MONTH / YEAR
Use this tool to keep your doctor informed about your mood symptoms.
At the end of each day, record your mood and related factors. The more thorough
your information, the more you can help your doctor and your treatment.
DATE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
MOOD TRACKING
EXTREMELY MANIC
Incapacitated or hospitalized
VERY MANIC
Difficulty with goal-oriented activity; not able to work
SOMEWHAT MANIC
Some difficulty with goal-oriented activity; able to work
MILDLY MANIC OR HYPOMANIC
Mild changes to usual routine; able to work
STABLE MOOD
Place a checkmark in the box that reflects your symptoms each day. If more than one apply, check multiple boxes for that day.
Daily Mood Tracker
MILDLY DEPRESSED
Mild changes to usual routine; able to work
SOMEWHAT DEPRESSED
Functioning with some effort; able to work
VERY DEPRESSED
Functioning with great effort; not able to work
EXTREMELY DEPRESSED
Incapacitated or hospitalized
u
u
u
MIXED STATE
u
u
notes
Place a checkmark if medication was taken each day.