We’ll start with a simple mood chart that can be useful in making a diagnosis, as well as in helping people construct meaningful relapse prevention plans. As we move forward in this book we’ll return to this illustration and see how it can be used to evaluate medications, stress reduction and relapse-prevention strategies, therapies, etc. The simplest approach is to put the moods on the left (the Y axis) and time on the bottom (the X axis). Basically, you’re constructing a timeline of your life, paying particular attention to abnormal shifts in your mood, when these occurred, how many episodes there have been over time, and so forth. See if you can track how long the moods lasted and if they were associated with particular things, such as a change in the seasons, menstrual cycle, the birth of a child, a major loss, or a major family event, and whether there are possible connections between the use of substances or medications, including going off medications.
Family/significant other/friends can be extremely helpful in completing an accurate mood chart, as many people with bipolar disorder will remember the depressed episodes far more than the manic, hypomanic, or mixed ones. Bringing a completed mood chart to your practitioner, especially early in the diagnostic process, will aid him in reaching a diagnosis and tailoring interventions. There’s no single correct way to complete these; some people find it helpful to do both a chart and a descriptive narrative:
“Thinking back I was very active through most of high school, got very little sleep, but didn’t seem to need it. I played two varsity sports, was on the honor roll, and had a part-time job on the weekends. The real problem started when I went off to college. I thought it had to do with moving away from home and my girlfriend breaking up with me, but I became severely depressed. I was unable to focus and had to drop out my second semester. I also started to smoke marijuana and I drank more than I should have; I had a horrible time trying to sleep at night and I think I used alcohol to help me pass out. I saw my medical doctor and she started me on Fluoxetine (Prozac) that didn’t seem to do anything, other than make me feel more irritable, and my thoughts felt like they were racing. I stopped the medication, didn’t tell my doctor and smoked pot heavily. I tried to work during this time, but ended up either not showing up for work, or getting fired because I couldn’t focus. On my twenty-first birthday I decided I couldn’t take it any longer. I wrote a note for my parents and went out to the woods behind our house with a bottle of vodka and every pill I could find. I woke up in the Intensive Care Unit and was then sent to a psych ward. They started me on two different antidepressants and referred me to a day program, I didn’t go and I didn’t take the medication. Around this time I stopped sleeping all together, decided that I wanted to be an artist, and began painting around the clock. I felt like I was flying and I wasn’t using any drugs at all. I had limitless energy and believed that my paintings were incredibly important and would transform the world; it felt amazing. My parents tell me that I was talking non-stop, that they couldn’t understand half of what I was saying. They tried to get me to go to the hospital, but I wouldn’t. One night we got into a really bad fight and I started to break things. They called the cops and I was back in the hospital. This time they started me on Lithium and an antipsychotic medication, it made me feel very sluggish, but they were able to get the dose down to where I can handle it and I’ve been doing pretty well since. Just lately, maybe because I got a promotion, I’ve noticed my sleep is starting to get bad again.”