daily MOOD JOURNAL
1
GZU01088A
© 2010 Pfizer Inc. All rights reserved.
Printed in USA/November 2010
daily MOOD JOURNAL1
TRACK YOUR MEDICINE AND MOOD A mood journal can be a valuable tool for people with bipolar disorder and their doctors. Use this journal daily, and over time it can help you and your doctor recognize the progress you’re making with treatment. And inspire you to stick with it. Example: June
1
2
3
4
5
6
7
Medicine taken Mania
Severe Moderate Mild Stable
Depression Mild Moderate Severe Note 6/3/10
I had another argument with my sister. I thought about it all day and had trouble sleeping.
2
3
EMERGENCY CONTACT Name: Phone:
DOCTOR(S) Name:
WHAT MEDICINE DO YOU TAKE DAILY? List your medicine. Record how many times per day you take each medicine and any other instructions your doctor gave you, like whether the medicine should be taken with meals.
Medicine
Times/day
Special instructions
Phone: Name: Phone:
PHARMACY Name: Phone:
4
5
WHAT ARE YOUR GOALS?
WHAT IS YOUR MOTIVATION? You want to stay well. But there may be times you’re tempted to stop your medicine. It may be helpful to think about why you sought treatment and reasons to stick with it. Write them down here. And when you need motivation, read them to yourself.
You may have put some goals on hold when you were diagnosed. As you start to feel more stable, you could consider setting new, realistic goals to work toward. Break your goals into small, manageable steps. Record them here. And check off each step as you complete it. We hope seeing the progress you’re making toward your goals will encourage you to stay on treatment.
GOAL 1:
Step 1:
Step 2:
Step 3:
GOAL 2:
6
Step 1:
Step 2:
Step 3: 7
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
8
9
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs on your mood chart.
10
11
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
12
13
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
14
15
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
16
17
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
18
19
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
20
21
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
22
23
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
24
25
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
26
27
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
28
29
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
30
31
GZU01088A
© 2010 Pfizer Inc. All rights reserved.
Printed in USA/November 2010
daily MOOD JOURNAL1
TRACK YOUR MEDICINE AND MOOD A mood journal can be a valuable tool for people with bipolar disorder and their doctors. Use this journal daily, and over time it can help you and your doctor recognize the progress you’re making with treatment. And inspire you to stick with it. Example: June
1
2
3
4
5
6
7
Medicine taken Mania
Severe Moderate Mild Stable
Depression Mild Moderate Severe Note 6/3/10
I had another argument with my sister. I thought about it all day and had trouble sleeping.
2
3
EMERGENCY CONTACT Name: Phone:
DOCTOR(S) Name:
WHAT MEDICINE DO YOU TAKE DAILY? List your medicine. Record how many times per day you take each medicine and any other instructions your doctor gave you, like whether the medicine should be taken with meals.
Medicine
Times/day
Special instructions
Phone: Name: Phone:
PHARMACY Name: Phone:
4
5
WHAT ARE YOUR GOALS?
WHAT IS YOUR MOTIVATION? You want to stay well. But there may be times you’re tempted to stop your medicine. It may be helpful to think about why you sought treatment and reasons to stick with it. Write them down here. And when you need motivation, read them to yourself.
You may have put some goals on hold when you were diagnosed. As you start to feel more stable, you could consider setting new, realistic goals to work toward. Break your goals into small, manageable steps. Record them here. And check off each step as you complete it. We hope seeing the progress you’re making toward your goals will encourage you to stay on treatment.
GOAL 1:
Step 1:
Step 2:
Step 3:
GOAL 2:
6
Step 1:
Step 2:
Step 3: 7
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
8
9
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs on your mood chart.
10
11
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
12
13
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
14
15
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
16
17
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
18
19
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
20
21
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
22
23
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
24
25
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
26
27
MONTH: HAVE YOU TAKEN YOUR MEDICINE? Indicate you’ve taken all your medicine with a check mark. Day of month
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
Medicine taken
HOW ARE YOU FEELING? Mark the box that best describes your mood. If you had both manic and depressive symptoms today, mark 2 boxes. Mania
Severe Moderate Mild Stable
Depression
Mild
Moderate Severe
28
29
WOULD YOU LIKE TO DESCRIBE YOUR FEELINGS? Write the date. Then describe your mood and events that affected it. This information can help you and your doctor understand any ups and downs your mood chart shows.
30
31
