特别是神经元的外部有脂肪。

It's a thin, fatty outside, and it's called the cell membrane.

外面是一层薄薄的脂肪，叫做细胞膜。

And things are floating around in that cell membrane, but it's kind of like jello that hasn't quite fixed.

细胞膜上漂浮着一些东西，但它有点像尚未完全固定的果冻。

And so things like receptors moving into the synapse or moving out of the synapse for homeostatic plasticity.

因此，受体进入突触或移出突触以实现稳态可塑性。

Things like the ability for certain genes to be turned on in a cell or not turned on can depend a lot on things that are happening in that cell membrane and how readily things move around in the cell membrane.

诸如某些基因在细胞中开启或不开启的能力之类的事情在很大程度上取决于细胞膜中发生的事情以及事情在细胞膜中移动的容易程度。

One way to think about this whole picture of membrane fluidity is that just imagine that every one of your cells has this layer.

思考膜流动性全貌的一种方法是想象你的每个细胞都有这一层。

It's kind of a gelatinous-like layer, and there are lots of little rafts floating around in there.

它是一种凝胶状的层，里面漂浮着很多小木筏。

But those rafts are able to move more quickly from one place to another or get more stuck in one place or another, depending on how set that jello is.

但这些木筏能够更快地从一个地方移动到另一个地方，或者更容易卡在一个地方或另一个地方，具体取决于果冻的凝固程度。

Inositol and lithium, and as we'll talk about next, omega-3 fatty acids, seem to change the fluidity of those membranes.

肌醇和锂，以及我们接下来要讨论的 omega-3 脂肪酸，似乎会改变这些膜的流动性。

In other words, they allow things to move in and out of those membranes more readily or not.

换句话说，它们允许物体更容易或不更容易地进出这些膜。

And this is no surprise given that those membranes are made out of fatty stuff.

鉴于这些膜是由脂肪物质制成的，这并不奇怪。

In particular, the membranes of neurons are what called a lipid bilayer.

特别是，神经元的膜被称为脂质双层。

It's two layers of fat.

这是两层脂肪。

Bi means two, and lipid, fat.

Bi的意思是二，脂质，脂肪。

And omega-3 fatty acids of the sort that are found in certain fish and that fatty fish in particular, and that are found in fish oil and cod liver oil, et cetera.

omega-3 脂肪酸存在于某些鱼类，特别是脂肪鱼中，也存在于鱼油和鱼肝油等中。

Omega-3 fatty acids, when we ingest them, are used for a lot of different things, but they can be readily incorporated into pathways or directly incorporated into cell membranes, changing the way those cell membranes work, and if those cell membranes are the cell membranes of neurons, changing the way that neurons work.

当我们摄入 Omega-3 脂肪酸时，它们可用于许多不同的用途，但它们可以很容易地融入通路或直接融入细胞膜，改变这些细胞膜的工作方式，如果这些细胞膜是神经元的细胞膜，就会改变神经元的工作方式。

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

因此，鱼油，特别是 omega-3 脂肪酸（有 EPA 和 DHA 等多种脂肪酸，我们稍后会讨论）的能力已经在相对高剂量下被探索，因为它们能够抵消躁狂症的一些影响，并抵消躁郁症中抑郁发作的影响。

And actually, the data there are pretty impressive, although they are varied, meaning you will find several studies, and I'll mention a few, that found no effect of omega-3 supplementation through fish oil.

事实上，那里的数据相当令人印象深刻，尽管它们各不相同，这意味着您会发现几项研究（我将提到一些）发现通过鱼油补充 omega-3 没有效果。

Usually, it's capsuled fish oil, although fish oil can also be taken in liquid form.

通常，它是胶囊鱼油，尽管鱼油也可以以液体形式服用。

Oftentimes, taking in liquid form is the more cost-efficient way to do it.

通常，采取液体形式是更具成本效益的方法。

Taking in capsule form is the more palatable way to do it because fish oil, for a lot of people, doesn't taste good.

服用胶囊形式是更可口的方法，因为对于很多人来说，鱼油味道不好。

But nonetheless, there are several studies that have shown that supplementing with fish oil or omega-3 fatty acids at levels of, for instance, four grams per day for a period of time.

