---
title: 'The Science & Treatment of Bipolar Disorder | Huberman Lab Essentials'
source: 'https://youtube.com/watch?v=UTB5gAkjevk'
video_id: 'UTB5gAkjevk'
date: 2026-07-16
duration_sec: 1873
---

# The Science & Treatment of Bipolar Disorder | Huberman Lab Essentials

> Source: [The Science & Treatment of Bipolar Disorder | Huberman Lab Essentials](https://youtube.com/watch?v=UTB5gAkjevk)

## Summary

This episode of the Huberman Lab Essentials podcast provides a comprehensive overview of bipolar disorder, covering its types (bipolar I and II), symptoms, diagnostic criteria, and the history of lithium treatment. It also discusses the neural mechanisms, the role of interoception, and emerging treatments, emphasizing the importance of combining drug therapy with talk therapy and lifestyle interventions.

### Key Points

- **Definition and Impact of Bipolar Disorder** [00:29] — Bipolar disorder involves maladaptive shifts in mood, energy, and perception, with a 20-30 times greater risk of suicide.
- **Prevalence and Age of Onset** [01:09] — Bipolar disorder affects about 1% of people, with typical onset between ages 20-25.
- **Bipolar I vs. Bipolar II** [01:25] — Bipolar I is characterized by manic episodes lasting 7 days or more; bipolar II involves hypomanic episodes (4 days or less) and often includes depressive episodes.
- **Symptoms of Mania** [02:08] — Key symptoms include distractibility, impulsivity, grandiosity, flight of ideas, agitation, no sleep, and rapid pressured speech. At least three symptoms are needed for diagnosis.
- **Discovery of Lithium Treatment** [08:29] — Australian psychiatrist John Cade discovered lithium's calming effect on guinea pigs and later on human patients, leading to the first effective treatment for mania.
- **Lithium's Mechanisms** [14:30] — Lithium suppresses inflammation, is neuroprotective, and prevents excitotoxicity, which may protect neural circuits involved in interoception.
- **Interoception and Bipolar Disorder** [15:23] — People with bipolar disorder show diminished interoception over time, contributing to their inability to recognize manic symptoms like lack of sleep or excessive speech.
- **Talk Therapy and Drug Therapy** [18:02] — Drug therapy is essential; talk therapy alone is rarely effective. Cognitive behavioral therapy and interpersonal/social rhythm therapy are used in combination with medication.
- **Electroconvulsive Therapy (ECT)** [20:04] — ECT is used for treatment-resistant depression but does not target mania. It is invasive, costly, and may cause memory loss.
- **Supplement Approaches: Inositol and Omega-3s** [23:29] — Inositol and high-dose omega-3 fatty acids (e.g., 9.6 g fish oil/day) show some benefit for bipolar depression, but should not replace standard treatments.
- **Creativity and Bipolar Disorder** [26:44] — Studies show a correlation between bipolar disorder and creativity, especially in poets, fiction writers, and actors, though no causal link is established.

### Conclusion

Bipolar disorder is a serious condition requiring a comprehensive treatment approach including medication, therapy, and lifestyle changes. Understanding its symptoms and mechanisms can help reduce stigma and improve outcomes.

