In the past TWO WEEK period:

1. Have you been feeling consistently depressed or down, most of the day, nearly every day?
No.
2. Have you been less interested in most things, or less able to enjoy the things you used to enjoy
most of the time?
No.
3. Has your appetite increased or decreased nearly every day? If yes, please specify.
No.
4. Has your weight increased or decreased (+-3kg in a month) without trying to change it
intentionally? If yes, please specify.
No.
5. Have you had trouble sleeping every night (e.g. sleeping more, less)?
No.
6. Have you talked or moved more slowly than normal, or have you been fidgety, restless and have
trouble sitting still?
No.
7. Have you felt tired and without energy almost every day?
No.
8. Have you felt worthless or guilty almost every day?
No.
9. Have you had difficulty concentrating or making decisions, almost every day?
No.
10. Have you repeatedly considered hurting yourself, felt suicidal, or wished you were dead?
No.
11. Has your ability to function socially or in an occupational capacity been affected?
No.
12. Has your mood been the result of either alcohol intake or the use of other substances? If so, can
you please indicate which substance and whether your mood symptoms occur without them?
No.
13. Do you use corticosteroids (e.g. asthma puffers)?
No.
14. Do you have any diagnosed medical conditions, including an insulin related (e.g. diabetes, insulin
resistance) or neurological (e.g. epilepsy) condition? If yes, please specify.
No.
15. Are you currently seeking treatment for depression? If so, for how long?
No.