The Mood Disorder Questionnaire

Some people with bipolar depression can go years without a clear diagnosis. So what do you do if you or someone you love is struggling with depressive symptoms? How do you find out if it could be bipolar depression—the kind associated with bipolar disorder? There is no one test or quiz that can diagnose the condition. Only an in-depth discussion with the doctor can do that.

You can use this simple interactive form as a basis for that discussion. Answer each question to the best of your ability. Then print or email the results to yourself and share the results with the doctor. Or, to print a blank form to take with you to your or your loved one’s appointment with your health care provider, click here.

To see patients’ and caregivers’ experiences in living with bipolar depression, watch these real-life stories.

Please note: We do not collect or save your personal information. The answers you enter can be printed by clicking the button at the end or by emailing them to yourself. For your security, these answers will not be saved.

This instrument is designed for screening purposes only and is not to be used as a diagnostic tool. Always consult with your health care provider.

Personalize your questionnaire:

Please answer the questions marked in red below.

Has there ever been a period of time when you were not your your friend or loved one was not their usual self and...

... you felt so good or so hyper that other people thought you were not your normal self, or you were so hyper that you he or she seemed to feel so good or so hyper that other people thought they were not their normal self, or were so hyper that they got into trouble?
... you were so irritable that you he or she was so irritable that they shouted at people or started fights or arguments?
... you felt he or she appeared to feel much more self-confident than usual?
... you got much less sleep than usual and found you didn’t he or she got much less sleep than usual and didn’t appear to really miss it?
... you were much more talkative or spoke he or she was much more talkative and/or spoke much faster than usual?
... thoughts raced through your head or you couldn’t slow your he or she has ever expressed that their thoughts raced in their head and/or they couldn’t slow their mind down?
... you were so easily distracted by things around you that you he or she was so easily distracted by things around them that they had trouble concentrating or staying on track?
... you he or she had much more energy than usual?
... you were much more active or he or she was much more active and/or did many more things than usual?
... you were much more social or outgoing than usual; for example, you telephoned he or she was much more social or outgoing than usual—for example, telephoning friends in the middle of the night?
... you were he or she was much more interested in sex than usual?
... you did things that were unusual for you or that he or she did things that were unusual for them or that you or other people might have thought were excessive, foolish, or risky?
... spending money got you or your family them or their family into trouble?

If you checked YES to more than one of the above, have several of these ever happened has your friend or loved one experienced several of these during the same period of time?

How much of a problem did any of these cause you your friend or loved one (like being unable to work; having family, money, or legal troubles; getting into arguments or fights)?

THE MOOD DISORDER QUESTIONNAIRE
©2000 by Robert M.A. Hirschfeld, MD. Reprinted with permission.

Email the results to yourself and use as the basis of a discussion with your doctor.

> If you have serious thoughts about suicide, call your health care provider right away or go to the hospital emergency room. You can also call the National Suicide Prevention Lifeline 24 hours a day at 1-800-273-8255.

This instrument is designed for screening purposes only and is not to be used as a diagnostic tool. Always consult with your health care provider.

©2000 by Robert M.A. Hirschfeld, MD. Reprinted with permission.