## Transcript

[music] where we revisit past episodes for the most potent and actionable health, physical health, and performance. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at
Stanford School of Medicine. Today we are going to be discussing bipolar depression. Bipolar depression is a condition in which people undergo massive shifts in their energy, their perception, and
their mood. However, it is very important to note that these shifts in mood, energy, and perception are all maladaptive. They can often cause tremendous damage to the person suffering from bipolar disorder and
tremendous damage to the people in their lives. In fact, people suffering from bipolar disorder are at 20 to 30 times greater risk of suicide. So, today is a serious discussion and it's certainly one in which people who are suffering
people that are suffering from manic bipolar disorder can benefit from. So, bipolar disorder impacts about 1% of people. 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. The typical age of onset is anywhere from 20 to 25 years old, although it can be much earlier. There are basically two kinds of bipolar disorder, referred to
as bipolar 1 and bipolar 2. Bipolar 1 is characterized by a fairly extended period of mania. What is mania? Mania is a period of very elevated mood, energy,
other symptomatology that we'll talk about going forward. But, this manic about going forward. But, this manic episode is extreme. One of the key clinical criteria or diagnostic criteria for bipolar 1 is that a person suffer
from these manic episodes or display these manic episodes for 7 days or more. Typically, a person will be brought into a clinic or a person would bring themselves to a clinic or meet with a psychiatrist. And the psychiatrist is
going to start to evaluate for a couple of different things. But first of all, is whether or not the person has at least three of the following symptoms. The first symptom is distractibility. People who are in a manic episode will
they saw the other day and then something they want to purchase and then a place they're going to travel to, etc. But they are also very prone to any stimulus within the room. So, highly distractible, highly impulsive.
Impulsivity relates to actions. So, the person might be fidgeting with something and then they might try and leave the room. The other is grandiosity. People who have manic bipolar disorder who are in a manic episode will often display
words of or actions of grandiosity. 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. Flight of ideas are also typical of
manic episodes. 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. 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. Um 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. And then another condition is no sleep. And when I say no sleep, I mean no sleep or very minimal sleep. As incredible as
it sounds, people who are in a manic episode can often go 7 days or more with zero sleep. And a key feature of this zero sleep is that they're not troubled by it. 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 and going and going with no sleep, up all hours, shopping, talking, things in the categories of other symptoms that we talked about before,
and it doesn't bother them that they're not sleeping. And then, the last sort of category of symptoms that the psychiatrist is evaluating for and seeing if they present is rapid pressured speech. It's coming at you,
there's really no room for conversation. So, we've got distractibility, impulsivity, grandiosity, flight of ideas, agitation, no sleep, and rapid pressured speech. For someone to be diagnosed as in a manic episode, they do
diagnosed as in a manic episode, they do not have to be engaging in or displaying all of those symptoms. They do, however, need to present at in order to meet the condition of bipolar one,
they have to be presenting those three symptoms for at least 7 days. It could be longer, but at least 7 days. Now, bipolar one disorder means they're having these extended manic episodes, 7 days or more, but it
does not necessarily mean that they are dropping into a depressive episode as well. 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. The second category of bipolar disorder is bipolar two. So, BP2, or bipolar disorder two, is somewhat different than bipolar disorder
one. 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. Bipolar two is often diagnosed on the basis of the presence
of manic episodes that are lasting 4 days or even less. So, someone with BP2 might have 4 days of this increased energy, goal-directed activity, they're irritable, they're euphoric, they're not sleeping, etc., but it's only lasting
for about 4 days. Or, they could be having longer extended periods of mania, but they are hypomanic episodes. They're not quite as intense. So, the pressured speech isn't quite as pressured. The impulsivity isn't quite as severe, etc.,
etc. The other aspect of bipolar 2 is one that I mentioned briefly a moment ago, which is that it's often associated with the drops into the depressive episodes. One person might go from very high highs that last 7 days or more to
very low lows. Bouts of depression, major depression that can last 2 weeks or more. Other people are rapid cycling by way normal, 3 days manic, and then dropping into 3 days depression. 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. It can take a lot of different forms. And again,
this is a serious challenge for the psychiatrist to diagnose people because 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. But, this is
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.
Because if you're noticing that somebody is very manic and then normal, well, somebody who's going from very manic to very deep bouts of depression. The very manic to deep bouts of depression is easier to recognize because of the
extremes of those highs and lows. Now, this might seem somewhat obvious to all of you as I describe it, and yet it's a 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 4 days or less or whether or not it's 7 days or more, these manic episodes really are the the defining criteria of bipolar disorder aka bipolar depression. Now, I'd like to
bipolar disorder. And in the discussion of those treatments, there's an absolutely incredible history of 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. The key player in this story is a physician by the last name Cade. 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. 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.
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 chemical in these people's brains that then they would
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. Eventually, he got out of this prison as we as we mentioned in 1945,
