NSTMS PHQ9/IDSSR Depression Assessments

Depression Assessments for

NeuroScience & TMS Treatment Centers
These depression assessments to help track your scores for progress. These assessments are helpful for monitoring your care, our care of you, and for insurance company prior authorization and evaluation of your progress.

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PHQ-9* Score
This will populate automatically after you complete the form in its entirety.
Q9 of PHQ9*
This will populate automatically after you complete the form in its entirety.
IDS-SR Score
Q18 of IDS-SR
Record your full name

First NameLast Name
Email address*
example@example.com
Are you currently receiving TMS or Spravato in the office?

YESNo - I don't know what treatment I will receive, or I am doing a consultNo - I am receiving other depression care
Which office do/did you receive your care?

Nashville Office - 2125 Belcourt AvenueEast Nashville Office - 3800 Gallatin Pk.Brentwood Office - 5300 Maryland WayFranklin Office - 381 Riverside Dr.I don't know as yet
Which clinician did you or will you see for your care?*

Q1. Over the last 7 days (1 week), how often have you been bothered by feeling down, depressed, sad, tearful, and/or hopeless*

Not at allUp to several daysHalf of the daysNearly everyday
Q2. Over the last 7 days (1 week), how often have you been bothered by trouble falling asleep, staying asleep, waking up too early, OR sleeping too much?*

Not at allUp to several daysHalf of the daysNearly everyday
Q3. Over the last 7 days (1 week), how often have you been bothered by little interest or pleasure in doing things?*

Not at allUp to several daysHalf of the daysNearly everyday
Q4. Over the last 7 days (1 week), how often have you been bothered by feeling worthless, hopeless, helpless, guilty, and/or like a failure?*

Not at allUp to several daysHalf of the daysNearly everyday
Q5. Over the last 7 days (1 week), how often have you been bothered by low energy, feeling tired, or fatigued?*

Not at allUp to several daysHalf of the daysNearly everyday
Q6. Over the last 7 days (1 week), how often have you been bothered by trouble with concentration (watching TV, reading, work) indecisiveness, and/or trouble maintaining focus?*

Not at allUp to several daysHalf of the daysNearly everyday
Q7. Over the last 7 days (1 week), how often have you been bothered by poor appetite or overeating?*

Not at allUp to several daysHalf of the daysNearly everyday
Q8. Over the last 7 days (1 week), how often have you been bothered by moving or speaking so slowly that other people couldhave noticed; OR, the opposite, feeling so fidgety or restless that you’ve been moving around more?*

Not at allUp to several daysHalf of the daysNearly everyday
Q9. Over the last 7 days (1 week), how often have you been bothered by thoughts that you would be better off dead or thoughts of hurting yourself in some way?*

Not at all1= Up to several days2- Half of the days3- Nearly everyday
Q10. If you had any symptoms above, how difficult has it been to do your work, take care of things at home, or get along with other people?*

Not at all difficultSomewhat difficultVery difficultExtremely Difficult
Here are some further questions about your mood

Choose the one response to each iteam which best describes you and your symptom for the the last 7 days
1. For the Last Seven (7) days describe your "Falling Asleep" symptom:*

I never take longer than 30 minutes to fall asleep.I take at least 30 minutes to fall asleep, less than half the time.I take at least 30 minutes to fall asleep, more than half the time.I take more than 60 minutes to fall asleep, more than half the time.
2. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Sleep During the Night*

I do not wake up at nightI have a restless, light sleep with a few brief awakenings each night.I wake up at least once a night, but I go back to sleep easily.I awaken more than once a night and stay awake for 20 minutes or more, more than half the time.
3. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Waking Up Too Early*

Most of the time, I awaken no more than 30 minutes before I need to get up.More than half the time, I awaken more than 30 minutes before I need to get up.I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually.I awaken at least one hour before I need to and can't go back to sleep.
4. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Sleeping Too Much*

I sleep no longer than 7-8 hours/night, without napping during the day;I sleep no longer than 10 hours in a 24-hour period including naps.I sleep no longer than 12 hours in a 24-hour period including naps.I sleep longer than 12 hours in a 24-hour period including naps.
5. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Feeling Sad*

I do not feel sadI feel sad less than half the time.I feel sad more than half the timeI feel sad nearly all of the time.
6. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Feeling Irritable*

I do not feel irritable.I feel irritable less than half the time.I feel irritable more than half the time.I feel extremely irritable nearly all of the time.
7. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Feeling anxious or tense.*

I do not feel anxious or tense.I feel anxious (tense) less than half the time.I feel anxious (tense) more than half the time.I feel extremely anxious (tense) nearly all of the time.
8. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Response of Your Mood to Good or Desired Events*

My mood brightens to a normal level which lasts for several hours when good events occur.My mood brightens, but I do not feel like my normal self when good events occur.My mood brightens only somewhat to a rather limited range of desired events.My mood does not brighten at all, even when very good or desired events occur in my life.
9. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Mood in relation to the time of day.*

There is no regular relationship between my mood and the time of day.My mood often relates to the time of day because of environmental events (e.g., being alone, working).In general, my mood is more related to the time of day than to environmental events.My mood is clearly and predictably better or worse at a particular time each day.
9A. Is your mood typically worse in the morning, afternoon, or night? (choose one)*

MorningAfternoonNight
9B. Is your mood variation attributed to the environment?*

YesNo
10. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: the Quality of Your Mood*

