Severe, long-lasting sense of despair, hopelessness, or emotional emptiness

Wanting to stay in bed for one or more days without being physically ill

Sleeping more than normal or exhausted yet unable to sleep

Aches and pains with no apparent physical origin

Major changes in appetite

Lethargic, low energy or restlessness and agitation

Lack of interest or pleasure in usual pursuits

Avoiding daily responsibilities

Social withdrawal

Feelings of guilt or worthlessness

Difficulty making decisions

Hostile, quick to anger

Deep, constant sadness

Sudden outburst (such as crying) for seemingly no reason

Inability to concentrate

Pessimism, hopelessness, and anxiety

Psychosis; hallucinations, delusions, thought disorders

Suicidal thoughts or attempt

Mixed episode is characterized by simultaneous mania and depression or alternating moods during the day.

Mixed mania is characterized by episodes that consist of a blend of mania (or hypomania) and depression.