Recovery often incorporates a sort of detective work on your part; in order to recognize which problems require attention, establishing your personal patterns can be critical.  There are a number of tools which offer organization, pattern detection, and progress tracking.  Among these are the creation of a patient treatment file, mood logs, journal, and depression inventory scales, such as the Goldberg Depression Questionnaire and Beck Depression Inventory (BDI-II).

 

    Susan Nolen-Hoeksema

    McGraw-Hill Companies, Inc., New York.  2004

 

"How to Chart Your Moods"

    Kimberly Bailey and Marcia Purse

    bipolar.about.com

 

"Learning From History"

    Robert H. Shmerling, M.D.

    May 27, 2003

    www.intelihealth.com

 

 

 

The journey towards recovery can be both intricate and overwhelming at times--a myriad of diagnostic tests and tools, consults with professionals, details that slip through the cracks, etc.  However, despite the complex nature of the recovery process, it IS possible to establish organization.  

 

With organization comes reduced likelihood of errors, access to information conducive to creating more efficient goal-oriented plans, and the personal feedback necessary to answering the questions,

"Is this working?  Am I experiencing any improvement yet?" 

 

If possible, I recommend putting together a personal treatment file at the commencement of your recovery process.  This will ensure that all documents and information that could prove helpful in the future will be together in an organized fashion, saving you the trouble of locating that tiny piece of paper you just knew you had a year ago but can't seem to dig up anywhere.  Even if your treatment has been ongoing, a personal treatment file still gives you a sense of direction in your path to recovery.

 

The following are some suggestions as to what you might consider including in your personal treatment file:

 

 

As it is, depression can be an elusive disorder, but as time passes, our memory of what we experienced when it was developing and evolving can become fuzzy.  Take the time, while you still may remember some details, to write a short synopsis of your experience.  Around how many years of age were you at the time of onset?  Did a life event set it off, or was it more gradual?  What differences did you notice in moods, thoughts, behaviors?  How did it affect your daily life?  Did any friends or family make comments about changes they noticed?  The more you can remember (and access in the future), the closer you'll be to ultimately solving the puzzle.

 

 

We all know the routine: You go to meet a new doctor and are greeted with a thick packet of questions to answer and boxes to fill in about yourself.  Instead of having to rely on your memory at that particular moment or running the risk of leaving pertinent information out, have all this information already in one place.  You might include the following: medical conditions, pending diagnoses or unexplained symptoms, medications (including vitamins, supplements, birth control pills, herbs, alternative/complimentary treatments, and pills you take "as needed"), allergies, and family medical history.

 

 

Once you are aware of psychiatric services covered by your insurance plan, keep lists of physicians, hospitals, and medication comparison costs.  You should also keep all treatment related receipts, and be sure to photocopy any documents, forms, and/or information that you send back to the insurance company.  (They seem to have a tendency to lose items or make careless mistakes--usually not in your favor, either.)

 

 

It's always good to have a section devoted to contact information--including addresses, phone numbers, fax numbers, e-mails, etc.  Among those listed: general practitioners, psychiatrists, therapists, insurance companies, pharmacies, hospitals, crisis lines, and support group meetings.

 

 

Over time, you may encounter some rather useful resources on the internet or in the bookstore.  If you keep a running list of these, you won't have to rely on memory if you wish to refer back to them in the future.  This can be quite helpful when it comes to looking up new medications, for example, at a site you find both comprehensive and easy to understand, as well as in recommending useful websites and books to friends and family.

 

 

Diagnostic test results (blood work, EKGs, MRIs, etc.) can be photocopied from the original results and stored for future reference.  This is helpful in the event the originals are lost in the shuffle and also can be handy to have during consultations with other treating professionals and/or trips to the hospital.  Crisis plans that you've constructed with the help of either your therapist or psychiatrist can also be kept in this section. 

 

 

Save your notes from discussions with your therapist, psychiatrist, etc., so that you can refer back to them at any time.  Also consider keeping a running list of things you would like to mention and/or ask at your next appointment.  This is also a good place to hang onto any handouts or pamphlets they give you.

 

 

Papers such as mood logs, depression scales, etc., are kept together in chronological order.  Don't forget to include sheets you've filled out in the past, the current monthly log, and blank sheets to photocopy for future use.  You may also wish to include a chart and/or graph to better visualize your progress based on these evaluation tools. 

