Daily Mood and Symptoms Tracking Sheet for Bipolar Disorder

Patient Information

Name: _________________ Date Range: //___ to //___

Daily Mood Scale

Rate your mood on a scale of -5 to +5:

• +5: Severe mania
• +3: Moderate mania
• +1: Mild elevation
• 0: Stable/neutral
• -1: Mild depression
• -3: Moderate depression
• -5: Severe depression

Daily Log

Time of completion: _______ AM/PM

Mood Rating: _____

Sleep Pattern

• Hours slept last night: _____
• Sleep quality (1-5): _____
• Time went to bed: _____
• Time woke up: _____

Medication Adherence

• Morning medications taken: □ Yes □ No
• Evening medications taken: □ Yes □ No
• Side effects noticed: ________________

Symptoms (check all that apply)

Manic Symptoms

□ Racing thoughts □ Decreased need for sleep □ Increased energy □ Rapid speech □ Risk-taking behaviors □ Irritability

Depressive Symptoms

□ Low energy □ Sleep changes □ Appetite changes □ Social withdrawal □ Difficulty concentrating □ Hopelessness

Triggers/Stressors Today

Coping Strategies Used

Weekly Summary

Total hours of sleep: _____ Average mood rating: _____ Medication compliance: ____%

Notes for Discussion with Healthcare Provider