- Check the days you go to talk therapy and support group.
- List your mood disorder medications, how many pills prescribed, and how many you take each day.
- List your medications for other illnesses and any other supplements you take.
- Check the days when you have side effects. If you have several bothersome side effects, use a line for each.
- Check the days when you have a physical illness.
- If applicable, check the days when you have your menstrual period.
- If applicable, check the days when you use alcohol and/or drugs.
- Write down how many hours of sleep you got.
- Write down how many meals and snacks you had.
- Check the days when you did some kind of physical activity or exercise.
- Check the days when you spent some time relaxing.
- Check the days when you reached out to other people.
- Check the days when you had a major life event that affected your mood. List the events if there are more than one.
- Fill in the box that describes your mood for the day. If your mood changes during the day, fill in the boxes for the highest and lowest moods and connect them.
- If you experience a mixed state, check the box.
- Look for patterns. See how your moods relate to your treatment and lifestyle.
|
Talk therapy / support groups |
Sun | Mon | Tues | Wed | Thu | Fri | Sat | ||
| Talk therapy | check the days you went to talk therapy | ||||||||
| Support group | check the days you went to support groups | ||||||||
|
Your prescriptions |
Sun | Mon | Tues | Wed | Thu | Fri | Sat | ||
| Medication name | Dose | # of pills per day | Total number of pills taken each day | ||||||
| Side effects | Sun | Mon | Tues | Wed | Thu | Fri | Sat | ||
| check the days you had side effects | |||||||||
| check the days you had side effects | |||||||||
| check the days you had side effects | |||||||||
| Physical illness | Sun | Mon | Tues | Wed | Thu | Fri | Sat | ||
| check the days you had a physical illness | |||||||||
| check the days you had a physical illness | |||||||||
| check the days you had a physical illness | |||||||||
| Menstrual period | check the days you had your period | ||||||||
| Drank/used drugs | check the days that you drank/used drugs | ||||||||
| Hours of night sleep | record the number of hours slept | ||||||||
| Number of meals | record the number of meals eaten | ||||||||
| Number of snacks | record the number of snacks eaten | ||||||||
| Physical activity | check the days you did a physical activity | ||||||||
| Relaxation time | check the days you spent time relaxing | ||||||||
| Helped others | check the days you helped others | ||||||||
| Major life event | Sun | Mon | Tues | Wed | Thu | Fri | Sat | ||
| check the day the event happened | |||||||||
| Mood tracking | Sun | Mon | Tues | Wed | Thu | Fri | Sat | ||
| Extremely manic | shade the box(es) that reflect your mood | ||||||||
| Very manic | shade the box(es) that reflect your mood | ||||||||
| Somewhat manic | shade the box(es) that reflect your mood | ||||||||
| Mildly manic or hypomanic | shade the box(es) that reflect your mood | ||||||||
| STABLE MOOD | shade the box(es) that reflect your mood | ||||||||
| Mildly depressed | shade the box(es) that reflect your mood | ||||||||
| Somewhat depressed | shade the box(es) that reflect your mood | ||||||||
| Very depressed | shade the box(es) that reflect your mood | ||||||||
| Extremely depressed | shade the box(es) that reflect your mood | ||||||||
| Mixed state | check the box if you experience a mixed state that day | ||||||||
