必备知识：双相情感障碍的科学与治疗

欢迎来到休伯曼实验室精华版，我们将重温过往节目，为你带来最有效、最实用的科学工具，帮助改善心理健康、身体健康和表现能力。

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

我是安德鲁·休伯曼，斯坦福大学医学院神经生物学和眼科学教授。

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

今天我们要讨论的是双相情感障碍，很多人也叫它双相抑郁。

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

双相抑郁是一种情绪、精力和认知会剧烈波动的状况。

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

但必须强调的是，这些情绪、精力和认知上的波动都是适应不良的。

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

它们不仅会对患者本人造成严重伤害，也会给周围人的生活带来巨大冲击。

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

事实上，双相情感障碍患者自杀的风险比普通人高出二十到三十倍。

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

所以今天的讨论非常严肃，无论是正在经历躁狂型双相障碍的人，还是身边有这样的人，都能从中获得切实的帮助。

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.

双相情感障碍影响大约百分之一的人群。

So bipolar disorder impacts about one percent of people.

这个比例听起来可能不高，但想象一下一百个人的房间，里面至少有一人很可能患有双相情感障碍。

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

通常发病年龄在二十到二十五岁之间，不过也可能更早出现。

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

双相情感障碍主要分为两种类型，分别是双相I型和双相II型。双相I型的特点是持续较长时间的躁狂发作。

There are basically two kinds of bipolar disorder referred to as bipolar I and bipolar Bipolar I is characterized by a fairly extended period of mania.

什么是躁狂？

What is mania?

躁狂是指情绪异常高涨、精力旺盛、注意力分散、冲动行事，还有一些其他症状，我们后面会详细讲。

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

但这种躁狂发作非常严重。

But this manic episode is extreme.

诊断双相I型的一个关键临床标准是，患者必须持续出现躁狂症状七天或以上。

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.

通常，患者会被家人送去医院，或者自己主动就医，也可能约见精神科医生。

Typically a person will be brought into a clinic or a person would bring themselves to a clinic or meet with a psychiatrist.

精神科医生会开始评估几个关键方面。

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

首先，他们要判断患者是否至少具备以下三种症状之一。

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.

第一个症状是注意力难以集中。

The first symptom is distractibility.

处于躁狂发作中的人，可能刚在说一支笔，接着就聊起前几天看到的事，然后又转到想买的东西，再说到要去旅行的地方，等等。

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, etcetera.

而且他们对房间里任何微小的刺激都特别敏感。

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

所以注意力极易分散，行为也特别冲动——冲动主要体现在行动上。

So highly distractible, highly impulsive, impulsivity relates to actions.

比如，患者可能会不停地摆弄手边的东西，甚至突然想站起来离开房间。

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

另一个是夸大妄想。

The other is grandiosity.

处于躁狂发作期的双相情感障碍患者，常常表现出言语或行为上的夸大妄想。

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

这些人真的会相信自己在世界上地位非凡，或者拥有非凡的机会和潜力。

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.

思维奔逸也是躁狂发作的典型表现。

Flight of ideas are also typical of manic episodes.

这和注意力分散有点像，但区别在于，他们会滔滔不绝地讲一件事，然后突然转到另一件事，又开始滔滔不绝。

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.

躁狂发作时还常出现焦躁不安，患者会感到身体极度不安，不停地抖动、来回走动。

The other aspect of manic bipolar disorder that often presents itself in the manic episodes are agitation, people feeling extremely physically agitated, so a lot of shaking and moving about.

这种情况可能会发展成偏执，但更多表现为坐不住、静不下来，根本无法保持平静的神情和举止。

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

还有一点就是完全睡不着觉。

And then another condition is no sleep.

我说的没睡觉，意思是完全不睡，或者几乎不睡。

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

听起来可能很难相信，但处于躁狂发作的人，常常连续七天甚至更久都不睡。

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

而这种完全不睡的关键特点是，他们根本不觉得这有什么问题。

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

我只能想象，换成我们大多数人，在这种状态下早就撑不住了，可他们却一直不停地活动——通宵购物、说话、跑步，做着前面提到的那些各种事，完全不因为没睡觉而感到困扰。

I 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.

