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Daily Mood and Symptom Tracking Chart for Bipolar Disorder

A self-monitoring tool for patients with bipolar disorder

Psychiatry

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Template Content

Last updated: Mar 24, 2025

Instructions for Use

Rate your symptoms daily using the scales below. Complete this chart at the same time each day.

Mood Scale (1-10)

  • 10: Severe mania - extremely elevated/agitated
  • 7-9: Moderate to high mania
  • 6: Mild mania/hypomania
  • 5: Balanced/stable mood
  • 4: Mild depression
  • 1-3: Moderate to severe depression

Daily Tracking Fields

Date: _______

Mood Rating (1-10): ___

Hours of Sleep: ___

Medication Adherence:

  • ☐ Took all medications as prescribed
  • ☐ Missed some medications
  • ☐ Missed all medications

Symptoms (check all that apply):

  • ☐ Racing thoughts
  • ☐ Increased energy
  • ☐ Decreased need for sleep
  • ☐ Irritability
  • ☐ Anxiety
  • ☐ Loss of interest
  • ☐ Fatigue
  • ☐ Changes in appetite

Triggers/Stressors Today:

Coping Strategies Used:

Weekly Summary

Highest mood: ___ Lowest mood: ___ Average hours of sleep: ___ Medication adherence %: ___

Share this chart with your healthcare provider during appointments to help track your progress and adjust treatment as needed.

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