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Patient {{$iPatientNo}}

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A multicentre, retrospective, observational survey study to analyse the role of Escitalopram in patients with depression and comorbid diabetes

Inclusion criteria:

Adult patients diagnosed with depression along with comorbid diabetes & prescribed Escitalopram as monotherapy or adjuvant therapy

DEMOGRAPHIC DATA

Initials*

Serial No.*

Age (yr) *

Weight (kgs)*

Gender *

Male Female

Marital status *

Single Married

Name of clinic/hospital*

Date of data collection*

DETAILS OF DIAGNOSIS AND TREATMENT

Comorbidities, if Yes

Conditions	YES or NO	Year	Months
Anxiety
Substance use disorder
Sleep disorders
Mention others if any

Place in therapy *

Use of Escitalopram in this patient as:

1^st line monotherapy As add-on

Daily Dose of Escitalopram*

5mg 10mg 15mg 20mg

Reasons for choosing Escitalopram*

Concomitant medication, if any

Sr. No	Generic Name	Route & Dose	Duration (months)
1
2
3
4
5

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