Mood Monitoring for Bipolar
Bipolar is an unpredictable illness that affects our insight and alters our judgement. We can spiral into lows or shoot into highs with normal periods in between. However, it is different for everyone. No two people experience bipolar the same.
Mood monitoring can really help us become aware of our mood pattern and is an essential tool in educating the medical professionals supporting us. It helps us to predict our mood pattern, which enables strategies to be put into place to limit the risk of relapse. We can also assess what triggers our mood changes and determine what we can do to manage these, helping us to live better lives.
Mood monitoring provides invaluable information over time that can maximize the potential of managing bipolar through crisis to recovery.
Monitoring With Journals
I have always monitored my moods, initially without even realizing it. I started writing a daily diary back in 2008, after recognizing something was wrong. I scribbled down my thoughts and how I felt, following no structure whatsoever. Every time I saw a doctor I took the diaries with me and at times, when I was unable to consciously speak my thoughts, I recited the few sentences that I felt would portray the severity of my feelings.
Any information we formulate for medical professionals is positive. There are many structured ways to do this but at the same time, simple diary notes can inform a psychiatrist or doctor of behaviour to be concerned about. If you write that you can’t cope anymore and you don’t want to live this will of course indicate depression and concern for suicidal thoughts. On the other hand if you write about big ideas with a clear annoyance for lack of understanding, you could be displaying manic symptoms. Any information is good.
I was an inpatient in a psychiatric unit in April this year and even in a crisis state, I somehow reminded myself to write a few notes every night about how I felt. I knew my illness and I knew I needed to help myself. I wrote about my vivid dreams, irritability, self-harming and my desperation for everything to be over. I noted issues with nurses or other medical professionals and triggers from people not understanding my symptoms.
The night before my weekly psychiatric appointment I sat down, forced myself to read my diary notes and scribbled down in only a few sentences what my main problems were. From that point on I was able to advocate for myself. I still requested my community psychiatric nurse and members of my family to be present but I took control. I told myself I was the expert of my body and what I thought and felt couldn’t be shared better by anyone else. It was quite liberating.
Thankfully I had a wonderful psychiatrist who would start the appointment with, "Go ahead Fliss," and then simply listen. At the end he would respond to each problem with a solution and as a result my medication might be tweaked, my sleep concerns addressed, nursing practice and strategies to manage triggers discussed.
It is worth remembering that we often talk about how we feel at that moment. Bipolar is renowned for being changeable and it is difficult to retain insight. I had a friend who I suspected of having a mood disorder after his continual talk of depression with bursts of energy where he felt life was so good and he could write essays in half the amount of time. His doctor put him on anti-depressants but he reported side effects and clouded thinking. He complained that his doctor wasn’t helping him.
I asked him one day what his doctor said about his highs and he looked at me confused? He had only reported his depression. He had lost insight in his high moments, most likely wanting them to continue so he didn’t have a true representation of his mood cycle. This could have been avoided through mood monitoring but we need to accept there is a problem first, which can be the difficult part.
Monitoring With Mood Charts
A more comprehensive way of mood monitoring is through mood charts. I was initially introduced to these by the first psychiatrist I ever had. She was extremely competent and wanted to make sure that any decisions she made took into consideration my overall situation. It was a simple graph where I ticked the boxes which represented the highest peak of my mood and the lowest with ratings of anxiety, irritability and hours of sleep.
I was also given an additional page for ‘notes’ where I added further information on each day if I felt something was important e.g. stress triggers including family arguments or relationship issues or accidentally missing a medication dose. Anything I felt was relevant to my mood was noted down.
Here is a copy of the same graph partially completed. I am sure you can agree it is very interesting to look at a mood pattern and the results are very enlightening! Using the graph, mood peaks and troughs became clear and using additional notes, so did the reasons for my behaviour. Other charts allow you to plot your mood alongside lifestyle changes that may impact your mood.
There is of course much discussion over mood monitoring and charting. It has to work for you. This paper chart worked for me because it was tangible and something to hold. It was also easy to complete and took me seconds at the end of each day. I took it to show my psychiatrist on every appointment and then made a copy for her at the end of the month. It’s really important that supporting medical professionals have your progress on record.
I love a piece of paper and something I can stick on my wall to make me consciously aware of my daily progress. However, some amazing apps have now been developed to make it easy for us to track our moods using our phones.
I have used Optimise, which is quick to rate your mood with supporting yes/no options. There is also room for notes. The great thing about this is that you can click to formulate a graph, which can be sent to your email and you’ve got a print out for yourself and your medical professional.
How This Information Can Help
The information we record can go a long way in aiding our treatment. My graphs showed I was rapid cycling and continued to do so with mood stabilizing medication. This was therefore changed and my mood highs and lows began to lessen.
It also became evident I was not eating properly and restricting my diet. I was referred to a CBT eating disorder specialist who worked with me for two years. I am now in remission.
It was also apparent that one of my ongoing stress triggers was my family because they didn’t understand my condition. As a result they were invited to part of my sessions to gain a better understanding of my signs and symptoms and how they could help.
At one point my hours of sleep were too low so I was prescribed sleeping tablets and provided with sleep hygiene information. As you can see, there are huge advantages to monitoring your moods and sharing them with medical professionals.
Ultimately, any information we record is hugely beneficial to our health, wellbeing and treatment. After seven years of battling bipolar with numerous medication complications, struggles, relapses and inpatient stays, I can now identity my signs and symptoms and feel happy to record these.
Even in my worst moments I remind myself that I can have control and I can empower myself through gathering information.
There are so many available mood charts and apps available that it is easy for us to complete something that will aid our recovery. Treatment is not one sided, and whilst we do need best nursing practice in terms of listening to our concerns, we need to help them also. We should attempt to provide both quantitative and qualitative data for them using simple and easy mood monitoring techniques.
I can’t recommend mood monitoring enough to prevent crisis, manage wellbeing and aid recovery — using whatever tools that work for you.