最后一种精神科医生会评估的症状是语速快、压力大的说话方式。

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

话像连珠炮一样冲着你来，根本没给你插话的余地。

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

所以我们现在有注意力分散、冲动、夸大妄想、思维奔逸、烦躁不安、睡眠缺失，还有语速快且压力大的说话方式。

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

一个人要被诊断为躁狂发作，并不需要表现出所有这些症状。

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

不过，他们至少需要表现出其中三项症状，并且为了符合双相I型的诊断标准，这些症状必须持续至少七天。

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.

时间可能更长，但最少得有七天。

It could be longer, but at least seven days.

双相I型障碍指的是患者会出现持续七天或更久的躁狂发作，但并不一定同时伴有抑郁发作。

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.

这是一个关于双相障碍的常见误解，因为人们常把双相障碍叫做双相抑郁，但实际上很多双相障碍患者并不会经历严重的抑郁期。

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.

双相障碍的第二类是双相II型。

The second category of bipolar disorder is bipolar II.

双相II型，也就是BP II，和双相I型有些不同。

So BP II or bipolar II is somewhat different than bipolar disorder I.

首先，它通常表现为躁狂发作和抑郁发作同时存在，或者更准确地说，是轻躁狂发作。

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.

双相II型的诊断往往基于持续四天甚至更短时间的躁狂发作。

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

所以，患有双相II型的人可能会有四天精力旺盛、目标明确的行为，情绪易怒或欣快，失眠等等，但这些症状通常只持续大约四天。

So someone with BP II might have four days of this increased energy, goal directed activity, they're irritable, they're euphoric, they're not sleeping, etcetera, but it's only lasting for about four days.

也有可能出现更长时间的躁狂期，但那属于轻躁狂发作。

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

程度没那么强烈。

They're not quite as intense.

言语急促的情况也没那么明显。

So the pressured speech isn't quite as pressured.

冲动行为也没那么严重，诸如此类的情况。

The impulsivity isn't quite as severe, etcetera, etcetera.

双相II型的另一个特点，我刚才简单提过，就是常常伴随抑郁发作。

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

有人可能从持续七天或更久的极度亢奋，突然跌入深深的抑郁，持续两周甚至更久。

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

有些人则是快速循环型，三天躁狂、三天正常、三天躁狂，接着又陷入三天的抑郁。

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

所以，别再以为躁郁症就是一条上下波动的波浪线，一直在躁狂和抑郁之间来回切换。

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.

它的表现形式其实多种多样。

It can take a lot of different forms.

这也给精神科医生的诊断带来了很大挑战，因为他们往往只能看到患者某个瞬间的状态，除非他们长期接触、了解这个人。

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

但这一点对你们尤其重要——无论你是自己患有双相抑郁，还是怀疑自己可能有，或者你认识的人有双相抑郁，甚至只是怀疑对方可能有双相障碍。

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.

因为如果你发现一个人突然特别亢奋，然后又恢复正常，这和一个人从极度亢奋直接跌入深重抑郁，完全是两种不同的情况。

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.

那种从极度亢奋直接坠入深沉抑郁的模式，更容易被识别，毕竟高低反差太明显了。

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

我这么说，你们可能觉得挺显而易见，但作为这个星球上关心他人的普通人，留意这些躁狂发作真的特别重要——不管它是持续四天以内，还是七天以上，这些躁狂发作才是双相障碍最核心的诊断依据，也就是我们常说的双相抑郁。

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

接下来我先休息一下，感谢我们的赞助商BetterHelp。

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

BetterHelp 提供由持证治疗师进行的全程在线心理辅导。

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

我做心理辅导已经很多年了，说实话，这跟健身很像。

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

有时候我想去做，有时候又提不起劲。

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

但每次辅导结束，我都会感觉好多了，觉得这时间花得值。

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

通常结束一次辅导后，我都会收获一个深刻的见解，或者好几个，又或者对正在困扰我的事——不管是工作、人际关系、自我认知，还是生活其他方面——有了新的看法。

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

有效的心理辅导带来的好处真的太多了。

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

而 BetterHelp 让你很容易就能找到一位专业的治疗师，帮你获得这些辅导带来的好处。

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

而且真的管用。

And it works.

