This mood may be recognised as irritability rather than sadness in children and adolescents. Sufferers often experience a decrease or increase in appetite resulting in weight loss or gain. Insomnia is frequently reported and fatigue is widely experienced. Everything requires a great effort to be done and guilt feelings are often present. In more severe cases, thoughts of death and suicide are present.
Women report that a depressive episode becomes worse right before the onset of a menstrual period.
In some cases there will be a mixed episode where there is a rapid change between moods and in which both the symptoms for a manic episode and a depressive episode are present. These mixed episodes cause disoriented thinking and behavior and are more common in younger people. Since the way in which the illness manifests itself varies from one person to another, a treatment plan has to be carefully chosen according to the individual's needs. Counselling may help some people but medication is often needed. Most patients respond well to lithium but it is not as effective in those who have frequent episodes.