Mood changes may be a constitutive feature of several psychiatric disorders and a broad classification based on the nature of the disorder (sadness or elation) can be made into depressive and manic mood changes, each presenting with distinct clinical features [1] [2]:

• Depressive disorders - Numerous subtypes have been described in literature - major depressive disorder, persistent depressive disorder, substance or medication induced, depression occurring as a result of another disease, premenstrual dysphoric disorder and unspecified forms [3] [4]. The presence of irritable or sad mood that substantially influences everyday life of affected individuals due to somatic and cognitive disturbances is a common finding in all of them, but their distinction can be made according to the duration, onset or the underlying etiology [2]. For example, major depressive disorder is diagnosed when mood changes last for at least two weeks, while persistent depression is suspected if symptoms last for two years in adults and one year in children [2]. Moreover, patients may suffer from psychotic, melancholic or catatonic episodes that can mislead the physician from depression as the underlying disorder.
• Mania and hypomania - Abnormally irritable and expansive mood present for one week accompanied by symptoms such as elevated self-esteem, decreased need for sleep, psychomotor agitation, racing thoughts, increased goal-directed activity and a propensity for distraction by irrelevant or unimportant stimuli are hallmarks of a manic episode [2] [5]. A fast rate of speech, verbosity, accelerated mental and physical activity, and personal belief that he/she is at an excellent mental state is often encountered, which can be dangerous or even life-threatening. A hypomanic state is described as a milder form of mania, lasting at least four days and presenting with less severe clinical symptoms than that observed in manic patients [5].
• Bipolar disorders - When manic episodes, depression, and/or hypomania are all seen in one individual, the diagnosis of a bipolar disorder should be suspected. Like in depressive disorders, several clinical types are recognized - type I, type II, drug-induced, etc. [1], while cyclothymia denotes a less severe form.

• Hypersomnia

  Sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave (delta) sleep. [doi.org]

  […] sadness, hopeless or helpless Having low self-esteem Excessive guilt Feelings of wanting to die Suicidal thoughts or attempts Loss of interest in usual activities or activities once enjoyed Difficulty with relationships Sleep disturbances (i.e., insomnia, hypersomnia [texaspanhandlecenters.org]

  Persistent feelings of sadness Feeling hopeless or helpless Low self-esteem Feelings of inadequacy Excessive guilt Wanting to die Loss of interest in activities once enjoyed Difficulty with relationships Sleep disturbances (for example, insomnia or hypersomnia [ucihealth.org]

  In addition to this, classification requires the individual to have four or more of the following associated problems: • Change in appetite or change in weight • Hypersomnia or insomnia (especially waking early) • Restlessness or feeling slowed down • [lupusuk.org.uk]

• Family History of Depression

  […] with minor depression from one another on the basis of past history of major depression or family history of depression. [doi.org]

  It is not clear whether people who have had depression before, or have a family history of depression, are more prone to this complication, and its causes are not understood. [benzo.org.uk]

  However, it can also occur in people who have no family history of depression. [0005] Major depressive disorder is prevalent in a large number of elderly patients, resulting in a significant increase in the number of suicides in this population. [faqs.org]

• Anorexia

  To customize her care, we harness our team’s expertise in helping women overcome anorexia, bulimia, overeating disorders, substance abuse and addiction, and other co-occurring conditions. [timberlineknolls.com]

  Bulimia Nervosa in Adolescents Anorexia Nervosa Anorexia Nervosa in Children Adjustment Disorders Behavior Disorders See More [hopkinsmedicine.org]

  With confidence easing its way back to my self, I volunteered at an anorexia foundation near my house. I lined the edges of my desk with stones. Writing was getting easier, words were unlocking. [nytimes.com]

  […] of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early-morning waking, psychomotor retardation, excessive weight loss (not to be confused with anorexia [en.wikipedia.org]

  […] of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early morning waking, psychomotor retardation, excessive weight loss (not to be confused with anorexia [faqs.org]

• Loss of Appetite

  […] of appetite, insomnia, and fatigue) associated with paresthesias affecting his toes. [ncbi.nlm.nih.gov]

  Having a mood disorder, particularly one that involves depression, increases the risk of other problems, such as inability to do daily activities and maintain relationships, loss of appetite, extreme anxiety, and alcoholism. [msdmanuals.com]

  Major depressive disorder can have a number of symptoms such as insomnia, loss of appetite, fatigue and overwhelming feelings of sadness or grief. There may also be thoughts of death or suicide. [questia.com]

  Other features include : significant weight change and appetite disturbance (especially loss of appetite), sleep disturbance, slowed movements and speech, restlessness, decreased feelings of energy, feelings of worthlessness, difficulty in thinking or [purgatory.net]

• Constipation

  Melancholia implies the biological symptoms of depression: early-morning waking, daily variations of mood with depression most severe in the morning, loss of appetite and weight, constipation, and loss of interest in love and sex. [britannica.com]

