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Medical Evaluation by Your Doctor
Do not diagnose depression on your own or think your depression isn't important enough to treat. It is very important to talk to your doctor if you think you are depressed. Print this form, fill it out and take it with you for your doctor to see. Do not use this to interpret your level of depression.
Select one answer and do so to the best of your ability. Over the past two weeks, how often have you been bothered by:
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Not at all |
Several days |
More than half the days |
Nearly everyday |
| 1. Little interest or pleasure in doing things. |
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| 2. Feeling down, depressed or hopeless. |
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| 3. Trouble falling or staying asleep or sleeping too much. |
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| 4. Feeling tired or having little energy. |
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| 5. Poor appetite or overeating. |
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| 6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down. |
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| 7. Trouble concentrating on things, such as reading the newspaper or watching television. |
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| 8. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual. |
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| 9. Thoughts that you would be better off dead, or of hurting yourself. |
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This article was reviewed and updated June 2007.
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