The mood (internal feelings) that I experience is very much a normal mood.My mood is sad, but this sadness is pretty much like the sad mood I would feel if someone close to me died or left.My mood is sad, but this sadness has a rather different quality to it than the sadness I would feel if someone close to me died or left.My mood is sad, but this sadness is different from the type of sadness associated with grief or loss.
11/12. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Appetite*

There is NO change in my usual appetite.I eat somewhat LESS often or lesser amounts of food than usual.I eat MUCH LESS than usual and only with personal effort.I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade me to eat.I feel a need to eat MORE frequently than usual.I regularly eat MORE often and/or greater amounts of food than usual.I feel driven to OVEREAT both at mealtime and between meals.
13/14. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Weight*

I have not had a change in my weight.I feel as if I've had a slight weight LOSS.I have LOST 2 pounds or more.I have LOST 5 pounds or more.I feel as if I've had a slight weight GAIN.I have GAINED 2 pounds or more.I have GAINED 5 pounds or more.
15. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Concentration/Decision Making*

There is no change in my usual capacity to concentrate or make decisions.I occasionally feel indecisive or find that my attention wanders.Most of the time, I struggle to focus my attention or to make decisions.I cannot concentrate well enough to read or cannot make even minor decisions.
16. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: View of Myself*

I see myself as equally worthwhile and deserving as other people.I am more self-blaming than usual.I largely believe that I cause problems for others.I think almost constantly about major and minor defects in myself.
17. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: View of My Future*

I have an optimistic view of my future.I am occasionally pessimistic about my future, but for the most part I believe things will get better.I'm pretty certain that my immediate future (1-2 months) does not hold much promise of good things for me.I see no hope of anything good happening to me anytime in the future.
18. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Thoughts of Death or Suicide*

0- I do not think of suicide or death.1- I feel that life is empty or wonder if it's worth living.2- I think of suicide or death several times a week for several minutes.3- I think of suicide or death several times a day in some detail, or I have made specific plans for suicide or have actually tried to take my
19. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: General Interest*

There is no change from usual in how interested I am in other people or activities.I notice that I am less interested in people or activities.I find I have interest in only one or two of my formerly pursued activities.I have virtually no interest in formerly pursued activities.
20. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Energy Level*

There is no change in my usual level of energy.I get tired more easily than usual.I have to make a big effort to start or finish my usual daily activities (for example, shopping, homework, cooking or going to work).I really cannot carry out most of my usual daily activities because I just don't have the energy.
21. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Capacity for Pleasure or Enjoyment (excluding sex)*

I enjoy pleasurable activities just as much as usual.I do not feel my usual sense of enjoyment from pleasurable activities.I rarely get a feeling of pleasure from any activity.I am unable to get any pleasure or enjoyment from anything.
22. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Interest in Sex (Please Rate Interest, not Activity):*

I'm just as interested in sex as usual.My interest in sex is somewhat less than usual or I do not get the same pleasure from sex as I used to.I have little desire for or rarely derive pleasure from sex.I have absolutely no interest in or derive no pleasure from sex.
23. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Feeling Slowed Down*

I think, speak, and move at my usual rate of speed.I find that my thinking is slowed down or my voice sounds dull or flat.It takes me several seconds to respond to most questions and I'm sure my thinking is slowed.I am often unable to respond to questions without extreme effort.
24. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Feeling Restless*

I do not feel restless.I'm often fidgety, wring my hands, or need to shift how I am sitting.I have impulses to move about and am quite restless.At times, I am unable to stay seated and need to pace around.
25. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Aches and Pains*

I don't have any feeling of heaviness in my arms or legs and don't have any aches or pains.Sometimes I get headaches or pains in my stomach, back or joints but these pains are only sometime present and they don't stop me from doing what I need to do.I have these sorts of pains most of the time.These pains are so bad they force me to stop what I am doing.
26. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Other bodily symptoms*

I don't have any of these symptoms: heart pounding fast, blurred vision, sweating, orhot and cold flashes, chest pain, heart turning over in my chest, ringing in my ears,shaking.I have some of these symptoms, but they are mild and present only sometimes.I have several of these symptoms and they bother me quite a bit.I have several of these symptoms and when they occur I have to stop doing whatever I am doing.
27. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Panic/ Phobic Symptoms*

I have no spells of panic or specific fears (phobia) (such as animals or heights).I have mild panic episodes or fears that do not usually change my behavior or stop me from functioning.I have significant panic episodes or fears that force me to change my behavior but do not stop me from functioning.I have panic episodes at least once a week or severe fears that stop me from carrying on my daily activities.
28. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Constipation/ diarrhea*

There is no change in my usual bowel habits.I have intermittent constipation or diarrhea which is mild.I have diarrhea or constipation most of the time, but it does not interfere with my day-to-day functioning.I have constipation or diarrhea for which I take medicine, or which interferes with - my day to-day activities.
29. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Interpersonal Sensitivity*

I have not felt easily rejected, slighted, criticized or hurt by others at all.I have occasionally felt rejected, slighted, criticized or hurt by others.I have often felt rejected, slighted, criticized or hurt by others, but these feelings have had only slight effects on my relationships or work.I have often felt rejected, slighted, criticized or hurt by others and these feelings have impaired my relationships and work.
30. Please choose the one response to each item that best describes you and your symptoms for the past 7 days: Leaden Paralysis/ Physical Energy*

I have not experienced the physical sensation of feeling weighted down and without physical energy.I have occasionally experienced periods of feeling physically weighted down and without physical energy, but without a negative effectI feel physically weighted down (without physical energy) more than half the time.I feel physically weighted down (without physical energy) most of the time, several hours per day, several days per week.
Should be Empty:

Here are some further questions about your mood