  Common side effects include drowsiness, blurred vision, constipation, dry mouth, agitation, drowsiness, nausea and headache. Some side effects of bipolar disorder medications often go away within the first few weeks. [psychguides.com]

  Adverse effects of the TCAs include sedation, weight gain, dry mouth, constipation, and sexual dysfunction. [emedicine.com]

• Increased Appetite

  Subject 15 had a dramatic increase in the intensity (but not the frequency) of panic attacks. In this group, calls to request a medication increase between visits were frequent. [benzo.org.uk]

  This mental fluidity could contribute to an increase in creativity. Moreover, mania creates increases in productivity and energy. [en.wikipedia.org]

  Diagnosticians recognize several subtypes or course specifiers: Atypical depression (AD) is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite ("comfort eating"), excessive sleep or somnolence [faqs.org]

• Visual Impairment

  Various leucodystrophies may have different clinical presentations, ranging from subtle cognitive and psychiatric manifestations to gross motor disabilities, visual impairment and seizure. [ncbi.nlm.nih.gov]

• Anger

  CONCLUSION: Anger and hostility could represent stable personality characteristics of prominent cyclothymic profile that endure even in remission. [ncbi.nlm.nih.gov]

  Take a Confidential Online Mood Disorder Screening Signs and symptoms of depression Prolonged sadness or unexplained crying spells Significant changes in appetite and sleep patterns Irritability, anger, worry, agitation, anxiety Pessimism, indifference [dbsalliance.org]

  Children and young adults struggling with mood disorders can experience symptoms including persistent feelings of sadness, irritability or explosive anger, and impulsive decision-making, which can be debilitating and disruptive to their lives as well [childmind.org]

  Sometimes depression shows itself through anger, worry, aggression, or apathy (not feeling or caring about anything). These feelings may come and go. Sometimes people who have depression may even seem “fine” to family and friends. [mindyourmind.ca]

  Symptoms may include anger, irritability, tension, decreased interest in usual activities, and sleep problems. Intermittent explosive disorder - This is a lesser-known mood disorder marked by episodes of unwarranted anger. [my.clevelandclinic.org]

• Feeling of Worthlessness

  Affective disorders may include manic (elevated, expansive, or irritable mood with hyperactivity, pressured speech, and inflated self-esteem) or depressive (dejected mood with disinterest in life, sleep disturbance, agitation, and feelings of worthlessness [britannica.com]

  Other symptoms of depression may include: changes in appetite, sleep disturbances, low energy, difficulty thinking or concentrating, feelings of worthlessness and guilt, anxiety and thoughts of suicide. [newmarkeducation.com]

  Symptoms, that are persistent and interfere with daily life, can include: Sadness or loss of interest or pleasure in activities the person used to enjoy Weight loss Difficulty sleeping or oversleeping Energy loss Feelings of worthlessness Thoughts of [wexnermedical.osu.edu]

  […] of worthlessness or guilt Difficulty concentrating Recurrent thoughts about suicide Major depressive disorder is much more common in women than in men. [sparknotes.com]

• Suicidal Ideation

  ideation and suicide. © 2014 John Wiley & Sons A/S. [ncbi.nlm.nih.gov]

  In severe cases depression can lead to suicidal ideation or psychosis. [youtube.com]

• Euphoria

  The presence of mania (p=0.033) or euphoria/elevated mood (p=0.041) were the pretreatment symptoms significantly associated with an "improved" rating. [ncbi.nlm.nih.gov]

  Depression is the more common symptom, and many patients never develop a genuine manic phase, although they may experience a brief period of overoptimism and mild euphoria while recovering from a depression. [britannica.com]

  Bipolar disorder also can cause elevated moods (mania) that are accompanied by feelings of euphoria, grandiosity, extreme energy and heightened arousal. [chihealth.com]

  […] worthless, guilty, or constant self-criticism Unable to concentrate or focus Irritable and easily frustrated Trouble sleeping or oversleeping Bipolar disorder Bipolar disorder causes extreme mood swings ranging from mania or extreme happiness, grandiosity, euphoria [bhevolution.org]

  During mania, notes The Harvard Mental Health Letter, bipolar patients “can be unbearably intrusive and domineering, and their reckless and restless euphoria may suddenly change into irritability or rage.” [wol.jw.org]

• Low Self-Esteem

  Bipolar Disorder can manifest in many ways, including: difficulty falling or staying asleep, difficulty waking up in the morning, chronic fatigue, anxiety, low self-esteem, high irritability and risky or destructive behaviors. [newmarkeducation.com]

  Dysthymic disorder can be characterized as a chronic low-grade depression, persistent irritability, and a state of demoralization, often with low self-esteem. [healthychildren.org]

