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Printable Depression Questionnaire

The following questionnaire has 16 simple questions that may help identify common symptoms of depression. Choose the items that best describe you. Then, use the print button at the bottom of this page to print this questionnaire and discuss the results with a qualified healthcare professional.

IMPORTANT: As with any medical illness or condition, only your doctor or other qualified healthcare professional can provide a diagnosis of depression. The following questionnaire is intended to help you discuss symptoms with a qualified healthcare professional. This questionnaire is not intended to serve as a substitute for a diagnosis of depression by a qualified healthcare professional. If you think you may have depression, you should visit your doctor or other qualified healthcare professional as soon as possible.

Falling asleep:
I never take longer than 30 minutes to fall asleep.
I take at least 30 minutes to fall asleep, less than half the time.
I take at least 30 minutes to fall asleep, more than half the time.
I take more than 60 minutes to fall asleep, more than half the time.

Sleeping during the night:
I do not wake up at night.
I have a restless, light sleep with a few brief awakenings each night.
I wake up at least once a night, but I go back to sleep easily.
I awaken more than once a night and stay awake for 20 minutes or more, more than half the time.

Waking up too early:
Most of the time, I awaken no more than 30 minutes before I need to get up.
More than half the time I awaken more than 30 minutes before I need to get up.
I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually.
I awaken at least one hour before I need to, and can't go back to sleep.

Sleeping too much:
I sleep no longer than 7-8 hours per night, without napping during the day.
I sleep no longer than 10 hours in a 24-hour period, including naps.
I sleep no longer than 12 hours in a 24-hour period, including naps.
I sleep longer than 12 hours in a 24-hour period, including naps.

Feeling sad:
I do not feel sad.
I feel sad less than half the time.
I feel sad more than half the time.
I feel sad nearly all of the time.

Decreased appetite:
There is no change in my usual appetite.
I eat somewhat less often or lesser amounts of food than usual.
I eat much less than usual and only with personal effort.
I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade me to eat.

Increased appetite:
There is no change from my usual appetite.
I feel a need to eat more frequently than usual.
I regularly eat more often and/or greater amounts of food than usual.
I feel driven to overeat both at mealtime and between meals.

Decreased weight (within the last two weeks):
I have not had a change in my weight.
I feel as if I've had a slight weight loss.
I have lost 2 to 5 pounds.
I have lost more than 5 pounds.

Increased weight (within the last two weeks):
I have not had a change in my weight.
I feel as if I've had a slight weight gain.
I have gained 2 to 5 pounds.
I have gained more than 5 pounds.

Concentration/Decision-making:
There is no change in my usual capacity to concentrate or make decisions.
I occasionally feel indecisive or find that my attention wanders.
Most of the time, I struggle to focus my attention or to make decisions.
I cannot concentrate well enough to read or cannot make even minor decisions.

View of myself:
I see myself as equally worthwhile and deserving as other people.
I am more self-blaming than usual.
I largely believe that I cause problems for others.
I think almost constantly about major and minor defects in myself.

Thoughts of death or suicide:
I do not think of suicide or death.
I feel that life is empty or wonder if it's worth living.
I think of suicide or death several times a week for several minutes.
I think of suicide or death several times a day in some detail, or I have made specific plans for suicide or have actually tried to take my life.

(Call your doctor right away if you have thoughts of suicide.)

General interest:
There is no change from usual in how interested I am in other people or activities.
I notice that I am less interested in people or activities.
I find I have interest in only one or two of my formerly pursued activities.
I have virtually no interest in formerly pursued activities.

Energy level:
There is no change in my usual level of energy.
I get tired more easily than usual.
I have to make a big effort to start or finish my usual daily activities (for example, shopping, homework, cooking, or going to work).
I really cannot carry out most of my usual daily activities because I just don't have the energy.

Feeling slowed down:
I think, speak, and move at my usual rate of speed.
I find that my thinking is slowed down or my voice sounds dull or flat.
It takes me several seconds to respond to most questions and I'm sure my thinking is slowed.
I am often unable to respond to questions without extreme effort.

Feeling restless:
I do not feel restless.
I'm often fidgety, wringing my hands, or need to shift how I am sitting.
I have impulses to move about and am quite restless.
At times, I am unable to stay seated and need to pace around.

Adapted from © 2000, A. John Rush, M.D., Quick Inventory of Depressive Symptomatology (Self Report) (QIDS-SR)


  




Important Safety Information About WELLBUTRIN XL
WELLBUTRIN XL is not for everyone. There is a risk of seizure with WELLBUTRIN XL which increases with higher doses. Taking more than 450 mg/day increases the chance of serious side effects. Don't use it if you've had a seizure or eating disorder, or if you abruptly stop using alcohol or sedatives. Don't take with MAOIs, or medicines that contain bupropion. When used with a nicotine patch or alone, there is a risk of increased blood pressure, sometimes severe. To reduce risk of serious side effects, tell your doctor if you have liver or kidney problems. Other side effects may include weight loss, dry mouth, nausea, difficulty sleeping, dizziness, sore throat, constipation, or flatulence.

WELLBUTRIN XL is approved only for adults 18 years and over. In some children, teens, and young adults, antidepressants increase suicidal thoughts or actions. Whether or not you are taking antidepressants, you or your family should call the doctor right away if you have worsening depression, thoughts of suicide, or sudden or severe changes in mood or behavior, especially at the beginning of treatment or after a change in dose (see Medication Guide: Antidepressant Medicines, Depression and Other Serious Mental Illnesses, and Suicidal Thoughts or Actions).

Antidepressant Medication Guide and Patient Information for WELLBUTRIN XL
Antidepressant Medication Guide and Patient Information for WELLBUTRIN XL® (bupropion HCl extended-release tablets), is provided in Adobe's Portable Document Format (PDF). To view these documents you will need Adobe Acrobat Reader; if you do not have it, follow the link to download a copy.
Complete Prescribing Information for WELLBUTRIN XL® (bupropion HCl extended-release tablets).
Complete Prescribing Information for WELLBUTRIN XL® (bupropion HCl extended-release tablets), is provided in Adobe's Portable Document Format (PDF). To view these documents you will need Adobe Acrobat Reader; if you do not have it, follow the link to download a copy.
If you are unable to or do not wish to download Acrobat Reader, but still wish to receive complete Prescribing Information, please click here.

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