Clinical Depression Screening

Please check the boxes that apply to you:

 Loss of interest or pleasure in activities once enjoyed
 Feelings of sadness and/or irritability
 Changes in weight or appetite
 Changes in sleeping pattern
 Feeling guilty
 Inability to concentrate, remember things, or make decisions
 Fatigue or loss of energy
 Restlessness or decreased activity noticed by others
 Feeling hopeless, or worthless
 Thoughts of suicide or death


If you checked five or more symptoms of depression and these symptoms have lasted more than two weeks, you may have clinical depression. Please talk to a mental health professional or your doctor about your alternatives (if you don’t have a provider, see the References and Supporting Research section for a place to start. In addition, learn more about addressing the underlying neurotransmitter imbalances that can often lead to depression.