and he started doing experiments in addition to seeing patients in his clinic. 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. 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? The exact measures that he was taking in these guinea pigs wasn't exactly clear. This is um at a time or an era in science when you could uh just sort of report things a little
were still numbers and statistics, what Cade figured out was that the urine from manic patients seemed to be more toxic for these guinea pigs. And he also knew that there are two toxic substances in urine, urea and uric
acid. 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. So instead he focused on the uric acid. 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. It just so happens that and you chemists will be familiar with just don't go into solution easily. You put the powder in a a vial, you add some you mix it up and the powder stays suspended in there. It just doesn't it
uh ever become a clear liquid that you can inject. So in order to try injecting different strengths of uric acid, he ended up using lithium to assist in the dilution. And lithium worked. 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? This is a lot of details, but this is important because what he eventually found is that
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. He also found that lithium urate had a
generally calming effect on these guinea pigs. So, now we're really off in crazy territory, if you right? We're talking about urine from patients that's separating out urea and uric acid. We're adding lithium to the uric acid. We're
This is getting pretty wild and pretty weird. But, this is medicine and from time to time this is medicine and science. Cade was a good scientist in addition to being a good physician. And by good
scientist, I mean that he did control experiments. 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. 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. When he did the proper control
experiment and injected only lithium solution into these guinea pigs, they calmed down. From there, he in sort of 1940s style medicine, and
this you 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. And lo and behold, found an
absolutely profound and positive effect of lithium in reducing symptoms of mania. 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. This is a paper that was published September 3rd, 1949 in the Medical Journal of Australia, a classic study in the field of
psychiatry. Lithium, I should mention, has a number of important features, but effects that need to be considered. First of all, it does have lithium in the blood need to be monitored extremely carefully. So, it's
just take it a given dose, and every patient responds the same. There's a lot of oversight and a lot of blood tests that have to be done, especially in the first 3 months of lithium treatment. 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. Scientists and physicians understand that just because we have one treatment that works,
is the possibility for better treatments. And only by understanding how lithium works at the cellular level, at the neural circuit level, etc., do we really stand to find those new discoveries. Lithium seems to be able to
suppress inflammation, and importantly, it can suppress inflammation in neural tissues and within the brain in particular. The other thing about lithium is that lithium is neuroprotective.
Neuroprotection is an ability for neurons to be better able to handle stress of different kinds, in particular, excitotoxicity. There's a phenomenon in bipolar disorder and a lot of other psychiatric
conditions in which hyperactivity of certain brain areas actually starts to 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
and neurotransmitters like glutamate, can actually kill the very neurons that are active. So, it seems that lithium can prevent some of that neurotoxicity. the Huberman Lab Podcast before, but there are two modes of perception.
Exteroception is literally an attention to things that are happening beyond the confines of our skin. Then there's interoception, which is perception of things that are happening internally. 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. 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 5 days, or they haven't eaten in a long period of time.
This atrophy of neural circuits for interoception is starting to emerge as one of the defining neural circuit characteristics or underpinnings of bipolar. 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. 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
sometimes it that can be even earlier, in the teens and so forth. But, that hyperactivity, we think, leads to a toxicity, an of certain elements of the neural circuits that are responsible for
interoception. And it appears that lithium very likely protects us against for interoception. 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 things are often talked about and suggested especially in online communities 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. First of all a key point about drug therapies versus non-drug therapies or talk therapies. Without question drug therapies are going to be most
effective when done also with talk therapies and we'll talk about which be most effective. 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 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. That's
just the reality of it. There are both established and more novel forms of talk being used again in concert with drug treatments for bipolar disorder. Cognitive behavioral therapy is the one that seems to be best at least by way of
the statistics and papers that exist. It's also the one that's been explored often considered the most popular or effective is because it's also been most. 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. And then there's a category of therapy
called interpersonal and social rhythm therapy. This is deserving of its own uh episode really. Interpersonal and social rhythm therapy is sort of an expansion on family focused therapy, although it's distinct in certain ways
and really focuses on how people are relating to others in their life and in environment and also within the family, etc. 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 not just talking to an examining a patient as one biological system, one
nervous system, one set of chemicals, and one life, but rather a set of that's embedded in the chemicals and neural circuits and lives of other people. 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, so these are people that have no positive response or ongoing positive response to