  These mood disorders share some common symptoms: Slowness in motor behavior/speech Slowed thought processes Blunted emotions Poor grooming Social withdrawal Weight loss/gain Early morning awakening Excessive sleeping Low self-esteem Agitation In addition [bhevolution.org]

  Symptoms may include: Persistent feelings of sadness, hopeless or helpless Having low self-esteem Excessive guilt Feelings of wanting to die Suicidal thoughts or attempts Loss of interest in usual activities or activities once enjoyed Difficulty with [texaspanhandlecenters.org]

  Differences in brain structure may contribute to major depression Depression is associated with certain psychological traits: Low self-esteem General negative emotionality Tendency to blame self for bad things that happen It's also been associated with [study.com]

• Agitation

  Keywords were mixed or mixed state or mixed features or mixed episode and anxious or anxiety or agitation and bipolar disorder or depressive disorder or mood disorder or affective disorder. [ncbi.nlm.nih.gov]

  These mood disorders share some common symptoms: Slowness in motor behavior/speech Slowed thought processes Blunted emotions Poor grooming Social withdrawal Weight loss/gain Early morning awakening Excessive sleeping Low self-esteem Agitation In addition [bhevolution.org]

  Affective disorders may include manic (elevated, expansive, or irritable mood with hyperactivity, pressured speech, and inflated self-esteem) or depressive (dejected mood with disinterest in life, sleep disturbance, agitation, and feelings of worthlessness [britannica.com]

  Take a Confidential Online Mood Disorder Screening Signs and symptoms of depression Prolonged sadness or unexplained crying spells Significant changes in appetite and sleep patterns Irritability, anger, worry, agitation, anxiety Pessimism, indifference [dbsalliance.org]

  agitation and aggressive behaviour have been associated with frontotemporal pathology not only in patients with FTD but also AD.18 For example, Tekin et al19 found that agitation was significantly correlated with the number of neurofibrillary tangles [scielo.br]

• Hyperactivity

  Affective disorders may include manic (elevated, expansive, or irritable mood with hyperactivity, pressured speech, and inflated self-esteem) or depressive (dejected mood with disinterest in life, sleep disturbance, agitation, and feelings of worthlessness [britannica.com]

  Disease under mind-set issue include: real depressive issue, bipolar issue (lunacy - euphoric, hyperactive, over expanded sense of self, implausible good faith), constant depressive issue (dependable second rate dejection), cyclothymia (a gentle type [omicsonline.org]

  Disease under mind-set issue includes: real depressive issue, bipolar issue (lunacy - euphoric, hyperactive, over the expanded sense of self, implausible good faith), constant depressive issue (dependable second rate dejection), cyclothymia (a gentle [longdom.org]

  Mood disorders include: Major depressive disorder — extremely low moods Bipolar disorder — extremely high (manic, euphoric or hyperactive) and low moods Persistent depressive disorder — depression that lasts more than three years Cyclothymia — a less [insightbhc.com]

  Peng Li, Lin Lu, Jun Yan, Huiling Wang, Hongxing Zhang, Huawang Wu, Yuping Ning, Dai Zhang, Tianzi Jiang, Bing Liu The British Journal of Psychiatry, FirstView Article Transition between child and adult services for young people with attention-deficit hyperactivity [bjp.rcpsych.org]

• Confusion

  There is some confusion between the characteristic of classical mixed states and the definition of the mixed features specifier with the newly added anxious distress specifier in DSM-5, specifically, whether to include anxiety and agitation as significant [ncbi.nlm.nih.gov]

  Medicines like LATUDA can raise the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). LATUDA is not approved for the treatment of people with dementia-related psychosis. [latuda.com]

  Sometimes the ups and downs seem to happen at almost the same time; this confusing state is called a mixed episode. These cycles and emotional states are more than the moodiness of pregnancy or postpartum. [postpartum.net]

  Confused and occasionally incapacitated by his mood swings, he was relieved to be diagnosed, in 1989, with what was then termed manic depression. [fi.bab.la]

  Recent Examples on the Web The confusion and controversy around schizoaffective disorder The biggest challenge for clinicians is that, by definition, the symptoms of schizoaffective disorder overlap with those of schizophrenia and a mood disorder, Dr. [merriam-webster.com]

• Lethargy

  The boy complained of lethargy and dysphoric mood in June 2008. He presented at the emergency department with epigastralgia and dyspnea in January 2009. Results of laboratory tests suggested type 1 diabetes mellitus with DKA. [ncbi.nlm.nih.gov]

  Mood Disorder Screening Signs and symptoms of depression Prolonged sadness or unexplained crying spells Significant changes in appetite and sleep patterns Irritability, anger, worry, agitation, anxiety Pessimism, indifference Loss of energy, persistent lethargy [dbsalliance.org]

  Depression is characterized by feelings of lethargy and lack of energy, a negative outlook on life, low or non-existent self-esteem and self-worth, and a sense that nothing is possible. [mentalhelp.net]