但尽管如此，有几项研究表明，在一段时间内每天补充 4 克鱼油或 omega-3 脂肪酸。

This is a study that we will link in the show notes.

这是一项我们将在展会笔记中链接的研究。

This is Murphy et al., 2012.

这是 Murphy 等人，2012 年。

This is a fatty acid supplementation of 70% EPA to DHA actually worsened symptoms of mania over a period of about 16 weeks, which on the face of it, makes it seem like, okay, omega-3 fatty acid supplementation very likely to not be good for bipolar disorder.

这种补充 70% EPA 和 DHA 的脂肪酸实际上会在大约 16 周的时间内恶化躁狂症状，从表面上看，补充 omega-3 脂肪酸很可能对双相情感障碍没有好处。

And yet, that was the manic phase.

然而，那是躁狂阶段。

When one looks at some of the other studies of omega-3 fatty acid supplementation, there is, for instance, a study published in 1999.

当人们查看其他有关补充 omega-3 脂肪酸的研究时，会发现例如 1999 年发表的一项研究。

This is a much higher dosage supplementation with omega-3 fatty acid.

这是更高剂量的 omega-3 脂肪酸补充剂。

This is a 9.6 grams of fish oil per day for four months, and that actually greatly reduced symptoms of bipolar depression compared to the control group, which received olive oil.

这是每天 9.6 克鱼油，持续四个月，与接受橄榄油的对照组相比，实际上大大减轻了躁郁症的症状。

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

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

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

因此，四个月内每天摄入 9.6 克鱼油就相当于一天要摄入的大量鱼油。

This was a double-blind study.

这是一项双盲研究。

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

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

Here's the major takeaway.

这是主要的收获。

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

补充高剂量的 omega-3 似乎确实对很多双相情感障碍患者有益。

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

然而，我想再次强调，它不应被视为双相情感障碍的唯一治疗方法。

This goes back to what I was saying before about the essential need in most every case for high-potency prescription drug treatments prescribed by a board-certified psychiatrist for bipolar disorder.

这可以追溯到我之前所说的，在大多数情况下，都需要经过委员会认证的精神科医生为双相情感障碍开出的高效处方药治疗。

However, omega-3 supplementation does seem to improve or reduce the depressive symptoms in the major depressive episodes of bipolar, and there are a couple studies, and we'll link to these in the show notes as well, that show that it may even improve some of the manic episodes as well, meaning it reduces some of the manic symptoms.

然而，补充 omega-3 似乎确实可以改善或减轻双相情感障碍的重度抑郁发作中的抑郁症状，并且有几项研究（我们也会在节目笔记中链接到这些研究）表明它甚至还可以改善一些躁狂发作，这意味着它可以减轻一些躁狂症状。

Now, I say all this from a place of great caution because I know, especially for listeners of this podcast, there's a lot of interest in the behavioral tools, the supplement-based tools, the nutrition tools that can support bipolar disorder.

现在，我非常谨慎地说这一切，因为我知道，尤其是对于这个播客的听众来说，人们对行为工具、基于补充剂的工具、可以支持双相情感障碍的营养工具很感兴趣。

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

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

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

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

I'd be remiss, however, if I didn't emphasize that the omega-3 fatty acid supplementation is very interesting, not just in terms of the subjective effects, people saying they feel less depressed or able to sleep better or maybe even some reduction in manic symptoms.

然而，如果我不强调补充 omega-3 脂肪酸非常有趣，不仅仅是在主观效果方面，那就是我的失职了，人们说他们感觉不那么抑郁或能够睡得更好，甚至可能减轻躁狂症状。

There's actually been some really good brain imaging to try and understand how omega-3 fatty acid treatments are actually changing the brains and neural circuits of people with bipolar, and I will put a reference to this.

实际上，已经有一些非常好的脑成像技术可以尝试了解 omega-3 脂肪酸治疗实际上如何改变双相情感障碍患者的大脑和神经回路，我将对此进行参考。

This is a paper that was published in the American Journal of Psychiatry.

