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Mood disorders are characterized by mood swings or episodes of abnormal highs or lows of mood. Major depressive episodes are the most common mood episodes. Nearly all patients with a mood disorder will have one at some point during their lifetime. The symptoms of major depressive episodes include:

• Altered mood. Patients may experience sadness, anxiety, anger, irritability or apathy (lack of emotion). They may be pessimistic (feel that everything in life will turn out badly) or discouraged and may experience crying spells or excessive emotional sensitivity.
  
  
• Anhedonia. Patients may experience a reduction or loss of interest in activities they once found pleasurable, such as food, sex, work, friends, hobbies and entertainment.
  
  
• Significant change in appetite or weight. Patients may experience reduced or increased appetite or significant weight loss or gain.
  
  
• Changes in sleep patterns. Patients may sleep too much (hypersomnia) or not enough (insomnia). Often, patients will wake up early in the morning and cannot go back to sleep.
  
  
• Changes in physical or verbal activity. Patients may be agitated and anxious, may wring their hands, or may pace or not be able to sit still. Conversely, patients may have sluggish movements or speech. They may pause before answering questions or starting actions. Patients may speak quietly or not be able to be heard. They may not speak except in response to a direct question or may become completely mute (not talking at all).
  
  
• Fatigue and loss of energy.
  
  
• Diminished self-worth. Patients may have feelings of worthlessness, self-reproach or excessive or inappropriate guilt.
  
  
• Impaired concentration. Patients may have a diminished ability to think or concentrate.
  
  
• Death thoughts. Patients may have recurrent thoughts of death and death wishes. They may think about committing suicide (suicidal ideation) or have suicidal actions. Patients may even attempt or complete suicide.

Symptoms of manic episodes include:

• Euphoria and elevated, “high” feelings or irritability. Patients remain in a good mood, even when events occur that would normally dampen the mood.
  
  
• Uncharacteristically elevated self-esteem, feelings of grandiosity or unrealistic confidence. Patients often feel very good about themselves or feel like they can take on the world.
  
  
• Decreased need for sleep. Patients may wake up feeling rested after only a few hours of sleep.
  
  
• Rapid talking, talking more than usual or feeling a need to keep talking. Patients may be excessively talkative. They may be loud or talk too fast.
  
  
• “Flight of ideas,” feeling as though thoughts are racing, distraction or agitation. Patients may be easily distracted or restless. They may have rapidly shifting thoughts that may be revealed in conversation as constantly changing subjects.
  
  
• Increased goal-directed activity. Productivity may be increased.
  
  
• Intrusive or aggressive behavior. Patients may seem nosy or aggressive, sometimes with destructive outbursts.
  
  
• Denial that anything is wrong. Because patients feel good and are often more productive, they may deny that there is a problem.
  
  
• Seeking pleasure without regard to consequences, reckless behavior or poor judgment. Patients may engage in spending sprees, sexual promiscuity, substance abuse or other behavior when they would normally exercise better judgment.

In children and adolescents, manic episodes are more likely to be characterized by irritability and destructive outbursts than by elation or euphoria.

Sometimes, symptoms of depression may occur during a manic episode, resulting in a mixed episode. These may be more frequent in early onset bipolar disorder.

Hypomanic episodes are similar to manic episodes, but are less severe or have a shorter duration. They may not cause actual impairment. In fact, hypomania often results in increased productivity.

In severe cases, these mood episodes can involve psychotic symptoms, such as hallucinations or delusions. Such psychotic features tend to be mood congruent. For example, during manic episodes, patients may believe they are invulnerable to physical harm and, during major depressive episodes, patients may believe they are guilty of a great crime or sin. Obsessions and compulsions may also occur.