Major depressive disorder research study interest form

If you’re interested in participating in Rogers' research study for depression that takes place in Brown Deer or Oconomowoc, Wisconsin, please complete the form below. To participate, you must be between the ages of 18 and 65. You can be currently in therapy and/or on a stable dose of medication for 90 days. Participants cannot have bipolar disorder, schizophrenia or active substance abuse.

Please read the following questions:

1.)   For the last two weeks or more, have you experienced at least one of the following?

  • Little interest or pleasure in doing things.
  • Feeling down, depressed or hopeless.

2.)   If so, do you also struggle with some of these things?

  • Trouble falling asleep or sleeping too much.
  • Feeling tired or having little energy.
  • Poor appetite or overeating.
  • Feeling bad about yourself—or that you are a failure, or have let yourself or your family down.
  • Trouble concentrating on things, such as reading the newspaper or watching television.
  • Moving or speaking so slowly that other people could have noticed, or being so fidgety or restless that you have been moving around a lot more than usual.
  • Thoughts that you would be better off dead or hurting yourself.

If you answered YES to questions one and two, please provide the following information so we can contact you regarding your potential enrollment in our study. Your information will NOT be shared with anyone else without your permission, except as required by law. You may contact us directly at any time at 414-865-2600.


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