这是一篇发表在《美国精神病学杂志》上的论文。

It's entitled "Omega-3 Fatty Acid Treatment and T2 Whole Brain Relaxation Times in Bipolar Disorder."

它的标题是“双向情感障碍中的 Omega-3 脂肪酸治疗和 T2 全脑松弛时间”。

I don't have the opportunity to go into a lot of detail right now about what T2 whole brain relaxation times are, but basically when people go into an MRI or F, functional MRI scanner, magnetic excuse me, magnetic resonance imaging scanner, what they're getting essentially is pulses of magnetic fields, and the way that brain structures and neural activity can be evaluated has a lot to do with the spinning, or not sort of.

我现在没有机会详细介绍 T2 全脑松弛时间是什么，但基本上，当人们进入 MRI 或 F、功能性 MRI 扫描仪、磁力对不起、磁共振成像扫描仪时，他们得到的本质上是磁场脉冲，而评估大脑结构和神经活动的方式与旋转有很大关系，或者不是。

It has to do with the spinning and the relaxation times of different elements, literally the protons and electrons within the neurons, so it gets really detailed there.

它与不同元素（实际上是神经元内的质子和电子）的旋转和弛豫时间有关，因此它在那里变得非常详细。

And the relaxation time is essentially looking at how quickly some of that spinning returns to rest, and in particular, the fact that the relaxation times are different for aqueous, that is liquid, versus lipid, fatty, versus other components of brain tissue.

弛豫时间本质上是考察一些旋转恢复到静止状态的速度，特别是水（即液体）与脂质、脂肪和脑组织其他成分的弛豫时间不同的事实。

And basically what this study shows is that the membranes of neurons within the brains of these people with bipolar disorder showed more fluidity, more ability of things to move in and around the membranes, which we know is an important component of neuroplasticity, in bipolar subjects that were treated with omega-3 fatty acids as compared to bipolar subjects that did not receive omega-3 fatty acids.

基本上，这项研究表明，与未接受 omega-3 脂肪酸治疗的双相情感障碍患者相比，接受 omega-3 脂肪酸治疗的双相情感障碍患者大脑内的神经元细胞膜表现出更高的流动性和更强的物质在膜内和膜周围移动的能力，我们知道这是神经可塑性的重要组成部分。

And fortunately, this study also included a healthy comparison group where they could essentially find that people with bipolar disorder who supplemented with omega-3s had changes at the cellular level and the neural circuit level that brought their brains and neural circuits closer to that of the healthy comparison subjects.

幸运的是，这项研究还包括一个健康对照组，他们基本上可以发现补充 omega-3 的双相情感障碍患者在细胞水平和神经回路水平上发生了变化，使他们的大脑和神经回路更接近健康对照组。

So while I don't want to point to omega-3 fatty acid supplementation as the be-all, end-all of treatment for bipolar disorder, certainly it is not, it does have a strong mechanistic basis for its possible support of neural circuitry, of neuroplasticity, and in particular, the ability to make changes in cell membranes that are very reminiscent of some of the neural circuit changes and changes in membrane fluidity that are seen with lithium treatment and other known prescription drug treatments that have been established now for decades to be very effective for bipolar disorder.

因此，虽然我不想将 omega-3 脂肪酸补充剂视为双相情感障碍的最终治疗方法，但它确实具有强大的机制基础，可以支持神经回路、神经可塑性，特别是改变细胞膜的能力，这非常让人想起锂治疗和其他已知的处方药治疗中看到的一些神经回路变化和膜流动性的变化，这些变化已经建立了数十年，非常有效。对双相情感障碍有效。

So what that says is that omega-3 supplementation, while not the only intervention that one should consider, is something to consider and talk about with your doctor, and it's operating in powerful ways.

因此，补充 omega-3 虽然不是人们应该考虑的唯一干预措施，但值得考虑并与您的医生讨论，而且它正在以有效的方式发挥作用。

It's not just that it's changing, for instance, your gut microbiome, which is powerful, but is indirect to the brain.

例如，它不仅仅是在改变你的肠道微生物组，它的作用很强大，但对大脑来说却是间接的。

It does seem to be having direct effects on neurons and neural circuits.

