One of the most interesting but tenebrous parts of the bipolar disorder (BD) story is the switch between (hypo)mania and depression, which can give bipolar patients a thrilling, but somewhat perilous, ‘ride’. Numerous studies have pointed out that there are some recognizable differences (either state-dependent or state-independent) in several brain regions of people with BD, including components of the brain’s reward system. Understanding the underpinning mechanisms of high and low mood statuses in BD has potential, not only for the development of highly specific and selective pharmaceutical agents, but also for better treatment approaches and psychological interventions to manage BD and, thus, give patients a safer ride. Herein, we review evidence that supports involvement of the reward system in the pathophysiology of mood swings, with the main focus on the mesocorticolimbic dopaminergic neural circuitry. Principally using findings from neuroimaging studies, we aim to signpost readers as to how mood alterations may affect different areas of the reward system and how antipsychotic drugs can influence the activity of these brain areas. Finally, we critically evaluate the hypothesis that the mesocorticolimbic dopamine reward system may act as a functional rheostat for different mood states.

双相情感障碍（BD）故事中最有趣但最紧张的部分之一是（低躁狂）情绪低落和抑郁之间的转换，这可能会使双相情感障碍患者激动而又有些危险。大量研究指出，BD患者的多个大脑区域（包括大脑奖励系统的组成部分）存在一些可识别的差异（无论是状态依赖性还是状态依赖性）。了解BD情绪高低状态的基础机制具有潜力，不仅可以开发高度特异性和选择性的药物，而且还可以用于治疗BD的更好的治疗方法和心理干预措施，从而为患者提供更安全的乘车体验。本文中，我们回顾了支持奖励系统参与情绪波动的病理生理的证据，主要集中在中皮层边缘多巴胺能神经回路上。我们主要利用神经影像学研究的发现，旨在就情绪变化如何影响奖励系统的不同区域以及抗精神病药如何影响这些大脑区域的活动向读者发出信号。最后，我们批判性地评估了中皮层皮质多巴胺奖赏系统可能充当不同情绪状态的变阻器的假设。