Oak Brook, IL

Depression Test Questionnaire

Am I a Candidate for Ketamine? Take the Depression Test Questionnaire to find out your level of depression here:

Over the last 2 weeks, how often have you been bothered by any of the following problems? (use "" to indicate your answer) Not at all Several days More than half the days Nearly every day
1. Little interest or pleasure in doing things 0 1 2 3
2. Feeling down, depressed, or hopeless 0 1 2 3
3. Trouble falling or staying asleep, or sleeping too much 0 1 2 3
4. Feeling tired or having little energy 0 1 2 3
5. Poor appetite or overeating 0 1 2 3
6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down 0 1 2 3
7. Trouble concentrating on things, such as reading the newspaper or watching television 0 1 2 3
8. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so figety or restless that you have been moving around a lot more than ususal 0 1 2 3
9. Thoughts that you would be better off dead, or of hurting yourself 0 1 2 3
(Healthcare professional: For interpretation of TOTAL,
please refer to accompanying scoring card).

Interpretation of Total

Total Score Depression Severity
1-4 Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression