Question Title 1. Are you currently experiencing symptoms of depression nearly every day for 2 - 8 weeks or more? Depression is characterized by severe, persistent feelings of sadness, helplessness, and a loss of interest in previously enjoyed activities. People with depression often experience a lack of appetite, fatigue, and sleep. Yes - 2 weeks or more Yes - 8 weeks or more No Unsure OK Question Title 2. For how long have you been feeling depressed in the current depressive episode (in months)? OK Question Title 3. Please check any symptom you have had, most days, for at least the last two weeks: Feeling sad or tearful Feeling that things will never get better for you Wanting or needing help to complete routine activities Feeling guilty for things you did or didn't do Loss of interest or enjoyment in activities you usually enjoy Trouble falling or staying asleep or oversleeping Loss of appetite or overeating Loss of energy Feeling slowed down or restless Difficulty concentration or making decisions Thoughts about your own death or wishing to be dead Worrying about the worst that could happen None of the above OK Please read the following statements and rate the extent to which they apply to you when you think about negativeexperiences or problems. OK Question Title 4. The same thoughts keep going through my mind again and again. Almost always Often Sometimes Rarely Never OK Question Title 5. Thoughts intrude into my mind Almost always Often Sometimes Rarely Never OK Question Title 6. I can't stop dwelling on them Almost always Often Sometimes Rarely Never OK Question Title 7. I think about many problems without solving any of them Almost always Often Sometimes Rarely Never OK Question Title 8. I can't do anything else while thinking about my problems Almost always Often Sometimes Rarely Never OK Question Title 9. My thoughts repeat themselves Almost always Often Sometimes Rarely Never OK Question Title 10. Thoughts come to mind without me wanting them to Almost always Often Sometimes Rarely Never OK Question Title 11. I get stuck on certain issues and can't move on. Almost always Often Sometimes Rarely Never OK Question Title 12. I keep asking myself questions without finding an answer Almost always Often Sometimes Rarely Never OK Question Title 13. My thoughts focus prevent me from focusing on other things Almost always Often Sometimes Rarely Never OK Question Title 14. I keep thinking about the same issue all the time Almost always Often Sometimes Rarely Never OK Question Title 15. Thoughts just pop into my mind Almost always Often Sometimes Rarely Never OK Question Title 16. I feel driven to continue dwelling on the same issue Almost always Often Sometimes Rarely Never OK Question Title 17. My thoughts are not much help to me Almost always Often Sometimes Rarely Never OK Question Title 18. My thoughts take up all my attention Almost always Often Sometimes Rarely Never OK Question Title 19. How helpful do you think it would be to address these issues? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title 20. When did you first experience depression? OK Question Title 21. Have you ever been hospitalized for anxiety or depression in the past? Yes No OK Question Title 22. How long ago was it that you went two months or longer being mostly free of depression symptoms? Less than 8 weeks ago Between 8 weeks ago and 24 months ago More than 24 months ago Unsure OK Question Title 23. How many prescription depression medications have you taken that have failed to adequately treat your depression during this depressive episode? 0 1 2 3 or more OK Question Title 24. What medications, are you currently taking to treat your depression? (please include dosage) OK Question Title 25. How long have you been taking your depression medication? OK Question Title 26. Are you currently taking any of the following supplements or treatments? Omega 3 SamE Fish Oil B Complex 5 HTP Theanine Vitamin D Medical marijuana Psychotherapy None of the above OK Question Title 27. Do you currently experience thoughts of suicide or self-harm? Yes No OK Question Title 28. Has a physician, doctor or other mental healthcare professionals ever told you that you have any of the following? Depressive episode with psychotic or catatonic features Bipolar disorder or any manic, hypomanic, or mixed episode Schizophrenia, schizoaffective, or other psychotic disorder Panic disorder Obsessive-Compulsive disorder Post-traumatic stress disorder (PTSD) Bulimia or Anorexia Nervosa Delirium, dementia, amnesia or any cognitive disorders Borderline or antisocial personality disorder Psychosis Unsure None of these apply OK NEXT