BetterHelp 的实时咨询服务在超过一百七十万条用户评价中，平均得分高达 4.9 分（满分 5 分）。

BetterHelp has an average rating of 4.9 out of five for its live sessions based on over 1,700,000 client reviews.

而且因为 BetterHelp 完全在线，非常节省时间。

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

不用开车去咨询师办公室，不用找停车位，也不用堵在路上。

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

如果你想试试 BetterHelp，访问 betterhelp.com/huberman，首月可享九折优惠。

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

再次提醒，网址是 betterhelp.com/huberman。

Again, that's betterhelp.com/huberman.

接下来我想聊聊双相情感障碍的一些治疗方法。

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

在讨论这些疗法时，有一个特别了不起的发现历程——某种疗法至今仍对许多患者效果显著，尽管有些人因为一些原因无法使用，我们待会儿会讲到。

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.

这个故事里的关键人物是一位姓凯德的医生。

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

凯德是一位澳大利亚精神科医生，同时也是一名士兵。在二战期间，新加坡沦陷后，他被日军俘虏，从1942年一直关押到1945年。

Cade was an Australian psychiatrist who also was a soldier 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.

在被囚禁的这段时间里，他有足够的时间观察他人，注意到一些狱友的情绪和精力波动非常剧烈，常常在躁狂和抑郁之间来回切换，有时也会从躁狂回到正常状态。

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.

不知出于什么原因——我查不到任何他提出这个假设的依据——他推测，这些人的大脑里可能积累了一种化学物质，而通过排尿排出后，人就会变得平静，不再躁狂。

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.

1945年他获释后，除了在诊所接诊病人，还开始做起了实验。

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.

他收集了躁狂患者和非躁狂患者的尿液，然后把这些尿液注射到豚鼠体内，作为实验模型。

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.

他的总体发现是，躁狂患者的尿液确实会让豚鼠表现出更明显的躁狂行为，对吧？

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, right?

不过，他当时具体测量了哪些指标，并不十分清楚。

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

那时候的科学界还比较宽松，研究者可以更主观地描述现象，当然，也还是有数据和统计的。

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

凯德发现，躁狂症患者的尿液对这些豚鼠似乎更具毒性。

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

他还知道，尿液中有两种有毒物质：尿素和尿酸。

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

于是他把躁狂患者和非躁狂患者的尿素与尿酸分离开来，发现两组人的尿素含量其实是一样的。

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，他把注意力转向了尿酸。

So instead he focused on the uric acid.

为了把尿酸溶解成溶液以便注射到豚鼠体内，他尝试了多种不同的化合物来稀释它。

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.

碰巧的是——你们搞化学的应该知道——有些物质就是很难溶解。

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.

你把粉末放进试管，加点水、生理盐水或者其他溶剂，搅一搅，粉末还是悬浮着，根本没法变成清澈的液体供注射。

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

为了测试不同浓度的尿酸，他最终用了锂盐来帮助溶解，结果锂盐真的管用。

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

所以他实际上做的，对化学背景的朋友来说，就是把尿酸和锂混合，制成了一种锂尿酸盐溶液，明白吗？

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, okay?

这些细节可能很多，但很重要，因为他最终发现，当用锂稀释尿酸、形成锂尿酸盐后，这种物质居然能平复那些被注射了有毒尿素的豚鼠的躁动。

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.

他还发现，锂尿酸盐对这些豚鼠整体上都有镇静作用。

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

现在我们真的进入疯狂的领域了，对吧？

So now we're really off in crazy territory, right?

我们在讨论病人的尿液，分离出尿素和尿酸。

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

我们在尿酸里加入锂。

We're adding lithium to the uric acid.

然后把这东西注射进豚鼠体内。

We're injecting this into guinea pigs.

这听起来越来越离谱、越来越怪了，但这就是医学——有时候，医学和科学就是这么回事。

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

凯德不仅是一位出色的医生，也是一位优秀的科学家——我说的优秀科学家，是指他做了对照实验。

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

他当时给动物注射了锂尿酸盐，观察到了效果，但他清楚，这种溶液里不只有尿酸，还有锂。

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.

于是他很合理地提出疑问：会不会是锂本身在起镇静作用？结果确实如此。

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

当他做了严谨的对照实验，只给豚鼠注射锂溶液时，它们也安静了下来。

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

接着，他以20世纪40年代的医学方式——这种做法现在根本不可能发生——迅速从动物实验转向人体试验，开始给病人注射或口服锂盐。

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

结果发现，锂对缓解躁狂症状有着极其显著的正面效果。

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

像所有优秀的医生科学家一样，他把结果整理成文，发表了一篇题为《锂盐在精神兴奋症治疗中的应用》的论文。

And as all good physician scientists do, he results and he wrote it up in a paper entitled Lithium Salts in the Treatment of Psychotic Excitement.

那时候他们不叫躁狂，而是称之为精神兴奋症。

Okay, back then they didn't call it mania, they called it psychotic excitement.

这篇论文发表于1949年9月3日的《澳大利亚医学杂志》，是精神病学领域的一篇经典研究。

This is a paper that was published 09/03/1949 in the Medical Journal of Australia, a classic study in the field of psychiatry.

我得提一下，锂盐有很多重要的特性，但同时也有一些不容忽视的副作用。

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

首先，它有一定的毒性，所以血液中的锂浓度必须严格监控，不能随便给每个人开同样的剂量，不同患者对它的反应差异很大。

First of all, it does have a certain toxicity and so levels of lithium in the blood need to be monitored extremely carefully, so it's not the sort of thing that people can just take at a given dose and every patient responds the same.

治疗初期，尤其是头三个月，需要频繁监测，做大量血液检查，管理非常严格。

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.

不过，科学家和临床医生一直很严谨地研究锂的作用机制，想借此弄清双相情感障碍的根本原因。

Now, 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.

医学界明白，哪怕一种疗法有效，只要它有副作用，就说明还有更好的治疗方案值得探索。

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.

只有深入理解锂在细胞层面、神经回路层面的作用机制，我们才有可能发现真正的新突破。

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

锂似乎能抑制炎症，尤其重要的是，它能抑制神经组织、特别是大脑内部的炎症反应。

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

锂的另一个特点是具有神经保护作用。

The other thing about lithium is that lithium is neuroprotective.

神经保护指的是神经元更能应对各种压力，尤其是兴奋性毒性。

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

在双相情感障碍以及其他许多精神疾病中，某些脑区的过度活跃实际上会杀死神经元。

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.

过度活跃并不总是导致这种情况，但研究发现，如果某些脑回路长期过度活跃，与神经活动相关的化学物质，比如钙和谷氨酸，反而会杀死这些活跃的神经元。

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.

因此，锂似乎能防止部分这种神经毒性。

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

我之前在休伯曼实验室播客里提到过，人的感知有两种模式。

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

外感受指的是关注我们皮肤以外发生的事情。

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

内感受则是感知身体内部发生的变化。

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

我们始终处于外感受和内感受之间的平衡中，但研究表明，双相障碍患者随着时间推移，尤其是在患病第二、第三个十年后，内感受能力会逐渐下降。

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

这很可能解释了为什么他们难以察觉到自己说话速度过快、连续五天没睡觉，或者很久没吃东西这些状况。

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

负责内感受的神经回路出现萎缩，正逐渐成为双相障碍的一个关键神经机制特征。

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

现在，我从锂盐能减轻神经回路过度活跃带来的神经毒性这一观点，过渡到接下来的讨论。

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.

