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Depth

A retrospective Study in Indian patients with depression to assess clinical Profile and impact on quality of life (DEPTH STUDY)

BASIC DETAILS

Patient code (Do not write name here) *

Date *

Diagnosis : (Depression (As per ICD 10 criteria))

Demographics

Patient's Age (years) *

Gender *

Male Female

Height (in cm) *

Weight (in Kg) *

Any pre-existing comorbidity that may lead to depression ? *

Yes No

Family history of neurological disorders *

Yes No

Active Smoker *

Yes No

Triggering factors

Genetic predisposition *

Yes No

Hormonal changes *

Yes No

Chronic illness or pain *

Yes No

Stressful events *

Yes No

Substance abuse *

Yes No

Trauma or abuse *

Yes No

Social loneliness *

Yes No

Symptoms

Persistent sadness or low mood; and/or *

Yes No

Loss of interests or pleasure *

Yes No

Fatigue or low energy *

Yes No

Disturbed sleep *

Yes No

Poor concentration or indecisiveness *

Yes No

Low self-confidence *

Yes No

Poor or increased appetite *

Yes No

Suicidal thoughts or acts *

Yes No

Agitation or slowing of movements *

Yes No

Guilt or self-blame *

Yes No

Impact on quality of life

Is the quality of your sleep impacted? *

Yes No

Have you ever thought of committing Suicide? *

Yes No

Is your financial / social functioning hampered because of your current medical condition (depression)? *

Yes No

Has suffering with depression in any way hampered your work or academic performance? *

Yes No

Are you able to do your daily chores without any hassle? *

Yes No

Are you satisfied with your quality of life? *

Yes No

Treatment options *

	Drug Name	Dose (mg)	Frequency	Duration (weeks)
Cognitive Behavioral Therapy (CBT)
Counselling
Pharmacotherapy

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