它似乎确实对神经元和神经回路有直接影响。

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

在我们开始结束关于双相情感障碍的讨论之前，我想谈谈这个词障碍。

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

这个主题不仅与双相情感障碍有关，还与其他精神疾病有关。

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

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

And certainly, bipolar disorder meets those criteria.

当然，双相情感障碍符合这些标准。

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

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

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

不管你相信与否，有充分的数据支持这样一个事实：狂热的某些方面与创造力有关。

Now, we are long overdue for an episode about creativity, its neural circuit basis, its chemical basis here on the Huberman Lab podcast, and certainly, we will have that conversation.

现在，我们早就应该在休伯曼实验室播客上播放有关创造力、其神经回路基础、其化学基础的一集了，当然，我们将会进行这样的对话。

But in the meantime, I'd like to just briefly touch upon this idea that certain occupations are associated with a higher incidence of bipolar depression.

但与此同时，我想简单地谈谈这个想法，即某些职业与双相抑郁症的高发病率有关。

And in fact, it's been explored at a research level.

事实上，它已经在研究层面上进行了探索。

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

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

So this is a study looking at mood disorders in eminent individuals.

这是一项针对知名人士情绪障碍的研究。

So these are people that are not just good at what they do, but are exceptional at what they do, and explored the percentage of people in given professions with either depression or mania.

这些人不仅擅长他们所做的事情，而且在他们所做的事情上表现出色，并探讨了特定职业中患有抑郁症或躁狂症的人的百分比。

And this was actually a dataset gleaned from more than 1,000 20th century Westerners based on their biographies that were reviewed by other people.

这实际上是根据 1000 多名 20 世纪西方人的传记收集到的数据集，并经过其他人的审阅。

So it's a bit of an indirect measurement.

所以这有点间接测量。

This isn't psychiatrist data.

这不是精神病学家的数据。

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

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

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

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

There are a lot of professions here.

这里有很多职业。

I will post this, or I'll post a link to it in the show note captions for you to peruse, but I'll just give you a sense of the extremes on this graph because they're very interesting.

我会发布这个，或者我会在显示注释标题中发布一个链接供您细读，但我只会让您了解这个图表上的极端情况，因为它们非常有趣。

Turns out that if you were to look at the profession, or I should say, among the professions they looked at in this study, because they didn't look at all professions, those in the military and those who are professional athletes or had jobs in the social or natural sciences, of those, there was a lower percentage of those that had depression or mania.

事实证明，如果你要看看这个职业，或者我应该说，在他们在这项研究中考察的职业中，因为他们没有考察所有职业，军队中的职业、职业运动员或在社会或自然科学领域工作的人，在这些职业中，患有抑郁症或躁狂症的比例较低。

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

在某些情况下，比如职业运动员，没有出现躁狂症，至少在这个数据集中是这样。

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

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

As high as 90%.

高达90%。

That's incredible.

那真是难以置信。

Contrast that with military, where it's as few as 10%, or professional athletes, where it's as few as 20%.

相比之下，军人的这一比例只有 10%，职业运动员的比例只有 20%。

And for the professional athletes, as I mentioned before, none of them had mania.

对于职业运动员来说，正如我之前提到的，他们没有一个有躁狂症。

So does this mean that being a poet will make you manic or depressed?

那么这是否意味着成为一名诗人会让你变得狂躁或沮丧？

Well, first of all, let's look at the poetry category.

好吧，首先我们看一下诗歌类别。

It turns out that 75% of these eminent poets, these highly accomplished poets, had major depression, whereas only about 20% of those poets had manic episodes.

事实证明，这些杰出诗人、成就斐然的诗人中，有 75% 患有严重抑郁症，而只有 20% 左右的诗人有躁狂发作。

Okay?

好的？

So again, it's not that being a poet is going to give you mania.

再说一次，成为一名诗人并不会让你狂热。

Certainly, we're not saying that.

当然，我们不是这么说的。

It's not that being a poet is going to give you depression, but it turns out that people with depression and people with depression and mania seem to gravitate towards poetry, or at least are very successful at poetry.

