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D2i1109:1106
19/10/11
English
This questionnaire is designed to help you assess how much the lights are helping. It is based on the
standard tool used by doctors. Not everyone will have every symptom but your total score should go
down over the weeks. You might like to talk it over with your doctor or another person in your household.
Compared with when you are well, how have you felt during the past week?
0 = no different
I have been...
down and depressed
less interested in doing things
less interested in sex
less interested in eating
losing weight
difficulty getting to sleep
sleeping badly, waking at night
waking too early
feeling a failure
feeling that life is not worth living
tense, irritable, worried about things
convinced I'm ill, excessively worried about my health
thinking or speaking more slowly
fidgety, restless, can't keep still
feeling cut off from what's going on, as if in a dream
paranoid, suspicious
preoccupied, easily distracted
physically tired e.g. heavy limbs, headaches, aching
back/muscles
other physical symptoms e.g. stomach problems,
sweating, urinating frequently, dry mouth, cramp,
heart palpitations, hyperventilating
morning is worse than evening
evening is worse than morning
feeling unsociable, avoiding people
gaining weight
wanting to eat more than usual
ACTUALLY eating more than usual
craving sweet and starchy foods
sleeping too much, feeling more tired than I should be
worse in the afternoon or evening, then better at least
an hour before bedtime
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1 = a little bit
2 = somewhat
3 = quite a lot
DEPRESSION SYMPTOMS CHART
4 = definitely, badly
before
after
after
using the
1 week
2 weeks
light
Standard depression score
Supplemental depression score
TOTAL standard and supplemental score
after
after
3 weeks
4 weeks
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