1. GENERAL INFORMATION
Gender ____________ Age __________________
Ethnicity ______________________
Sexual Orientation __________________
Religion ________________________
Annual Personal Income (approximate) ______________________
Occupation _________________________
Level of Education (please check one):
Did not complete high school ____
Completed High School ____
Diploma/Certificate after high school ____
University Undergraduate Degree ____
University Postgraduate Degree ____
2. THE PRESCRIBING PROCESS
In what year were you first prescribed anti-depressant medication? ________________
What is the name of your anti-depressant (if you know) ______________________
Who first suggested the idea of taking antidepressants? (please circle one)
Myself Relative Friend GP Psychiatrist Other (please say who)________
Who prescribed it ? (please circle one) GP Psychiatrist Other
What problem(s) did you think the anti-depressants were being prescribed for?
______________________________________________________________________________
Did the prescribing doctor say what problem(s) s/he thought you had that would be helped by taking anti-depressants? YES NO
If ‘Yes’ what did s/he say?
______________________________________________________________________________
In the two weeks before first being prescribed anti-depressants which, if any, of the following did you experience:
(Participants will be provided with boxes to tick)
(1) depressed mood most of the day, nearly every day
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
(3) significant weight loss when not dieting, or weight gain (e.g., a change of more than 5% of body weight in a month)
(4) insomnia or hypersomnia (sleeping too much) nearly every day
(5) psychomotor agitation (e.g. unintentional and purposeless motions, including pacing around a room, wringing one’s hands) or retardation (e.g. slowing down of thoughts and reduction of physical movements) nearly every day
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day
(9) recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Please describe any other experiences or problems that you were having, that are not described above, which led to you being prescribed antidepressants.
______________________________________________________________________________
In the two months before being prescribed anti-depressants did you experience a significant loss (eg. the death of a loved one, relationship break-up, loss of your job etc.) YES / NO
If YES, please briefly state the nature of your loss:
______________________________________________________________________________
Were you told what positive effects you could expect from taking the anti-depressants? Yes / No
If ‘Yes’ what positive effects were you told about?
______________________________________________________________________________
Did the prescribing doctor tell you how anti-depressants work? Yes / No
If yes, can you give a brief summary of what you were told?
______________________________________________________________________________
Did the prescribing doctor tell you how long you should take the anti-depressants for? YES NO
If ‘Yes’…
about a month ___
1 – 3 months ___
4 – 6 months ___
7 – 12 months ___
more than a year ___
the rest of your life ___
until you felt better ___
How would you describe your relationship with the doctor?
very satisfactory …. satisfactory …. not sure …. not satisfactory …. not at all satisfactory
How well do you think s/he understood your problem(s)?
A lot …. Quite a lot…. OK …. Not a lot …. Not at all
About how long did the doctor spend with you on the day s/he prescribed anti-depressants?
0 – 10 minutes ___
11 – 20 minutes ___
21 – 30 minutes ___
31 – 40 minutes ___
41 – 50 minutes ___
51 – 60 minutes ___
more than an hour ___
How well did the doctor inform you about possible side effects?
Very well Quite well A little Not at all
What possible side effects did the doctor tell you about?
____________________________________________________________________________
3. YOUR EXPERIENCE OF ANTIDEPRESSANTS
Did you take the anti-depressant? (please circle one) Yes No
If ‘No’ please state briefly why not
_____________________________________________________________________________
If ‘Yes’ for how long did you take the anti-depressant? ________________________
Are you still taking them? Yes No
If ‘No’ please say why not, by ticking one or more of the options below
I felt better so no longer needed them ___
I finished the amount prescribed to me ___
They didn’t work ___
They had unpleasant side-effects ___
Other (please state what)
____________________________________________
Overall, I have found anti-depressants: (Please circle one)
Very Helpful … Helpful …Had no effect … Harmful… Very Harmful
While taking anti-depressants I felt:
Much less depressed … A bit less depressed… The same ….. A bit more depressed… Much more depressed…
If your anti-depressant reduced your depression, how quickly did that happen
same day… next day… 2–7 days … 2nd week … 3rd week … 4th week … next month
While taking anti-depressants my quality of life was:
Greatly improved … Slightly improved…. Unchanged… Slightly worse … A lot worse
Please rate your level of depression for the following three time periods from
1 = not at all depressed to 10 = the most depressed I can imagine being
The year before taking anti-depressants ____
While taking anti-depressants ____
Since stopping anti-depressants ____ (leave blank if you are still taking them)
Which, if any, of the following side effects do you think you experienced as a result of taking the anti-depressants ?
Please rate as: 0 – not at all, 1 – mild, 2 – moderate, 3 – severe
Nausea _____
Diarrhea _____
Agitation _____
Headaches _____
Loss of sex drive _____
Erection difficulties _____
Failure to reach orgasm _____
Suicidality _____
Dry mouth _____
Drowsiness _____
Dizziness _____
Weight gain _____
Weight loss _____
Tremors _____
Feeling not like myself _____
Emotional numbing _____
Reduction in
positive feelings _____
Feeling aggressive or violent _____
Caring less about others _____
Addiction to the anti-depressants _____
Withdrawal effects after stopping taking the anti-depressants _____
Other (please state)
______________________________________________________ _____
Other (please state)
______________________________________________________ _____
Which, if any, of the following benefits did you experience as a result of your use of antidepressants?
Calmer ___
Better mood ___
Happier ___
Enjoyed self more ____
More active ____
Slept better ___
Ate better ____
More energy ___
Less anxiety ____
Less fear ____
Felt healthier ____
More confident ____
Better concentration ____
Able to work better ____
Got on better with others ____
Less headaches ___
Less physical discomfort ____
As the final question in this section, could you please complete this sentence or paragraph.
In my life, antidepressants have been …
___________________________________________________________