并不是说成为一名诗人就会让你感到抑郁，但事实证明，患有抑郁症的人和患有抑郁症和躁狂症的人似乎都倾向于诗歌，或者至少在诗歌方面非常成功。

Again, associative, correlative, no causal relationship here.

再次强调，这里是关联的、相关的，没有因果关系。

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

但令人震惊的是，创造性的职业，诗歌，小说，艺术，非小说写作，尽管非小说写作是关于非小说的，但它仍然是创造性的，音乐创作，戏剧，狂热等事物的发生率要高得多。

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

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

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

在他们调查的演员中，约有 30% 患有躁狂症或患有全面的躁狂症。

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

所以我提到这些数据是因为，首先，我发现它们非常有趣，对吧？

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

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

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

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

That said, in no way, shape, or form do I believe that being depressed is a good thing or that being manic is a good thing.

也就是说，我无论如何都不相信抑郁是一件好事，或者躁狂是一件好事。

Again, we return to the basic foundational criteria for bipolar disorder and major depression, which is that the pressured speech, the not sleeping, the incredible increases in energy, and the flights of ideas are generally not going to lead, or I think it's fair to say, are not going to lead to good places.

再次，我们回到双相情感障碍和重度抑郁症的基本标准，即压力性言语、不睡觉、精力令人难以置信的增加以及思想的飞翔通常不会导致，或者我认为公平地说，不会导致好的地方。

In fact, often lead to bad places.

事实上，往往会导致不好的地方。

But we would also be wrong if we didn't consider the fact that there is a somewhat inextricable relationship between mania and creativity.

但如果我们不考虑狂热和创造力之间存在着某种密不可分的关系这一事实，我们也会错的。

And it could be that hypomania or brief periods of mania, maybe even an hour a day or 30 minutes a day of composing or writing poetry, maybe even some of the lows that we feel, right?

这可能是轻度躁狂或短暂的躁狂，甚至可能是每天一个小时或每天 30 分钟作曲或写诗，甚至可能是我们感受到的一些低谷，对吗？

Some of the sadness, some of the grief, some of the nostalgia that we feel, provided that it's not pathologic, that it's not persistent for the four or seven days that are diagnostic of bipolar II and bipolar I disorder, respectively.

我们感受到的一些悲伤、一些悲伤、一些怀旧，只要它不是病态的，它不会持续四天或七天，分别诊断为双相II型和双相I型障碍。

Well, then we can start to view emotional states as something that can actually lend themselves to positive outcomes and maybe even to creativity and to improved occupations.

好吧，那么我们就可以开始将情绪状态视为实际上可以带来积极结果，甚至可能带来创造力和改善职业的东西。

So it's important that we have a nuanced view of what sadness versus depression versus major depression are.

因此，重要的是我们对悲伤、抑郁和重度抑郁有一个细致入微的看法。

It's important that we distinguish between Being erratic, being very energized, and full-blown bipolar disorder.

重要的是，我们要区分不稳定、精力充沛和全面的双相情感障碍。

And I raise this for another reason as well.

我提出这个问题还有另一个原因。

Nowadays, it's very common to hear people saying, "Ugh, that person is OCD." Well, on the episode about OCD that I did a few weeks back, that you can find if you like at hubermanlab.com.

如今，经常听到人们说：“呃，那个人是强迫症患者。”好吧，关于我几周前制作的有关强迫症的剧集，如果您喜欢，可以在 hubermanlab.com 上找到。

In that episode, I pointed out that OCD, obsessive compulsive disorder, is very maladaptive.

在那一集中，我指出OCD（强迫症）是非常不适应的。

I think it's number seven, as I recall, on the list of debilitating diseases, all diseases, in terms of lost time at work, suffering, relationships, et cetera.

我记得，在所有使人衰弱的疾病清单上，从工作时间损失、痛苦、人际关系等方面来看，它排在第七位。

So it's a really serious condition, and yet we often hear, "Oh, that person is obsessive." And as I pointed out, there is obsessive compulsive personality disorder, and then there is obsessive compulsive tendencies, which actually benefit people.

