Changes in the symptoms of patients with Mood Disorders (MD) are accessed in clinical practice systematically and longitudinally through questionnaires and clinical observation.

The logical benefit in the clinical follow-up of patients using the Moodr App is an increase in the quality, quantity and accuracy of the daily information collected about the individual.

The probability of improved decision-making with the appropriate detail of this information is also intuitive and obvious.

Moodr boasts C-level scientific evidence, case series with hundreds of individuals evaluated and the consequent artisanal improvement of the app over several years.

In addition, several of the principles underpinning Moodr have already been proven in Randomized Controlled Studies in the medical literature and have proved to be useful and effective.

Apps that record symptoms are the continuation of a long tradition dating back to Kraepelin's (1) pioneering studies into bipolar disorder.

Moodr is a practical technological update of the mood chart, which comes from a well-established tradition in psychiatry, the self-monitoring (2). Apps are a current trend well accepted by patients, easy to access and use.

Daily paper records, such as the LCM-p scale (prospective NIMH Life Chart Method), have been used for many decades, are effective and have been validated (3), including in Brazil (4). They are also highly correlated and concordant (5) with traditional scales such as the HAM (Hamilton, 1960) and the Young (Young et al., 1978). However, simplified daily longitudinal self-recording of symptoms is quick, valid (6) and better than the scales (7)  because it is more accurate in measuring instability. The usual scales, despite being the current standard for monitoring mood, are applied weeks apart and are cross-sectional in nature, without capturing the longitudinal course of symptoms between measurements, producing a less reliable summary of the evolution of the disorder. They are also more subject to memory and mood biases on the day of application.

On the other hand, some simplified scales such as the LCM-p only use 4 levels of severity for the symptoms: mild, low moderate, high moderate and severe. This requires minimal psychoeducation of the patient on how to fill in the instrument properly. With Moodr we instruct the patient to record the most severe level of mania and/or depression symptoms that occurred that day. A “recalibration” can be made at each visit according to the successes and failures observed in the diary. The LCM-p has proven its greatest value by providing clinicians and their patients with immediate and very precise graphic visualization of the course of mood symptoms (2) over longer periods of time.

Electronic records have evidence of being better than those made on paper. The adherence (7) to recording mood in the LCM-p in an electronic version was double when compared to the same instrument on paper. The use of mobile apps to record daily mood symptoms reduced the risk of memory bias (4). The fact that the patient clicks on a simplified score that corresponds to their mood that day favors completion (7)  and is reliable. Cell phone applications filled in daily have adequately captured the symptoms of MD (8).

Simplified versions (6) have already been studied for 3 mood levels instead of the 4 of the LCM-p scale. The results, using exactly the same principles as Moodr (symptoms can be “mild”, “moderate” or “severe”), were satisfactory in correlating with the usual scales (HAM and Young). In addition, there was a moderate to high correlation (6) between mood symptom scores compared between patients and clinicians. The Moodr way of recording symptoms in 3 levels of severity has already been tested and approved in the literature.

The use of mood records has been associated with an increase in euthymic periods and a decrease in days in depression, mania and hypomania (4). The use of systematic daily follow-ups on paper has improved the treatment of MD. Mobile apps have the same technical principles as successful paper diaries. However, they have some better comparative results and clear advantages in terms of practicality of use and availability, with the potential to positively influence the outcomes of MD.

Moodr was developed and adapted to the most important clinical needs of the initial phase of treatment, mainly the evaluation of the response to the proposed drugs and their side effects.

Environmental factors were also highlighted. 

Suggestions from the literature such as passive measures that don't require effort from the patient (automatic measurement of daily steps in the case of Moodr) have been added to the app (10).

The final product, continually revised, remains based on:

1. Being simple, intuitive, easy and quick to complete;
2. Being constantly revised in line with the relevant literature;
3. Be intended for use at the beginning of the treatment of mood disorders;
4. Its main purpose should be to monitor and assist in the process of stabilizing the condition;
5. Be focused on the beginning of treatment. Moodr is essentially an “attack” app, for use in the office during the initial unstable phase of treatment, after which it can be “paused”;
6. In its simplicity, Moodr differs from academic apps used to study the details of mood disorders. Requirements such as daily logging of various mood moments, prolonged use over months or years and the violation of privacy rules under particular scientific conditions are common in academic apps. These requirements are not accepted by platforms such as IOS (which prevents GPS records, voice recording, frequency of use on social media, etc.) The conditions necessary for academic study are inappropriate in everyday clinical outpatient care;
7. Moodr's clinical focus is evident in the choice of characteristics that are symptoms of Mood Disorders but are also side effects of the medications used, such as changes in libido, sleep and appetite;
8. These characteristics (along with mood) are fundamental to the choice of treatments and a more accurate assessment of the response to them, potentially affecting the patient's acceptance of and adherence to the therapies employed and probably affecting their quality of life.