 

9) Calendar     

 

In addition to your regular calendar or agenda book, you might wish to have a separate calendar specifically reserved for treatment information.  On this page, you could map out treatment goals, appointments, support group meetings, dates by which you would need to refill prescriptions, etc.  While most of these you would most likely transfer to your regular calendar, this is a way to eliminate the "clutter" of unrelated events on your schedule so that you can focus solely on scheduling aspects of your treatment in a timely manner.

 

 

 

These are a great way to keep records of a variety of information pertaining to your treatment progress (and are extremely helpful in highlighting trends).  While there is an infinite number of possibilities in setting up a mood chart, you'll often find the examples are set up in spreadsheet form and span the course of a month per page.  They're typically quite detailed--therefore, perfect to bring with you to appointments, since they eliminate the need to remember what you experienced since your last appointment.  

They also provide the doctor or therapist with a visual representation of your progress. 

 

In the beginning, they may seem a bit bewildering and, consequently, take more time and care to fill out; however, once you get used to the format, you'll be able to complete an entire day in less than 5 minutes.

 

Click here to view a list of sample mood charts, or use the following suggestions to customize your own.

 

- name

- month and year

- body weight (a monthly weighing around the same time each    

   month to track effects of meds and/or eating behavior changes)

- medications (daily dosages go in boxes for each drug)

- therapy ("X" each day that you attend)

- exercise ("X" each day you get sufficient physical activity)

- for females, indicate first day of menstruation (can circle date

   or "X" off box)

- number of hours of sleep that night (or if you fill it out at night, 

   hours slept the night before)

- ratings for items like anxiety, irritability, (in)ability to function

   (for example, a scale from 0-3, "0" being "not present", "3"

   being "severe") 

- boxes for mood range so that it appears as a mood graph over

   time (for example, severe depression <-----> elation)

- comments (could include anything from side effects to factors   

   that could have influenced the day's mood)

 

 

These attempt to provide the patient with a fairly objective measure of the severity of their depression at any given time.

 

 

Answer the 18 questions, then determine your total score using the numbers next to your answers.  Usually, the questions refer to how you've felt during the past week.  A change of 5 points (when you have taken the questionnaire more than one time) is considered significant.

 

Score Interpretation:

 

0-9      No depression likely

10-17  Possibly mildly depressed

18-21  Borderline depression

22-35  Mild-moderate depression

36-53  Moderate-severe depression

54+     Severe depression

 

 

 

 

This depression scale is similar to the Goldberg Depression Questionnaire; however, since it is copyrighted (by Psychological Corporation), it cannot be reproduced on this website.  Ask your physician for a copy of the BDI-II if you're interested.

 

 

 

There's something about the act of writing things down on paper that can be so freeing, so cathartic.  You start with a blank page and make it yours by letting your creativity and thoughts run rampant.  Sometimes, your writing might have direction; other times, it might seem like rambling.  But, in the end, it's not the product that counts so much as the process by which it came to be.

 

Journaling can be a wonderful means of self-expression.  Whether you choose to sit down and add your thoughts on a regular basis or just in times of need, it can open your eyes to issues you were previously unaware of and strengths you never realized were within you. 

 

To some individuals, the pen flows freely without much hesitation; however, for those among us who are not quite sure what to write or where to start, here are some ideas:

 

1)  Write about the first thing that comes to mind

2)  Think about your day, and comment on events or conversations that took place

3)  Select an emotion from the list on this page and write about how you experience it--physically  

     and mentally, things that could generate that emotion, and strategies you use to deal with it, if 

     applicable.

4)  Start writing freely with your non-dominant hand to see what results are produced by tapping into 

     the other side of the brain and utilizing a task requiring greater concentration (since it's not

     habitual).

5)  Look around the room and take note of the first thing that catches your attention.  Use that for

     inspiration: If it's a book, perhaps you could write about a character who serves as a role model for

     you; if it's a lamp, you might opt to write about your own energy and internal light.

6)  Pick out a quote and comment on the significance of that concept or lesson in your life.  You

     might consider taking advantage of the "Quote of the Day" service at Quoteland.com.

7)  Try one of the self-discovery "games" in a book like Kokology: The Game of Self-Discovery,

     by Tadahiko Nagao and Isamu Saito.  (You read a short scenario, decide how you might respond

     based on the prompt, then read the interpretation to your answer.)  Did you find the interpretation

     to be on target?  What are your thoughts regarding this topic? 

Navigating through the storm...

The Depression Guide