事实上，双相抑郁患者在疾病早期，大脑中某些神经回路的活动水平很可能已经升高，而这种变化通常在二十岁出头开始出现，有时甚至更早，出现在青春期。我们推测，这种过度活跃会导致负责内感受的神经回路产生兴奋性毒性，而锂盐很可能正是通过保护这些回路，减缓它们的萎缩。

The reality is that people with bipolar depression very likely have 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, but that hyperactivity we think leads to a toxicity, an excitotoxicity of certain elements of the neural circuits that are responsible for interoception, and it appears that lithium very likely protects us against some of that atrophy of those circuits for interoception.

我们先短暂休息一下，感谢赞助商AG1。

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

AG1是一种含有维生素、矿物质、益生菌、益生元和适应原的营养饮品。

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

我早在2012年就发现了AG1，那时还没做播客，但从那以后我每天都坚持服用。

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

我开始服用AG1的原因，也是我至今每天都在服用的原因，是因为在我看来，AG1是市面上质量最高、成分最全面的基础营养补充剂。

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

AG1的设计旨在支持肠道健康、免疫系统和整体能量水平，它能帮助弥补你日常饮食中可能存在的营养缺口。

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

我经常被人问到，如果只能选一种补充剂，你会选哪一个？

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

我的答案永远都是AG1。

And my answer is always AG1.

它对我的身体健康、心理健康和表现提升都提供了极大的帮助。

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

如果你想试试AG1，可以访问drinkag1.com/huberman，享受专属优惠。

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

目前限时赠送一瓶他们新推出的Omega-3辅酶Q10产品。

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

Omega-3和辅酶Q10被广泛认为有助于心血管健康、细胞健康与能量代谢、大脑功能，以及其他多种益处。

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

我本人每天都服用这两种。

I personally take them both every day.

再次提醒，前往 drinkag1.com/huberman，首次订阅 AG1 即可免费获得一盒新型欧米伽三和辅酶 Q10 产品。

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

接下来我想聊聊一些不太常见的双相情感障碍疗法，同时也指出那些曾经尝试过但被证明无效的治疗方法，因为这些方法在网上社区里经常被提及和推荐。

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.

虽然这些方法单独使用未必有明显危险——当然有些确实存在风险——但我认为非常重要的是，考虑到双相情感障碍的时效性和早期干预的紧迫性，为了防止神经回路发生长期改变，如果能避开那些效果不佳或已被证实无效的疗法，患者对抗双相障碍的成功率会高得多。

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.

首先，关于药物治疗与非药物治疗或心理治疗的一个关键点。

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

毫无疑问，药物治疗配合心理治疗的效果最好。

Without question, drug therapies are going to be most effective when done also with talk therapies.

我们一会儿会具体讲讲哪些心理治疗方法已被证实最有效。

And we'll talk about which talk therapies have been demonstrated to be most effective.

关于接下来我要说的内容，有些人可能有不同看法，但总体来说，大多数精神科医生——至少我接触过的都表示——仅靠心理治疗，几乎从不适用于双相抑郁或双相障碍，无论是 BP1 还是 BP2。

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.

这就是现实情况。

That's just the reality of it.

这两种疗法，无论是传统的还是较新的，都是和药物治疗配合使用的。

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

认知行为疗法看起来效果最好，至少从现有的数据和研究来看是这样。

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

它也是被研究得最多的一种。

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

所以它常被认为最流行或最有效，部分原因是因为它出现得早，研究也最充分。

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.

认知行为疗法总的来说，是在临床环境中以高度可控的方式，逐步让患者接触那些可能加重双相障碍的诱因或情境。

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.

还有一种疗法叫人际与社会节律疗法。

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

这其实完全值得单独做一期节目来详细讲。

This is deserving of its own entire episode really.

人际与社会节律疗法可以说是家庭聚焦疗法的一种延伸，不过也有其独特之处，主要关注人们在生活、工作、学校以及家庭等环境中与他人的互动方式。

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, etcetera.

