Every guideline for bipolar disorder asks for two documents that almost nobody has: a record of the illness over time, and a written plan for what happens when it starts again. Both are usually described as things a clinician will do with you, and both work far better if you arrive with a draft.
The short answer: this sheet is two things. A daily log of mood, sleep and activity, because assessment guidelines require a clinician to document the course of the illness and the symptoms between episodes, and no appointment can reconstruct that from memory. And a relapse-prevention plan naming triggers, early warning signs, an agreed response and who to call — which is exactly what the guideline asks be developed jointly with you and, if possible, someone close to you. The early-warning-sign approach has the strongest evidence type in this field: a Cochrane review found time to first recurrence favoured it, hazard ratio 0.57.¹ ² ³
Before you start
- Name: · Started this log on / /
- What I am using it for: ☐ getting assessed ☐ a medication review ☐ relapse prevention ☐ a disability or leave claim ☐ my own pattern
- Who else sees it: ☐ nobody ☐ my therapist ☐ my prescriber ☐
- Current medications and doses:
A note on what this does and does not do. Daily mood charting is a validated method for tracking bipolar illness over time. It has not been validated as a test for whether you have bipolar disorder, and no chart can settle a diagnosis. What it does is give a clinician the longitudinal record the guidelines ask for, and give you a pattern you cannot see from inside a week.² Why the diagnosis takes so long →
The daily row
One line a day, at roughly the same time. Sixty seconds. The scale runs from −5 (most depressed you have been) through 0 (your own normal) to +5 (most elevated you have been).
| Date | Mood −5 to +5 | Hours slept | Bedtime | Woke | Energy 0–10 | Anxiety 0–10 | Alcohol / substances | Meds taken | Note (one line) |
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Why sleep gets its own three columns. The one randomised trial of insomnia treatment in bipolar disorder found the treated group had fewer days in a bipolar episode over six months than a psychoeducation comparison (3.3 against 25.5) and a lower hypomania or mania relapse rate (4.6 percent against 31.6 percent) — a pilot of 58 people, with only a marginal effect on overall relapse, but the best evidence there is that sleep is a lever rather than a readout.⁴ And in the trial that established rhythm-focused therapy, people who increased the regularity of their daily and social rhythms during acute treatment were less likely to recur later.⁵
Record hours slept and need for sleep separately in the note column if they diverge. Four hours and tired is a bad night. Four hours and fine is a signal.
The life-events line
Under each week, one line for anything that changed: travel, a time-zone shift, a night shift, a deadline, a breakup, a dose change, an illness, a bereavement, a stopped medication.
- Week of / :
- Week of / :
This is the column that makes the log interpretable. A mood chart without context is a squiggle; with context it is a story a clinician can work with. The assessment guideline explicitly asks for "triggers to previous episodes and patterns of relapse."²
The pattern review, every two weeks
Sit down with the last fortnight and answer four questions in writing.
- Highest mood: on / · Lowest: on /
- Shortest night: hours on / . Did anything follow it two or three days later?
- Did I return to 0 at any point? ☐ yes ☐ no. The guideline asks a clinician to document "symptoms between episodes" — this is that question, asked of yourself.²
- What would somebody who lives with me have written differently?
The early warning signs, written while well
This is the part with the evidence behind it. A Cochrane review of interventions teaching people to recognise early signs of recurrence found time to first recurrence favoured the intervention (hazard ratio 0.57, 95% CI 0.39–0.82) and concluded that services "should consider routinely providing EWS interventions to adults with bipolar disorder."¹
Be specific to the point of embarrassment. "I get manic" is not a warning sign. "I start replying to emails at 3 a.m." is.
Signs that a high may be starting — my own, in the order they usually appear
Common ones, to prompt you: needing less sleep without feeling tired · talking faster or being told you are · new projects or purchases · irritability at small obstacles · feeling unusually confident or creative · spending · increased libido · driving faster · reconnecting with people you had drifted from.
Signs that a low may be starting
Common ones: cancelling one particular thing · sleeping more or waking at 4 a.m. · not answering the phone · the specific routine that goes first · food changing · not showering · hopeless thoughts arriving as facts.
