Sometimes, the person must be hospitalized in order to prevent harm to self or others. However, the person is not delusional and understands that 'something' is wrong. Contrarily, the major depressive syndrome of the illness manifests in a depressed or irritable mood most of the day, nearly every day, as indicated either by subjective account or observations by others. In addition, there is a diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. Due to this lack of interest, the person may demonstrate significant weight loss or weight gain when not dieting.
Some sufferers complain of a decrease or increase in appetite nearly every day.
Similarly, insomnia or hypersomnia is also an issue for the person in a major depressive syndrome. The bipolar person may now show a psychomotor retardation that is significantly different from the psychomotor agitation of the manic phase of the illness. Invariably, at this phase of the illness, the person complains of fatigue or loss of energy nearly every day. The effort it takes to perform daily activities may encourage feelings of worthlessness or excessive or inappropriate guilt nearly every day. In other words, they may borrow other's problems as their responsibility.