Depression Self-Assessment Questionnaire

Welcome to the depression self-assessment questionnaire for Capital Clinical Research Associates (CCRA), a private clinical research center located in Rockville, MD. Our clinical research team is lead by Dr. Norman E. Rosenthal, CCRA's medical director and principle investigator, who supervises research and participant study-related care in each of our studies.

We are currently recruiting participants from 18 to 65 who are experiencing symptoms of depression to participate in a research study evaluating an investigational medication. Depression affects both men and women. Approximately 15% of the population will experience depression during their lifetime.

Some of the typical symptoms experienced by people with depression include low mood, sadness, loss of interest in usual activities, feelings of hopelessness, feelings of guilt, worthlessness or helplessness, irritability or restlessness, loss of energy or fatigue, difficulty concentrating and forgetfulness, changes in sleep such as insomnia or sleeping too much, changes in appetite (loss of appetite or overeating) and thoughts of suicide.

Although you will need a full screening by our medical staff to qualify for one of our depression studies, your answers to this questionnaire are important. Please take a moment to answer the following questions and tell us about yourself.

Please enter your zip code:
(Please note that all participants must be within driving distance of the Washington, DC Metro Area.)

How old are you?

What is your gender?

Female

Male

Symptoms

We’d like to know what symptoms of depression have caused you to visit our site. Please check any that may apply from the list below, and also feel free to add more in the comments section.

Sadness, guilt, loss of hope, or discouragement

Trouble concentrating, remembering things, or making decisions

Restlessness or irritability

Lack of energy, tired feeling

Trouble completing everyday duties and chores

Loss of interest in activities that were once enjoyable

Changes in weight

Pessimistic thoughts or a feeling of failure

Please feel free to use the space below to list additional symptoms, ask questions or tell us more about yourself.

Your Contact Information

We’d love to give you a call and further discuss our research programs. Please provide your best contact information below:

First Name:
Last Name:
Phone 1:
Phone 2:
Best time to reach you:
E-mail:
Image Verification:
 
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