Join a research study evaluating potential new investigational treatments for Depression
Clinical trial participants should:
Be between 18-65 years old
Have been experiencing a major depressive episode for at least a month
Participation overview:
Reimbursement for study-related expenses may be available to you
Study is supervised by trained doctors and medical staff
Study-related care and investigational medication are provided at no cost, no insurance is needed
Convenient study site near you with limited spots available
Get started – see if you prequalify
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Do you consent to the collection and processing of your personal data, including information about your race and ethnicity (as applicable), and your health information, including symptoms, diagnoses, medications, and treatments and our sharing of this information for the purpose of recruitment into clinical research studies, determining your eligibility for studies, and provision of other services you requested? You may withdraw your consent at any time by contacting us at
info@autocruitment.com
. Please note that your revocation will not impact any records or health data already collected, disclosed, or processed based on your consent. *
Yes
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First Name *
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Last Name *
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Phone Number *
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Email *
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Date of Birth MM/DD/YYYY *
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Zip Code *
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Are you Male or Female? *
Please select one...
Female
Male
Prefer not to say
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Have you been diagnosed
by a doctor
with Major Depressive Disorder (MDD)? *
Please select one...
Yes
No
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Are you currently experiencing any of the following symptoms of depression? *
Please select all that apply…
Persistent feeling of sadness or emptiness
Loss of interest in things I normally enjoy
Lack of sleep or too much sleep
Lack of energy
Lack of concentration or poor memory
Agitation / outburst / frustration
None of the above
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Did your
current
depressive episode start
more than 4 weeks ago
? *
Please note: A depressive episode is a period of two weeks or longer in which a person experiences certain symptoms of major depression: feelings of sadness and hopelessness, fatigue, weight gain or weight loss, changes in sleeping habits, loss of interest in activities, or thoughts of suicide.
Please select one...
Yes – More than 4 weeks ago
No
Unsure
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Within the past 12 months, have you tried 2 different antidepressant medications for at least 6 weeks? *
Please note: "2 courses of antidepressants" refers to trying two different antidepressant medications, each for at least 6 weeks.
Please select one…
Yes
No
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Were the 2 courses of antidepressant medications taken for your
current
depressive episode? *
Please select one…
Yes
No
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In the past 12 months, have you been diagnosed by a doctor with a personality disorder? *
Examples of personality disorders are: Borderline personality disorder, antisocial personality disorder, avoidant personality disorder, paranoid personality disorder, schizoid personality disorder.
Please select one…
Yes
No
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Have you
ever been diagnosed
by a doctor with any of the following psychiatric disorders? *
Select all that apply.
Bipolar disorder
Obsessive-compulsive disorder (OCD)
Schizophrenia
Post-traumatic Stress Disorder (PTSD)
Alcohol or substance use disorder
None of the above
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In the past 3 years, have you been diagnosed by a doctor with anorexia nervosa, bulimia nervosa, or binge eating? *
Please select one...
Yes
No
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Have you been diagnosed
(by a doctor)
with any other medical conditions? *
(For example: Uncontrolled diabetes mellitus, acute stress disorder, adjustment disorder, impulse control disorder, cancer, kidney disease, liver disease, unstable coronary artery disease, COPD, seizures, epilepsy, substance use disorder, suicidal ideation, seizure, skull fracture, cerebral contusion, cerebral hemorrhage)
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.
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Have you ever received treatment with Electroconvulsive Therapy (ECT), vagus nerve stimulation, or transcranial magnetic stimulation (TMS) for your depression? *
Please select one…
Yes
No
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Have you received ketamine or esketamine (e.g. SPRAVATO®) treatment within the past 2 years, or Salvinorin A within the last 6 months? *
Salvinorin A is a hallucinogen that may cause symptoms of hallucinations and dissociation.
Please select one...
Yes
No
Unsure
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Are you willing to avoid marijuana, CBD oil, and other cannabinoid use for the duration of the study? *
Please select one...
Yes
No
Unsure - I would like to discuss this further
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Please, select your height from the dropdown below. *
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How much do you weigh in Lbs (pounds)? *
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If female, are you currently pregnant, breastfeeding, or planning to become pregnant? *
Please select one...
Yes
No
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Which racial or ethnic group(s) do you identify with? *
Please select all that apply.
American Indian or Alaskan Native
Asian
Black or African American
Hispanic Latino or Spanish
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Another race or ethnicity
I prefer not to answer
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What is the best day/time to reach you via telephone (we know you are busy)? *
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. By providing your phone number and clicking “Submit” below, you consent to receive messages, including SMS/MMS text messages, sent by or on behalf of AutoCruitment, with information about research studies for which you may be eligible. By clicking Submit, you also agree to our
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