This is a form I use to keep track of progress when treating depression. Please answer the following questions based on the past week.
start
 
1. Sadness


 
2. Pessimism


 
3. Past Failure


 
4. Loss of Pleasure


 
5. Guilty Feelings


 
6. Feeling Punished


 
7. Self-Dislike


 
8 Self-Criticism


 
9. Suicidal Thoughts or Wishes


 
It's important that you talk with a professional right away. If you are actively making suicidal plans, and are a current patient, call 888-464-1800 and press option 3 to reach me (Dr Majeres) directly. If you have trouble reaching me, or are not a current patient, please call 911 or present to a local emergency room. This is much more important the finishing the depression questionnaire!
You may also contact the National Suicide Prevention Lifeline: 
http://www.suicidepreventionlifeline.org

 
10. Crying


 
11. Agitation


 
12. Loss of Interest


 
13. Indecisiveness


 
14. Worthlessness


 
15. Loss of Energy


 
16. Changes in Sleeping Pattern


 
17. Irritability


 
18. Changes in Appetite


 
19. Concentration Difficulty


 
20. Tiredness or Fatigue


 
21. Loss of Interest in Sex


 
What is your first name?

 
Are you currently a patient of Dr. Majeres?

     
 
Great! He will discuss this with you at your next visit.

 
In that case, this test is solely for your own information. If you do become a patient of his in the future, he will ask you to retake this test (your results from this time will not be reviewed or saved).

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