Please print this survey and share your answers with your physician
This survey is reprinted from www.WebMD.com.
Rate Your Risk for Depression

Could You Be Depressed?
Depression affects people differently. Some people cry a lot and feel sad. Others seem angry, irritable, or anxious. For others, depression shows itself in vague physical problems like constipation, muscle aches, headaches. Take a minute to think about how you have felt over the past two weeks. Which of these statements describe you?

I feel sad or down most of the time.
Yes
No

I've lost interest in the activities I used to enjoy.
Yes
No

I feel tired almost every day.
Yes
No

I have problems sleeping. I'm either sleeping too much or staying awake at night.
Yes
No

My appetite has changed. I'm not eating enough, or I'm eating too much.
Yes
No

I have trouble concentrating.
Yes
No

My friends say I'm acting different. I'm either anxious and restless or lethargic.
Yes
No

I feel worthless or hopeless.
Yes
No

I'm having frequent headaches, stomach problems, muscle pain, or back problems.
Yes
No

I find myself thinking a lot about dying.
Yes
No