  Symptoms of Depression: Prolonged sadness or unexplained crying spells Significant changes in appetite and sleep patterns Irritability, anger, worry or agitation, anxiety Pessimism, indifference Loss of energy, persistent lethargy Feelings of guilt, worthlessness [jfssd.org]

• Dizziness

  Most common among the latter were malaise, weakness, insomnia, tachycardia, lightheadedness, and dizziness. None had seizures, psychosis, or significant neurological or EEG abnormalities. [ncbi.nlm.nih.gov]

  Over 50% of patients whose drugs are discontinued experience symptoms such as insomnia, agitation, anxiety, tremor, irritability, headache, nausea, and dizziness (4-10). [benzo.org.uk]

  LATUDA may make you sleepy or dizzy, may cause a decrease in your blood pressure when changing position (orthostatic hypotension), and can slow your thinking and motor skills, which may lead to falls that can cause fractures or other injuries Seizures [latuda.com]

The diagnosis of a mood disorder can be quite challenging, having in mind the diverse clinical presentation and its variable appearance in patients. In addition, concomitant presence of anxiety disorders (social phobias, obsessive-compulsive disorders, or even panic attacks) may be noted, creating an even bigger issue to discern between the disorders [5]. For this reason, physicians must bear in mind that a long and carefully obtained patient history is the essential component during workup, as the majority of symptoms may not be evident during the hospital visit, but more importantly, because the diagnosis is made almost solely on clinical criteria [2] [5]. Not all patients will be able to describe typical changes seen in mood disorders, and some will not even admit that anything extraordinary is happening, which is why parents, close friends or even relatives can be interviewed as well. Apart from determining symptoms related to mood changes, physicians must inquire about recent use of drugs or substances that can induce such changes [3] [4], but also exclude some organic diseases that may mimic depression [5]. Thyroid hormone levels should be measured to exclude hypothyroidism, while folate, B12 and a complete blood count are recommended in the diagnostic workup as well [5].

BACKGROUND: There is suggestive evidence that prior illness history may have little association with response to long-term treatment in bipolar disorder (BD) or recurrent major depressive disorder (MDD), but relationships of illness-history to treatment-response [ncbi.nlm.nih.gov]

No specific treatment is required, other than support and reassurance. [emedicine.com]

This change is of concern because a large proportion of patients with mixed features are now unspecified, and this may influence treatment planning and prognosis. [ncbi.nlm.nih.gov]

Like cancer, "mood disorder" is a general term for a group of disorders that can vary widely in terms of symptoms, prognosis and treatment. [cnn.com]

Such differentiation might be important for establishing prognosis and optimal treatment. [ajp.psychiatryonline.org]

The etiology of the mental illness could be related to the processes contributing to the development of parkinsonism. [ncbi.nlm.nih.gov]

[…] irritable or sad mood that substantially influences everyday life of affected individuals due to somatic and cognitive disturbances is a common finding in all of them, but their distinction can be made according to the duration, onset or the underlying etiology [symptoma.com]

Centers for Disease Control and Prevention National Center for Health Statistics Office of Analysis, Epidemiology & Health Promotion, Room 6433 Hyattsville USA 2. National Institute of Mental Health Bethseda USA 3. [doi.org]

Keywords: age of onset, mood disorders, anxiety disorders, alcohol use disorders, comorbidity, NESARC, epidemiology 1. [ncbi.nlm.nih.gov]

This paper reviews the studies on the pathophysiology of SAD with emphasis on circadian, neurotransmitter, and genetic hypotheses. [ncbi.nlm.nih.gov]

These fund allow the American Foundation for Suicide Prevention to invest in new research, create educational programs, advocate for public policy, and support survivors of suicide loss. [geiselmed.dartmouth.edu]

Depression Maintaining healthy lifestyle habits is the best way to prevent depression. [apps.carleton.edu]

It may be possible to detect symptoms of BD or other mood disorders early in adolescence and prevent the disorder from further interfering with someone's life. [clinicaltrials.gov]

[…] dependence are consistently associated with a higher prevalence of psychiatric comorbidities, could be considered important predictors of other psychiatric disorders, and deserve greater public heath attention, pointing to the need for alcohol abuse prevention [ncbi.nlm.nih.gov]

1. Marvel CL, Paradiso S. Cognitive and neurological impairment in mood disorders. Psychiatr Clin North Am. 2004;27(1):19-viii.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition. Arlington, VA: American Psychiatric Publishing; 2013.
3. Quello SB, Brady KT, Sonne SC. Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Science & Practice Perspectives. 2005;3(1):13-21.
4. Tolliver BK, Anton RF. Assessment and treatment of mood disorders in the context of substance abuse. Dialogues Clin Neurosci. 2015;17(2):181-190.
5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.