drug therapies or other therapies. The problem with ECT is that it's really only useful for treatment-resistant depression. It doesn't actually target the manic aspects of bipolar uh depression and bipolar disorder, but
nonetheless is used when drug treatments don't work. Some of the negatives of electric shock therapy um or electroconvulsive therapy ECT is the is the proper acronym and and way it's described is that it's
quite invasive, right? This is something that um you need to go to the hospital inpatient care required after the electric shock uh convulsive therapy. It's a fairly high cost, especially for those that don't have insurance. And of
people that's not going to be a problem, but uh for many people that could be a problem. And there's often some associated memory loss. associated memory loss. And so the memory loss, the invasive
nature of ECT, and the cost often times rule out ECT for most patients, and kind of last resort type thing for treatment-resistant depression. There are two naturopathic, or I should say nutrition supplement-based approaches to
bipolar disorder that get talked about a lot, and one of them shows some interesting promise or effectiveness even in a limited context. Before marching into this description of these two compounds, in fact, before
even mentioning these two compounds, I do want to emphasize what's been said and written about over and over again, and what was relayed to me from expert psychiatrists. 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. 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. 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 think might suffer from bipolar disorder, now, all that is not to say that there aren't useful lifestyle interventions
disorder. So, I just briefly want to mention those. And again, I'm lifting 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 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 disorder, but they braid together to neurochemistry and the neural circuits of anybody and everybody. 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. And those two things are inositol and omega-3 fatty acids. Now, inositol is a compound that is taken for a variety of reasons.
podcast before. 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 900 mg of myo-inositol every third night or so in order to
improve my sleep. It also seems to have a fairly potent anti-anxiety effect during the day. So, the ability for fish oil, and in particular the omega-3 fatty acids, which come in varieties like EPA and DHA, have been explored at
relatively high dosages for their ability to offset some of the effects of mania and to offset the effects of depressive episodes in bipolar disorder. shown that supplementing with fish oil or omega-3 fatty acids at
levels of, for instance, 9.6 g of fish oil per day for 4 months greatly reduced symptoms of bipolar depression compared to the control group, which received olive oil. Olive oil is a different form of fat,
monounsaturated fat, but doesn't contain as much of the omega-3 fatty acids and as much of the omega-3 fatty acids and so forth. So, 9. 9.6 g of fish oil per so forth. So, 9. 9.6 g of fish oil per day over 4 months is a lot of fish oil
a double-blind uh study. 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
the sort of longitudinal or changes over time that one sees in bipolar disorder. Here's the major takeaway. Supplementing with high-dose omega-3s does seem to be beneficial for a good number of people with bipolar disorder.
However, again, I want to highlight, however, it should not be viewed as the disorder. But I don't think I can overemphasize enough that, especially for bipolar disorder and the great risk of suicide and suffering and, you know,
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 lifestyle interventions are going to completely uh suppress or treat bipolar
disorder. 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. Before we begin to I want to talk a little bit about this word disorder.
And this is a theme that doesn't just relate to bipolar disorder, but other psychiatric disorders as well. 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. And certainly bipolar disorder meets those criteria. However,
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. And believe it or not, there are good data to support the fact that certain aspects of mania are associated with creativity. It's been explored at a research level. 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. So, this is a study looking at mood disorders in eminent individuals. So, these are people that are not just good at what they do, but are exceptional at what they do and
are exceptional at what they do and explored the percentage of people in given professions with either depression or mania. And this was actually a data set gleaned from more than a thousand 20th century
Westerners based on their biographies that were of an indirect measurement. This isn't, you know, psychiatrist data. This is you know, psychiatrist data. This is data or I should say these are data that
were compiled from self-reports or from reads of self-reports. professions. 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, etc. 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 had the of those, there was a lower percentage of those that had depression or mania. In some cases, like didn't seem to have There was no incidents of mania, at least in this
data set. Whereas, at the opposite extreme of the graph, those 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 90% of these very successful poets had either depression or mania. Again,
associative correlative, no causal relationship here. 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. In fact, for the people in theater, the actors, even though the overall occurrence of depression and mania is
occurrence of depression and mania is lower than that in poets, the fraction of those individuals that have mania is exceedingly high. It's about 30% of those that they looked at who are actors
have manic episodes or have full-blown mania. So, I'm referring to these data because, first of all, I find them incredibly interesting, right? Up until disorder and other mood disorders for their maladaptive effects, and
again, they're extremely maladaptive, much, much higher incidence of of suicide, et cetera. 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
well to creativity, or to the performing arts, or to poetry. 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 mechanisms. I do hope you found it beneficial
both for yourself and for others. I just want to remind people that bipolar disorder is an extremely serious condition. If you suspect that you have who does, please make sure that you or they talk
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.