In some cases the sufferer could become psychotic or catatonic. As the manic episode develops there is a tendency towards alcohol use which makes the condition worse. Manic episodes usually start in the early twenties but there have been cases in teens and in senior citizens. During a depressive episode the sufferer will experience a loss of interest in pleasurable activities and an overall depressed mood for at least two weeks. 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.