Let’s start with a recent medical history written by the patient himself: “34 years old, male. It has been fifteen years since he officially went to a specialist hospital in 1997. In the past 15 years, I have been suffering from pain and pain and have been to all the major hospitals in Nanjing, Beijing, Hefei and Xuzhou, but I have not been able to solve the problem. The following is a description of my condition: Yan Wenwei, psychiatrist of the Third People’s Hospital in Taicang, was sentimental, sensitive and suspicious when I was young, and had a strong competitive spirit. There is no clear line before and after the onset of the disease, and I feel that the disease developed slowly. When I was in junior high school, I sometimes felt that there were two “me “s in two different periods, one period of “me” was more excited and the other period of “me” was more depressed. In 1996, there was a time when the mood was clearly different. In 1996, there was a time when the mood was clearly depressed. However, all of a sudden, there was an improvement in mood, and I felt that my thinking became fast and responsive. Suddenly, I liked to play with people and felt that my future was in good hands. He also invented the “WC” hand signal. He also claimed to have invented the method of “thieves can wear shoes backwards on snowy days to commit crimes, so that they are not easily caught”, and felt that he was very unusual, and talked more and acted more. However, they did not lose control of themselves and did not attack others. His classmates could feel that he was a little different from his usual self, but no mental disorder was suspected. In 1997, he went to a hospital in Nanjing for the first time and was diagnosed as a social phobic, and applied psychological methods, which were not effective. 2001, he attempted suicide because of work and love problems. In July of the same year, he was diagnosed with major depression by a hospital in Beijing, and was given venlafaxine. Two weeks after taking the medication, he suddenly felt better and returned to work. It turned out that he was afraid to walk on the main road, and that night, he purposely walked in the middle of the road, not afraid to see people. I was so excited at night that I couldn’t sleep and felt that I was now well. The next day, I went to the office of my colleague and talked endlessly as if I had found a solution to the problem, as if everything was so wonderful; at that time, I talked endlessly, and my colleagues around me could only listen. In 2004, I had another depressive episode and felt very miserable. I couldn’t stand it, so I went to a hospital on Saturday. I went to a hospital on Saturday and felt that it was not ideal. At that time, I heard a nurse introduce a psychological clinic outside the hospital. When I got there, I felt brighter and more hopeful, so I immediately called my family and told them that I was saved, and I swore to my wife that I would take her on a trip after I got well. In 2005 and 2006, he had several depressive episodes and was still diagnosed with social phobia, and was repeatedly hospitalized and treated with paroxetine and sertraline, but the results were not good. 2009, he stopped taking his own medication and underwent psychotherapy for 10 months, but the results were not good either. to 225 mg. I remember that in the middle of the treatment, there was a period of time when I felt good and energetic, and I was addicted to fishing, doing preparations about weekend fishing during the day, watching articles and videos about fishing on the Internet at night, feeling the need to sleep less and being very exhilarated. Even want to do night fishing, want to participate in fishing tournaments, become an expert fisherman, etc. During these good moods, life felt very good and relaxing, and action was scrambled. After about a month of this, I felt tired and depressed, and I was tired and sleepy, and I couldn’t get up in the morning and slept all day. On May 9, 2011, I went to the hospital for a follow-up visit and told my doctor about the above situation, and he said that it might be bipolar disorder and added 250 mg of one tablet of magnesium valproate on top of 225 mg of venlafaxine daily. Anyway, during these ten years, there were many depressive relapses. In the last few years, the episodes have become more frequent. Sometimes an episode once a month, up to a maximum of two months, and definitely a depressed mood, for about four or five to ten days. When you are depressed, you have no energy, don’t want to talk, don’t want to do anything, slow thinking, can’t get up in the morning, self-blame, worry, fear, and so on. After that, the mood will suddenly improve, at this time, feeling that everything is fine, they are not worse than others, but more responsive than them, smarter than them, everything is so good, set themselves ambitious goals. But after a short time, you will again fall into depression and fear. For more than ten years, I have been in this cycle. I have attempted suicide once, been hospitalized three times, suffered from the pain, and have no way to escape from this ‘magic circle’.” 1. This is a very typical manic-depressive disorder. Unfortunately, many doctors did not recognize it and only knew that he was depressed and only knew to give him antidepressants. From the already uncountable depressive episodes, and the several apparent manic episodes in 1996, 1997, 2004 and 2010, it seems that the diagnosis of manic-depressive disorder in these 4 cases is not a problem at all. Many doctors, or parents, tend to confuse ‘manic’ with ‘manic’. As I said long ago, our predecessors misused the word ‘mania’ when they translated the term mania. In fact, ‘mania’ just means high emotions, as in this case. This is not the case with ‘mania’, that is true madness, which can be impulsive, hitting people and fooling around. The excitement and impulsiveness of schizophrenia is ‘manic’, not ‘manic’. 2. Manic-depressive disorder (bipolar disorder) and depression are two different diseases, but in the depressive period, it is difficult to distinguish from the surface symptoms. If antidepressants are given for a long time, the manic-depressive patient will often change suddenly and have a sudden improvement in mood, or even an excessive high, as in this case (generally called “transient mania”). We can use this to make the diagnosis of manic-depressive disorder. 3, manic depressive disorder must be applied to emotion adjustment agent treatment. The so-called ’emotion modifier’ refers to the drugs that can treat manic-depressive disorder: lithium carbonate, sodium valproate, carbamazepine, and lamotrigine. Originally, we called them collectively as ‘anti-manic drugs’; later, following the example of foreign countries, we changed the name to ’emotion modifiers’. In fact, this term was changed so badly that many doctors mistook them as drugs that can adjust various emotions, so “as long as there are some mood problems, they will use sodium valproate”, which is used indiscriminately for various patients of schizophrenia and so on. In the manic phase of manic-depressive disorder, if there is really excessive excitement and no way to control it, we often use antipsychotics such as clozapine, olanzapine or risperidone to put the excitement ‘under pressure’. But we don’t take clozapine and other medications just as emotion modifiers; because they can’t really solve the problem of manic depression. The propaganda purpose of those drug companies is to sell more drugs; as doctors, they should not blindly listen to and use drugs indiscriminately. 5, there is another very important point: manic-depressive patients must not use antidepressants alone for a long time; otherwise, the condition will turn into a “rapid cycle” type, causing difficulties in treatment (we call cases with more than 4 episodes per year a “rapid cycle” type ). This rapid cycle of cases, often require a combination of several emotional adjustment agents, in order to solve the problem. 6. The dosage of emotion modifiers must be in place. In this case, a doctor considered the possibility of manic-depressive disorder in 2002 and May 2011, but used only one tablet of sodium valproate per day, which of course could not achieve the effect. Generally speaking, regardless of the mood modifier, in the beginning, 2 tablets can be given 2 to 3 times a day. After the efficacy is achieved, it is changed to 1 or 2 tablets 2 or 3 times a day for maintenance. It seems that it will be difficult to maintain if you reduce the dosage again. 7.As long as you keep taking the maintenance amount of emotion adjustment agent, manic depression will never come back, and you can fully return to the pre-morbid situation. 8.Lithium carbonate, sodium valproate and carbamazepine, have the possibility of affecting the fetus, so they are less suitable for pregnant women. Lamotrigine is reported to have no such problem.