所以这是一个非常严重的情况，但我们经常听到，“哦，那个人有强迫症。”正如我所指出的，有强迫性人格障碍，然后有强迫性倾向，这实际上是对人有益的。

But that is distinct from obsessive compulsive disorder as a clinically diagnosed thing.

但这与临床诊断的强迫症不同。

Similarly, we hear that, "Oh, somebody's being bipolar.

同样，我们听到这样的话：“哦，有人患有躁郁症。

They're all over the place, they're bipolar." Well, that's a very subjective label that people give one another in passing.

他们到处都是，他们是两极分化的。”嗯，这是人们顺便给彼此贴上的一个非常主观的标签。

More and more often I'm hearing this, and yet bipolar disorder, whether or not it's BP1 or BP2, are extremely maladaptive and extremely associated with high suicide risk.

我越来越频繁地听到这种说法，但双相情感障碍，无论是 BP1 还是 BP2，都极其不适应环境，并且与高自杀风险密切相关。

So while I'm not here to police people, I'm certainly not the word police or the nomenclature police.

因此，虽然我来这里不是为了警察，但我当然不是“警察”这个词或术语“警察”。

I do think that whether or not you refer to people as OCD or as bipolar, et cetera, that's up to you.

我确实认为，无论你是否将人们称为强迫症或躁郁症等等，这取决于你。

It's not my place to say, but I do think it's important that all of us understand that these psychiatric conditions carry with them tremendous maladaptive weight.

这不是我该说的，但我确实认为重要的是我们所有人都明白这些精神疾病带来了巨大的适应不良的影响。

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

所以今天，我们真正深入研究了双相情感障碍、双相情感障碍中存在或可能存在的躁狂和抑郁成分以及不同形式的双相情感障碍，以及双相情感障碍的一些主要治疗方法。

In particular, lithium and its underlying mechanisms and some of the neural circuit and chemical basis and neuroplasticity basis of the treatments for bipolar disorder.

特别是锂及其潜在机制以及双相情感障碍治疗的一些神经回路和化学基础和神经可塑性基础。

In particular, homeostatic scaling or homeostatic plasticity.

特别是稳态缩放或稳态可塑性。

All of that, of course, is relevant to bipolar disorder and I hope will be useful in your understanding and maybe even in your pursuit of treatments for bipolar depression, bipolar disorder for you or other people.

当然，所有这些都与双相情感障碍有关，我希望对您的理解有所帮助，甚至可能有助于您为自己或其他人寻求双相抑郁、双相情感障碍的治疗方法。

I also hope that it will be useful in your understanding of how brain circuits work in normal conditions or in conditions where there is no disease state or maladaptive conditions.

我还希望它有助于您了解大脑回路在正常条件下或在没有疾病状态或适应不良条件下如何工作。

Homeostatic plasticity is present in all of us.

我们所有人都存在稳态可塑性。

Membrane fluidity, due to how easily things move around in the surface, the fatty layers on the outside of neurons and the movement of receptors in and out of neurons, that is present in all of us.

膜的流动性是由于物体在表面移动的容易程度、神经元外部的脂肪层以及受体进出神经元的运动而产生的，这种流动性存在于我们所有人身上。

The influence of omega-3 fatty acids is central to that discussion, as is the discussion about various drug treatments.

omega-3 脂肪酸的影响是该讨论的核心，关于各种药物治疗的讨论也是如此。

Because even if you're not somebody who's taking a drug treatment or who is pursuing a drug treatment for bipolar disorder or another psychiatric condition, your serotonin levels, your dopamine levels, your acetylcholine levels, all of these play into what we call your mental and physical health.

因为即使您不是正在接受药物治疗或正在寻求药物治疗双相情感障碍或其他精神疾病的人，您的血清素水平、多巴胺水平、乙酰胆碱水平，所有这些都会影响我们所说的您的精神和身体健康。

In fact, if any of you are interested in the various categories of neuromodulators and tools to adjust those neuromodulators under more standard non-disease conditions, we did an episode on neurochemicals and how to control them.

事实上，如果你们中的任何人对各种类别的神经调节剂和在更标准的非疾病条件下调整这些神经调节剂的工具感兴趣，我们做了一集关于神经化学物质以及如何控制它们的节目。

You can find that at hubermanlab.com, along with all other episodes of the Huberman Lab podcast.