我得指出，精神病学和心理学领域正在形成一个共同趋势，那就是尽可能多地融入社会因素和人际互动的维度。

And I should say that a 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.

换句话说，不再仅仅把患者看作一个独立的生物系统、神经系统、化学物质组合和个体生命，而是要把这些化学物质、神经回路，和嵌入在他人生命与神经活动中的个体生命结合起来看待。

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.

有一种非常令人振奋且正在兴起的治疗方法，对双相障碍展现出巨大潜力，甚至在某些案例中效果显著——你可能想不到，那就是电休克疗法，通常用于治疗对药物无效的重度抑郁。

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, generally used for treatment resistant depression.

这些患者对药物治疗或其他疗法都没有反应，或者反应无法持续。

So these are people that have no positive response or ongoing positive response to drug therapies or other therapies.

电休克疗法的问题在于，它主要只对药物无效的抑郁有效。

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

它并不能直接针对双相障碍中的躁狂症状，但在药物治疗失效时，仍会被使用。

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

电休克疗法，也就是正确的术语——电抽搐疗法（ECT），有一些明显的缺点，比如它是一种相当侵入性的治疗方式，对吧？

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

这事儿得去医院处理，通常电休克治疗后还需要住院观察。

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

费用挺高的，尤其是没保险的人。

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

当然，这过程需要麻醉。

And of course it requires anesthesia.

对大多数人来说这不是问题，但对不少人来说确实是个难题。

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

而且常常会伴随一些记忆丧失。

And there's often some associated memory loss.

由于记忆受损、侵入性强，再加上费用高，大多数患者都难以接受电休克治疗，所以它通常只在药物和其他疗法都无效时才作为最后的选择。

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.

目前有两种基于营养补充剂的自然疗法，常被提及用于治疗双相障碍。

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

它们被讨论得很多，其中一种在有限范围内已经显示出一些不错的潜力和效果。

They get talked about a lot, and one of them shows some interesting promise or effectiveness even in a limited context.

在详细介绍这两种物质之前，甚至在提到它们之前，我想再次强调一点，这一点专家精神科医生反复提醒过我，也多次在文献中提到。

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.

单靠心理治疗或自然疗法来治疗双相情感障碍是不明智的，因为这种疾病症状严重，患者自杀风险很高。

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.

这是一种涉及化学物质和神经回路的紊乱，必须由经过认证的精神科医生，通过正规的药物治疗来直接应对。

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.

我这么说不是为了自保，而是真心希望保护那些自己可能患有双相情感障碍，或者身边有人疑似患有这种病的人。

I don't say this to protect me, I say this truly to protect those who either suffer from or think they may suffer from bipolar disorder, if you know someone who you think might suffer from a bipolar disorder.

不过，这并不意味着没有一些有益的生活方式调整可以帮助双相情感障碍患者。

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

所以我简单提一下这些方法。

So I just briefly want to mention those.

我接下来要说的内容，主要参考了斯坦福大学和其他机构精神科医生的一些优质线上讲座，他们反复强调：保证良好睡眠、适度运动、均衡营养、建立健康的社会关系，白天多晒太阳、晚上避免强光，这些因素共同作用，能有效支持双相患者的大脑和情绪系统——但其实，这些对任何人、任何人的神经化学和大脑回路都有帮助。

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, but they braid together to port the psyche and the neurochemistry and the neural circuits of anybody and everybody.

说到这里，有两种物质通常作为膳食补充剂使用，当然它们也存在于某些食物中，已有部分研究显示，它们在缓解双相情感障碍症状方面效果显著。

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.

这两种物质是肌醇和欧米伽-3脂肪酸。

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

肌醇是一种被用于多种目的的化合物。

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

我们以前在播客里也聊过这个东西。

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

我本人吃肌醇并不是因为患有双相情感障碍——事实上我很幸运，没有这个问题——但我每隔几天就会吃900毫克的肌醇，主要是为了改善睡眠。

I personally take inositol not because I have bipolar disorder, in fact, I am quite lucky that I don't have bipolar disorder, but I take inositol at nine hundred milligrams of myo inositol every third night or so order to improve my sleep.