Who else will be watching for these: · They have a copy ☐
The plan, agreed in advance
The guideline asks for a risk-management plan developed jointly with you and, if possible, a carer, covering triggers and early warning signs; a protocol for coping strategies and — where a prescriber has agreed it beforehand — medication changes; how services should respond; and who to contact.³ Fill this in while well, not while ill. That is the entire point of it.
| At the first sign of a high | At the first sign of a low |
|---|---|
| I will: | I will: |
| Sleep protection plan: | Activity floor (the minimum I keep doing): |
| I will contact: within hours | I will contact: within hours |
| Decisions I will not make: ☐ money over $ ☐ quitting a job ☐ ending a relationship ☐ travel ☐ stopping medication | Decisions I will not make: ☐ quitting a job ☐ ending a relationship ☐ stopping medication ☐ |
| What I have asked others to do: | What I have asked others to do: |
Contacts, in order
- Prescriber: · Phone: · After hours:
- Therapist: · Phone:
- Person who knows the plan: · Phone:
- Crisis: 988, free and 24/7 · Local crisis line:
Copies given to: ☐ me ☐ my prescriber ☐ my therapist ☐ on / / Plan reviewed on / / · Next review / /
The guideline also asks that after any crisis, the plan be reviewed with the person and their family.³ Put the review date in the calendar now.
Bringing it to an appointment
- ☐ Print the last eight weeks rather than describing them
- ☐ Mark the three days you most want asked about
- ☐ Bring the early-warning list, and say it is a draft you want their input on
- ☐ Bring someone who was there, if you can — the guideline asks clinicians to encourage exactly this, and elevated mood is the symptom people report worst about themselves²
- ☐ Bring your medication list with start dates, and what happened on each
- ☐ Ask the two questions that decide the medication conversation: what is each drug for, and when do we review it
What to ask about medication → · The therapies with evidence → · For the person watching alongside you →
Q&A
Q: Can a mood chart diagnose bipolar disorder? A: No. It is a validated way of tracking the illness over time and it gives a clinician the longitudinal record the guidelines require, but it is not a diagnostic test and no pattern on a chart settles the question.²
Q: How long should I keep it? A: Two weeks makes an appointment better. Eight weeks makes a pattern visible. Longer is how you learn your own triggers, and the guideline framing of relapse prevention assumes an ongoing record rather than a one-off exercise.³
Q: I forget for days at a time. Does a gap ruin it? A: No. Fill in what you remember, mark the gap as a gap, and carry on. A record with holes beats a memory with holes, and the days you cannot face filling it in are themselves data.
Q: Should I use an app instead? A: Whatever you will actually use. Paper on a fridge has one advantage: the other person in the house can see it, and the early-warning evidence assumes somebody else is watching too.¹
Q: What if my clinician doesn't want it? A: Ask them to look at the four questions in Step 4 rather than the whole chart. And say plainly what the guideline asks them to document: the course of the illness, the symptoms between episodes, and the triggers to previous episodes.²
Ready to find a therapist who works from a record rather than a recollection? Filter by approach, schedule and payment route → · The full bipolar map →
Sources
- Morriss RK, Faizal MA, Jones AP, Williamson PR, Bolton C, McCarthy JP, "Interventions for helping people recognise early signs of recurrence in bipolar disorder," Cochrane Database of Systematic Reviews 1, 2007, CD004854 — "Time to first recurrence of any type (RE, hazards ratio 0.57, 95% CI 0.39 to 0.82), time to manic/hypomanic episode, time to depressive episode, and percentage of people hospitalised and functioning favoured the intervention group"; "Mental health services should consider routinely providing EWS interventions to adults with bipolar disorder" — searches to October 2005 — doi.org.
- National Institute for Health and Care Excellence, "Bipolar disorder: assessment and management," clinical guideline CG185, recommendation 1.3.2 — document "a detailed history of mood, episodes of overactivity and disinhibition or other episodic and sustained changes in behaviour, symptoms between episodes, triggers to previous episodes and patterns of relapse, and family history"; "encourage people to invite a family member or carer to give a corroborative history" — nice.org.uk.
- National Institute for Health and Care Excellence, clinical guideline CG185, recommendation 1.4.1 — the risk management plan developed "jointly with the person, and their carer if possible," covering triggers, early warning signs, a coping and medication protocol agreed in advance, service response and contacts, with copies given to the person and their doctor; and recommendation 1.3.7.4 on reviewing crisis plans with families after a crisis — nice.org.uk.
- Harvey AG, Soehner AM, Kaplan KA, et al., "Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial," Journal of Consulting and Clinical Psychology 83(3), 2015, 564–577 — 58 participants; "the CBTI-BP group had fewer days in a bipolar episode relative to the PE group (3.3 days vs. 25.5 days)… a significantly lower hypomania/mania relapse rate (4.6% vs. 31.6%) and a marginally lower overall mood episode relapse rate (13.6% vs. 42.1%)" — doi.org.
- Frank E, Kupfer DJ, Thase ME, et al., "Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder," Archives of General Psychiatry 62(9), 2005, 996–1004 — 175 participants; "Ability to increase regularity of social rhythms during acute treatment was associated with reduced likelihood of recurrence during the maintenance phase (P = .05)" — doi.org.
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