Can mood tracking apps reduce mood episodes in bipolar disorder management?

Mood Tracking Apps in Bipolar Disorder: Limited Evidence for Reducing Mood Episodes

The current evidence does not support that mood tracking apps alone reduce mood episodes in bipolar disorder, though they show promise for monitoring symptoms and may increase illness insight when combined with comprehensive treatment. The available research focuses primarily on feasibility and validity of electronic mood monitoring rather than demonstrating clinical efficacy in preventing or reducing mood episodes.

Evidence for Clinical Outcomes

Lack of Direct Evidence for Episode Reduction

• No randomized controlled trials have specifically investigated whether electronic mood self-monitoring tools alone reduce mood episodes in bipolar disorder 1
• The existing RCTs primarily evaluated heterogeneous electronically delivered interventions rather than isolating the effect of mood tracking apps themselves 1
• Studies are limited by methodological issues and risk of bias, preventing strong conclusions about clinical benefits 1

What Apps Can Actually Do

• Smartphone monitoring shows high adherence rates (91% completion of daily prompts in one study, 92% median weekly compliance in another), suggesting patients find them acceptable 2, 3
• Apps can validly capture depressive symptoms when compared to clinical rating scales (validated in 6 out of 6 studies), but are less reliable for manic symptoms (validated in only 2 out of 7 studies) 1
• Mood monitoring may increase illness insight and potentially influence behavioral change, based on qualitative patient reports 4

Practical Limitations and Concerns

Monitoring Mania is Problematic

• Electronic self-monitoring of manic symptoms shows poor validity compared to clinical rating scales 1
• This is a critical limitation since detecting early manic episodes is essential for relapse prevention in bipolar disorder 1

Patient-Reported Concerns

• Patients express concerns about potential preoccupation with monitoring and paranoia about being tracked 4
• The need for personalization, flexibility, and consideration of context when monitoring mood is emphasized by users 4
• Apps cannot capture mood fluctuations occurring between assessment points (e.g., daily changes missed by weekly monitoring) 3

Integration with Evidence-Based Treatment

Apps as Adjunctive Tools Only

• Mood tracking apps should be viewed as supplementary monitoring tools within comprehensive bipolar disorder treatment, not as standalone interventions 5, 6
• The American Academy of Child and Adolescent Psychiatry emphasizes that pharmacotherapy (lithium, valproate, or atypical antipsychotics) combined with evidence-based psychosocial interventions remains the primary treatment approach 6
• External memory aids and structured monitoring can support cognitive functioning as part of broader symptom management strategies 5

Appropriate Clinical Context

• Apps may be most useful for tracking patterns over time to inform clinical decision-making rather than preventing episodes 7, 2
• Smartphone data showing decreased social communication (outgoing texts) and reduced physical activity (cell tower movements) predicted increases in depressive symptoms 7
• However, these associations do not demonstrate that monitoring itself prevents symptom worsening 7

Critical Gaps in Evidence

The fundamental problem is that no studies have demonstrated that using mood tracking apps actually reduces the frequency, duration, or severity of mood episodes in bipolar disorder 1. While apps can monitor symptoms with reasonable validity for depression, the lack of rigorous RCTs investigating beneficial versus potentially harmful effects means we cannot recommend them as episode-prevention tools 1.

The evidence supports using apps as monitoring adjuncts within established treatment frameworks that prioritize mood stabilizers and evidence-based psychotherapy, but clinicians should not expect apps alone to reduce mood episodes 5, 6, 1.