它白天还能有效缓解焦虑情绪。

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

鱼油，尤其是其中的欧米伽-3脂肪酸，比如EPA和DHA，已经被研究用于高剂量干预，以减轻双相情感障碍中的躁狂和抑郁症状。

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

有多项研究显示，连续四个月每天服用9.6克鱼油，相比服用橄榄油的对照组，能显著缓解双相抑郁症状。

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

橄榄油是另一种脂肪，属于单不饱和脂肪，但所含的欧米伽-3脂肪酸要少得多。

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

每天摄入9.6克鱼油，连续四个月，这量可真不小。

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

这是一项双盲研究。

This was a double blind study.

我要提一下，这项研究只纳入了30名受试者，男女都有，年龄跨度也很大，从18岁到64岁不等——这一点很重要，因为双相情感障碍的症状会随时间变化。

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.

这里的关键结论是：

Here's the major takeaway.

高剂量的Omega-3补充剂，对不少双相情感障碍患者确实有帮助。

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

但要注意，这不能被视为治疗双相情感障碍的唯一方法。

Highlight however, it should not be viewed as the only treatment approach for bipolar disorder.

我再怎么强调都不为过：对于双相情感障碍来说，尤其是考虑到自杀风险、情绪失控、过度消费和冲动行为这些严重问题，很难想象单靠谈话疗法、鱼油和生活方式调整就能完全控制或治愈这种病。

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.

双相情感障碍患者真正需要的是全面看待治疗方案——药物治疗、心理治疗、生活方式调整，再加上像Omega-3这样的营养补充剂，这才是应对这种疾病的完整且必要的组合。

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-three supplementation as a full and necessary picture for dealing with their illness.

我们先插播一小段广告，感谢我们的赞助商 Eight Sleep。

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

Eight Sleep 生产智能床垫罩，具备制冷、加热和睡眠监测功能。

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

要保证睡个好觉，最关键的一点就是让卧室的温度保持在合适范围。

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

因为要入睡并保持深度睡眠，你的体温需要下降大约一到三摄氏度。

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

而要醒来时感觉神清气爽，你的体温又得上升一到三摄氏度。

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

Eight Sleep 会根据你的个人需求，整夜自动调节床垫温度。

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

我用了快五年 Eight Sleep 的床垫罩，睡眠质量得到了彻底改善。

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

目前最新的型号是 Pod Five。

The latest Eight Sleep model is the Pod five.

我现在睡的就是这个，真的特别喜欢。

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

它有太多令人惊叹的功能了。

It has so many incredible features.

比如，Pod Five 有个叫自动模式的功能，是一个AI系统，能学习你的睡眠模式，并在不同睡眠阶段自动调节床铺温度。

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

如果你打鼾，它还会帮你抬高头部，还会做其他调整来优化你的睡眠。

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

如果你想试试Eight Sleep，去八sleep.com/huberman，可以享受最高350美元的优惠。

If you'd like to try Eight Sleep, go to eight sleep dot com slash huberman to get up to $350 off the new Pod five.

Eight Sleep支持全球许多国家配送，包括墨西哥和阿联酋。

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

再次提醒，访问8sleep.com/huberman，最多可省350美元。在我们结束关于双相情感障碍的讨论之前，我想聊聊‘障碍’这个词。

Again, that's 8sleep.com/huberman to save up to $350 Before we begin to conclude our discussion about bipolar disorder, I want to talk a little bit about this word disorder.

这不仅适用于双相情感障碍，也适用于其他精神类疾病。

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

当我们提到‘障碍’这个词时，通常会想到一种严重损害我们生活的东西——影响工作、学习、人际关系，甚至从多个方面拖垮我们的健康。

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.

毫无疑问，双相障碍完全符合这些特征。

And certainly bipolar disorder meets those criteria.

但也有这样一种观点：像双相障碍这样的情况，甚至在某些情况下像精神分裂症，可能恰恰是人类数百年来那些杰出创意和艺术作品的来源之一。

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.

