Major Depressive Disorder Scale (MDD)
Please answer as honestly as you can.
Name
*
First Name
Last Name
Date Completed:
*
-
Month
-
Day
Year
Date
Email:
*
example@example.com
Over the past two weeks, how often have you been bothered by any of the following problems?
*
Not At All
Several Days
More Than Half The Days
Nearly Every Day
Little interest or pleasure in doing things
Feeling down depressed or hopeless
Trouble falling sleep, staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself – or that you’re a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
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
Thoughts that you would be better off dead or of hurting yourself in some way
If you checked off any problems, how difficult have those problems made it for you to do your work, take care of things at home, or get along with other people?
*
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
How many anti-depressant prescription medications do you currently take or have tried in the past?
*
0
1
2-4
5+
Not Sure
For Office Use Only
Submit
Should be Empty: