If you think you might have
depression symptoms, this checklist can help you talk
about your concerns with your doctor.
Just print this page, answer the questions, and take the
finished checklist to an appointment with a doctor or
other healthcare professional. Your answers can help your
doctor determine if you have depression.
Over the past two weeks,
how often have you been bothered by any of
the following problems?
1. Little interest or pleasure
in doing things
Not at all
Several days
More than half the days
Nearly everyday
2. Feeling down, depressed
or hopeless
Not at all
Several days
More than half the days
Nearly everyday
3. Trouble falling or staying
asleep, or sleeping too much
Not at all
Several days
More than half the days
Nearly everyday
4. Feeling tired or having
little energy
Not at all
Several days
More than half the days
Nearly everyday
5. Poor appetite or overeating
Not at all
Several days
More than half the days
Nearly everyday
6. Feeling bad about yourself,
or feeling that you are a failure or have let yourself
or your family down
Not at all
Several days
More than half the days
Nearly everyday
7. Trouble concentrating
on things such as reading the newspaper or
watching television
Not at all
Several days
More than half the days
Nearly everyday
8. Moving or speaking so
slowly that other people notice. Or the opposite
- being so fidgety
or restless that you have been moving around a lot
more than usual
Not at all
Several days
More than half the days
Nearly everyday
9. Thinking that you would
be better off dead or wanting to hurt yourself in
some way
Not at all
Several days
More than half the days
Nearly everyday
