Measurement-based care describes a treatment strategy of collecting patient information (data) and to use that information to more precisely improve treatment, based on patient symptoms and treatment-response. In the treatment of bipolar disorder, tracking daily mood changes is perhaps the most important measurement for care. Listed below are several strategies for tracking day-to-day moods, called mood charting. In addition, we have included several apps for smartphones that can help with anxiety, sleep, and medication adherence. Note that there are literally hundreds of apps available for these issues, but we have selected apps that have some data supporting their utility, or have been reviewed in a more rigorous fashion. We have also included apps that are either free or available at very low cost. 

Mood Charting

Mood charting is an extremely helpful method of keeping track of daily moods. Mood charts are daily diaries of your mood, showing its ups and downs. Most mood charts also incorporate information about sleep, medications, anxiety, and stresses. Mood charting is helpful both for patients and providers, as they often reveal subtle fluctuations in mood that may be forgotten from one appointment to the next. Paper mood charts have been the standard for years, but there are now a number of apps that can also help track daily moods. We have included a downloadable mood chart as well as links to several apps.

NIMH Mood Chart

The National Institute of Mental Health’s (NIMH) prospective Life Chart Method (NIMH-LCM) uses daily ratings by the person with bipolar disorder. The ratings specify the polarity and severity of manic and depressive episodes and their course, also recording the concomitant use/impact of medications and life events that may precipitate episodes.  Patients chart daily mood fluctuations for the month, as well as anxiety, sleep and irritability. Instructions describing how to fill out the chart are included in the download.

DBSA Wellness Tracker

This app was developed by the Depression and Bipolar Support Alliance (DBSA) as a way that patients could track multiple aspects of well-being, including mood. It can create downloadable reports as well. The app is free and available for iOS and Android systems.

iMoodJournal

iMoodJournal is extremely customizable and can track mood, sleep, medications, energy, and more. Users can add hashtags to specific topics to establish connections between moods and experiences. The app costs $1.99 and is available for iOS and Android systems.

Help with Anxiety and Sleep

Patients with bipolar disorder frequently suffer from anxiety disorders and sleep difficulties. Several apps have been developed to help patients manage anxiety. Sleep charts and apps can be helpful in tracking sleeping patterns. There is also an excellent app to help patients and family-members take medications.

Breathe2Relax

Breathe2Relax was created by the National Center for Telehealth and Technology, as part of the US Department of Defense. It is a portable stress management tool which provides education on stress management as well as tools to aid in stress management techniques, such as diaphragmatic breathing and guided imagery techniques. It is free and available for iOS and Android systems.

CBT-i Coach

The Veteran’s Administration’s National Center for PTSD partnered with Stanford University’s School of Medicine and the Department of Defense’s (DoD) National Center for Telehealth and Technology to build CBT-I Coach, a free mobile app designed to augment clinician-administered Cognitive Behavioral Therapy for Insomnia (CBT-i).   CBT-i coach helps deliver sleep educational materials, daily sleep diary completion, stimulus control guidelines, sleep restriction procedures, and anxiety management and cognitive therapy tools. Studies by the VA suggest that CBT-i Coach is favorably received in terms of its potential to improve practice and address common adherence issues and that it is being widely used by CBT-I patients.

Helping with Medication Adherence

There is an excellent app to help patients and family-members take medications, Medisafe.

Medisafe

Tech-writer David Pogue tested 47 pill-reminder apps and declared that the Medisafe app was far-and-away the best pill-reminder app on the market, and it’s free. The app has all of the features that are needed: easy-to-enter medication names, pictures of pills, easy-to-enter times, drug warnings, family monitoring (the app can send a family member a warning if someone forgets to take a medication), a to-do list of medications that are coming up as well as a history of past pill-taking, smart-rescheduling, and lock-screen dismissal.