Daily Mood Journal Template
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5Use the following scale as reference:
Using this daily diary to track your mood
MANIA
This diary helps you monitor your mood on a daily basis. It provides a daily
and monthly recap for you and your doctor (or other health care professional)
Severe
Family and friends want me in the hospital
as you review your treatment.
High moderate
Much feedback that behavior is outlandish or bizarre
It’s simple to use. At the end of each day, prior to taking your evening
Low moderate
Some feedback that behavior is difficult or odd
medication, take a few moments to think about your day, what you experienced,
Mild
Very energetic; functioning may be enhanced or slightly disorganized
how you felt, how you functioned, etc. Then simply follow these steps for
STABLE MOOD
recording the information.
DEPRESSION
Mild
Low mood; essentially no impairment in usual functioning
1. Medications
Low moderate
Some extra effort needed in usual roles
List the medications your doctor has prescribed in the spaces provided,
High moderate
Much extra effort needed; marked difficulty in usual routines
including the total daily dosages and number of tablets that should be
Severe
Largely unable to function because of depression
taken each day. At the end of each day, indicate the exact number of tablets
Please note:
or capsules of each medication that you actually took that day in the
When the energized state is unpleasant or dysphoric, please indicate by placing a check mark ( ) in the
appropriate space.
appropriate space for that day
If hospitalized, use an “ ” to continue rating the severity of your mood in the appropriate space (
)
2. Hours of sleep
6. Indicate your menstrual period (if applicable)
Estimate the number of hours of sleep you had the previous night.
Place a check mark ( ) by the days you have your menstrual period.
3. Rate your overall mood
7. Record significant events each day
Rate your mood for the day and write in a number between 0 and 100,
The next page in the diary provides more space for you to record meaningful
based on the mood scale below. If you experience sudden, distinct, or
events that occur each day. For each day, record the following:
significant mood changes within 1 day, enter the highest and lowest mood
Life events—Enter significant events of the day, along with their
values reached.
corresponding impact on you:
0 . . . . . . . . . . . . . . . . . . . . 50 . . . . . . . . . . . . . . . . . . 100
-4
-3
-2
-1
0
+1
+2
+3
+4
Most depressed ever
Balanced
Most manic (activated) ever
Extremely negative
Neutral
Extremely positive
Side effects—Record any side effects of your medication(s) and indicate
4. Record the number of mood changes
the severity of your discomfort or interference with your functioning by
placing a check mark ( ) in the appropriate Mild/Mod/Sev box.
Enter the number of sudden, distinct, and significant mood changes (if
any) that occur within a single day. Mood changes may occur within the
Coexisting symptoms—Write in any additional problems you
same mood state or between mood states. (Rate your most severe level
experience each day (e.g., anxiety, alcohol abuse, paranoia, headache). If
of manic or depressed mood for the entire day if your mood varies
applicable, continue to indicate the presence and frequency of these
gradually over the course of the day.)
symptoms on following days (e.g., number of panic attacks, number of
drinks, etc).
5. Rate the severity of your mood episodes
The following four pages are an example of how to use your calendar. Taking just
Indicate how your mood has affected your ability to function in your
a few minutes at the end of each day to fill it out and reviewing it with your doctor
•
usual roles at home, work, or school by filling in the space
(
)
at every visit can have a positive impact on your treatment and everyday life.
corresponding to the appropriate level of functional impairment.
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