For at least the past two weeks, have you experienced:

1. feelings of sadness or depression most of the day for nearly every day?
Yes No

2. a loss of interest or pleasure in all or most activities each day?
Yes No

3. a significant loss of weight (without dieting) or a significant weight gain?
Yes No

4. a significant decrease or increase in your appetite nearly every day?
Yes No

5. difficulty sleeping or sleeping too much nearly every day?
Yes No

6. feeling restless or feeling dragged down most days?
Yes No

7. feeling fatigued with a loss of energy most days?
Yes No

8. feelings of guilt and/or worthlessness nearly every day?
Yes No

9. difficulties in concentrating or in making decisions?
Yes No

10. recurrent thoughts of death or thoughts of suicide?
Yes No

11. difficulties in meeting your obligations (work, school, relationships) because of your depression?
Yes No