From One Heart

Re-introducing Our Hearts as One

*What is your gender?
Male
Female
What is your age?
18-25
26-35
36-45
46-55
56-Older
Are or have you suffered with depression?
yes
no
in the last year
currently
Do you consider your depression chronic? (long lasting or recurrent)
yes
no
Are or have you been treated with anti-depressants?
yes
no
How long have you been treated with anti-depressants if yes to previoius question?
less than 1 year
More than 1 year
Have you been on more than one anti-depressant or required a dosage change?
yes
no
Do you feel you benefited from using anti-depressant medications?
yes
no

Who prescribed your anti-depressant medication?
Doctor (Primary)
Psychiatrist
Other
If taking anti-depressants, do you also utilize counseling in partnership for treatment?
yes
no
Was Psychotherapy (counseling) suggested in partnership with the anti-depressant medication?
yes
no
Were alternatives like exercise, diet, etc. mentioned to you, re: their aide with depression?
yes
no
Have you tried any of the following alternative treatment for depression?
exercise
diet change
homeopathic treatment
herbal treatment
over the counter suppliments
meditation
affirmation/prayer
counseling (professional or other)
Has your prescribing professional made mention to you "Placebo effect" in relation to anti-depressants?
yes
no
Was it explained to you how anti-depressants effect brain chemistry? (Both the negative and positive effects?)
yes
no
Is depression.....?
a defect
a defense
a result of
What do you believe depression to be?
A bio-chemical imbalance, only treatable with medication
An emotional/stress "drain" on the body resulting in bio-chemical imbalance
neither of the above
Would you consider learning more about the following for treatment of depression?
Meditation
Self discovery
Affirmations
Do you believe how we view ourselves and the world around us effects mood/behavior?
yes
no
Your level of stress on a daily basis
1 (minimal)
2
3
4
5
6
7
8
9
10 (maximum)
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