Depression episodes of manic depression include the following symptoms:
- Persistent sad mood
- Loss of interest or pleasure in activities that were once enjoyed, including sex
- Significant change in appetite or body weight
- Oversleeping or difficulty sleeping
- Physical slowing down or agitation
- Loss of energy
- Feelings of worthlessness or inappropriate guilt
- Difficulty thinking or concentrating
- Recurrent thoughts of death or suicide.
Mania episodes of manic depression include abnormally and persistently high mood or irritability and at least three of the following symptoms:
- Overly inflated self-esteem
- Decreased need for sleep
- Increased talkativeness
- Racing thoughts
- Increased goal-directed activity, such as shopping
- Physical agitation
- Excessive involvement in risky behaviors or activities.
In mixed-state manic depression, symptoms of mania and depression are present at the same time. These symptoms frequently include:
- Trouble sleeping
- Significant change in appetite
- Suicidal thinking.
The episodes may be separated by periods of wellness during which a person suffers few to no symptoms, especially early in the course of manic depression. When four or more episodes of illness occur within a 12-month period, the person is said to have manic depression with rapid cycling. The condition is often complicated by co-occurring alcohol or substance abuse.