Response key:
0 = Not at all  |  1 = several days  |  2 = more than half the days  |  3 = nearly every day  |  4 = every day

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things
0 1 2 3 4

Feeling down, depressed, or hopeless
0 1 2 3 4

Trouble falling or staying asleep, or sleeping too much
0 1 2 3 4

Feeling tired or having little energy
0 1 2 3 4

Poor appetite or overeating
0 1 2 3 4

Feeling bad about yourself—or that you are a failure or having let yourself or your family down
0 1 2 3 4

Trouble concentrating on things, such as reading the newspaper or watching television
0 1 2 3 4

Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual
0 1 2 3 4

Thoughts that you would be better off dead or of hurting yourself in some way
0 1 2 3 4

Total score: ______

If your score is a 10 or greater, we advise you to call our office and schedule a FREE consultation. Don’t wait. Contact us today!

*Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.