你可能想不到，确实有扎实的研究数据表明，躁狂的某些特质与创造力密切相关。

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

这一点已经在科研层面被深入探讨过。

It's been explored at a research level, really.

数据显示，某些职业的人群往往更具创造力，而这种创造力与双相抑郁，甚至其他类型的抑郁，存在某种关联——注意，这不是因果关系，而是相关性。

There are data pointed 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 incidence of bipolar depression and maybe even other forms of depression.

这是一项关于杰出人物中情绪障碍的研究。

So this is a study looking at mood disorders in eminent individuals.

这些是那些不仅做得好，而是真正出类拔萃的人，研究考察了不同职业群体中患有抑郁或躁狂的比例。

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.

这项研究的数据其实来自一千多位二十世纪西方人的传记，由他人审阅整理而成。

And this was actually a dataset gleaned from more than a thousand twentieth century Westerners based on their biographies that were reviewed by other people.

所以这算是一种间接的测量方式。

So it's a bit of an indirect measurement.

这不是精神科医生的临床数据，而是基于自我报告或对自我报告的分析汇总而成的，研究覆盖了多种职业。

This isn't psychiatrist data, 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.

比如，他们考察了军人、职业运动员、自然科学家、社会科学家、公职人员、音乐表演者、艺术家、非虚构作家、诗人等等。

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, non fiction writers, poetry, etcetera.

结果发现，军人、职业运动员，以及从事社会科学或自然科学的人群中，患有抑郁或躁狂的比例相对较低。

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

像职业运动员这类群体，在这个数据集中甚至没有发现一例躁狂症状。

In some cases like those who are professional athletes didn't seem to have, there was no incidence of mania, at least in this dataset.

而在另一端，那些诗人——也就是成就卓著的诗人、杰出的小说家、艺术家和非虚构作家——尤其是诗人，高达百分之九十的人都曾经历过抑郁或躁狂。

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 non fiction writers, well, there, especially for the poets, you find that as many as ninety percent of these very successful poets had either depression or mania.

再次强调，这只是相关性，不是因果关系。

Again, associative, correlative, no causal relationship here.

但真的很引人注目，那些创意类职业——诗歌、小说、艺术、非虚构写作，哪怕非虚构写作讲的是真实事件，本质上还是创作，还有音乐创作、戏剧——这些领域中躁狂症的发病率要高得多。

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

尤其是戏剧界的演员，虽然整体抑郁和躁狂的发生率比诗人低，但其中患有躁狂的比例却高得惊人。

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.

他们研究的演员中，大约有百分之三十曾经历过躁狂发作，或者患有完全形式的躁狂症。

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

所以我提到这些数据，首先是因为我觉得它们特别有意思，对吧？

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

到目前为止，我们一直在讨论双相情感障碍和其他情绪障碍的负面影响。

Up until now, we've been talking about bipolar disorder and other mood disorders for their maladaptive effects.

而且确实，这些障碍的负面影响非常严重，自杀率要高得多，等等。

And again, they're extremely maladaptive, much, much higher instance of suicide, etcetera.

但我们若因此断言躁狂的某些特质不利于创造力，或者重度抑郁的某些特质不利于创造力、表演艺术或诗歌，那就错了。

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.

今天，我们深入探讨了双相情感障碍，包括其中的躁狂和抑郁成分，不同类型的双相障碍，以及主要的治疗方法，尤其是锂盐及其作用机制。

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

希望今天的分享对您和身边人都有帮助。

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

我想提醒大家，双相情感障碍是一种非常严重的疾病。

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

如果您怀疑自己或身边人可能有双相情感障碍，请务必寻求专业医疗人员的帮助。

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.

再次感谢大家今天参与我们关于双相情感障碍的生物学机制与治疗的讨论，最后，也非常感谢你们对科学的关注。

So once again, thank you for joining me today for our discussion about the biology and treatment of bipolar disorder and last but certainly not least, thank you for your interest in science.