您可以在 hubermanlab.com 上找到该内容以及 Huberman Lab 播客的所有其他剧集。

I should mention everything is timestamped, so you can navigate to the specific topics and tools of interest to you.

我应该提到的是，所有内容都带有时间戳，因此您可以导航到您感兴趣的特定主题和工具。

And meanwhile, I just want to thank all of you for joining me on this voyage through the biology and the treatments for bipolar disorder.

与此同时，我只想感谢你们所有人与我一起踏上双相情感障碍生物学和治疗的旅程。

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

我确实希望您发现它对您自己和他人都有好处。

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

我只是想提醒人们，双相情感障碍是一种极其严重的疾病。

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

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

If you're learning from and are enjoying this podcast, please subscribe to our YouTube channel.

如果您正在学习并喜欢这个播客，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 subscribe to the podcast on Spotify and Apple.

此外，请订阅 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 suggestions about topics you'd like us to cover or guests you'd like us to interview on the Huberman Lab podcast, or if you have questions about material already covered on the Huberman Lab podcast, please put that in the comment section on YouTube.

如果您对希望我们在 Huberman Lab 播客上报道的主题或采访嘉宾有任何建议，或者如果您对 Huberman Lab 播客中已涵盖的材料有疑问，请在 YouTube 的评论部分中提出。

We do read all the comments.

我们确实阅读了所有评论。

In addition, please check out the sponsors mentioned at the beginning of today's episode.

另外，请查看今天节目开头提到的赞助商。

That's the best way to support this podcast.

这是支持这个播客的最佳方式。

During today's episode, and certainly on many previous episodes of the Huberman Lab podcast, we talk about supplements.

在今天的节目中，当然也在 Huberman Lab 播客的许多之前的节目中，我们谈论了补充剂。

Once again, while supplements aren't necessary for everybody, many people derive tremendous benefit from them, for things like enhancing sleep and focus and hormone support, and other aspects of mental and physical health and performance.

再说一次，虽然补充剂并不是每个人都需要的，但许多人都从它们中获得了巨大的好处，例如增强睡眠、注意力和激素支持，以及心理和身体健康和表现的其他方面。

As I mentioned at the beginning of today's episode, the Huberman Lab podcast is happy to announce that we partnered with Momentous Supplements.

正如我在今天节目开头提到的，Huberman Lab 播客很高兴地宣布我们与 Momentous Supplements 合作。

If you'd like to see our supplements and the ones that we've designed in concert with Momentous, you can go to livemomentous.com/huberman.

如果您想查看我们的补充品以及我们与 Momentous 合作设计的补充品，您可以访问 livemomentous.com/huberman。

Please also check out Huberman Lab on social media.

另请在社交媒体上查看 Huberman 实验室。

We are Huberman Lab on both Twitter and Instagram.

我们在 Twitter 和 Instagram 上都是 Huberman Lab。

In both places, I cover 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 information covered on the Huberman Lab podcast.

在这两个地方，我都介绍了科学和科学相关的工具，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中涵盖的信息不同。

We also have a newsletter.

我们还有一份时事通讯。

It's called the Neural Network Newsletter.

它被称为神经网络通讯。

It's completely zero cost, and it contains summaries of podcasts and some actionable protocols from each podcast.

它完全是零成本，并且包含播客摘要和每个播客的一些可操作协议。

You can sign up for it by going to hubermanlab.com, go to the menu and click on Neural Network Newsletter.

您可以通过访问 hubermanlab.com 进行注册，进入菜单并单击“神经网络新闻通讯”。

You can also see some examples of previous newsletters there.

您还可以在那里看到以前的时事通讯的一些示例。

I should mention that by signing up, you do provide your email, but we do not share your email with anybody, and again, it is completely zero cost.

我应该提到的是，通过注册，您确实提供了您的电子邮件，但我们不会与任何人共享您的电子邮件，而且，这完全是零成本。

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

再次感谢您今天与我一起讨论双相情感障碍的生物学和治疗。

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

最后但并非最不重要的一点是，感谢您对科学的兴趣。