The goal of the current study is to see if there is any link between the amount of inflammation in your body and your ability to respond to anti-depressant medication coupled with an anti-inflammatory medication. Our study doctor believes that people with high levels of inflammation have a harder time getting well. This is an 6 week treatment study for people between 50 and 80 with and without depression. The study is different depending on whether you are currently depressed.
These questions are voluntary and confidential. Your responses will be stored in a secure online database called REDCAP. Do you consent to completing this screening online and having your responses and contact information stored in REDCAP?
* must provide value
Yes
No
Thank you for showing interest in our study. You have not consented to completing this survey online or having your responses stored in our secure database.
If yes..do you consent to us reviewing your electronic medical records associated with Penn Medicine
* must provide value
Yes
No
N/A- I do not have a medical record with Penn
Date of Birth:
* must provide value
Today M-D-Y
View equation First name:
* must provide value
Last name:
* must provide value
Primary phone number:
* must provide value
What is the best way to reach you?
Secondary phone number (optional):
What is the best time of day to reach you? You may select more than one option.
Please note that our research team's regular hours are 8:30am - 5:30pm.
How did you hear about our study?
* must provide value
iConnect Flyer/ Brochure Dr. Referral Craigslist VA Radio PATCO Penn Radnor Penn Data Store Social Media (Facebook, Instagram) Other
If you chose referral source option "other" please describe the resource in the space provided.
* must provide value
Male
Female
Transgender
Other
Are you right-handed?
* must provide value
Yes
No
Please note that you must be 18 years or older to participate in our research studies. Participants may be required to provide proof of date of birth (e.g., state issues ID, passport, etc.) during in person screening visit.
Have you been treated for depression in the last 5 years?
Yes
No
What depression treatment have you received in the last 5 years?
How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
What heart conditions do you have/had?
* must provide value
What breathing problems do you have/had?
* must provide value
What liver or kidney problems do you have/had?
* must provide value
What thyroid or hormone problems do you have/had?
* must provide value
What neurological disorders do you have/had?
* must provide value
What inflammatory disease(s) do you have/had?
* must provide value
What other medical disorder(s) do you have/had?
* must provide value
What psychiatric disorder(s) do you have/had? (including depression, bipolar disorder, anxiety, schizophrenia, etc)
* must provide value
Please provide date of diagnosis
What medication(s) are you allergic or sensitive to?
* must provide value
How many different medications are you CURRENTLY using?
* must provide value
Please note that we will need to know the names, dose, and frequency of all of your current medications before you can enroll in the study.
1st medication name:
* must provide value
example: 1 time a day
1st medication start date:
Today M-D-Y approximate start date is acceptable
2nd medication name:
* must provide value
example: 1 time a day
2nd medication start date:
Today M-D-Y approximate start date is acceptable
3rd medication name:
* must provide value
example: 1 time a day
3rd medication start date:
Today M-D-Y approximate start date is acceptable
4th medication name:
* must provide value
example: 1 time a day
4th medication start date:
Today M-D-Y approximate start date is acceptable
5th medication name:
* must provide value
example: 1 time a day
5th medication start date:
Today M-D-Y approximate start date is acceptable
6th medication name:
* must provide value
example: 1 time a day
6th medication start date:
Today M-D-Y approximate start date is acceptable
7th medication name:
* must provide value
example: 1 time a day
7th medication start date:
Today M-D-Y approximate start date is acceptable
8th medication name:
* must provide value
example: 1 time a day
8th medication start date:
Today M-D-Y approximate start date is acceptable
9th medication name:
* must provide value
example: 1 time a day
9th medication start date:
Today M-D-Y approximate start date is acceptable
Have you had any significant past surgeries, major illnesses, or hospitalizations that you have NOT already indicated?
Yes
No
Please describe what significant past surgeries, major illnesses, or hospitalizations you've had.
Have you ever had an MRI before?
Yes
No
Unsure
On what part of your body?
Do you have any metal in your body?
* must provide value
Yes
No
Unsure
Please briefly describe the metal in your body to the best of your ability (i.e., location, type, etc).
Do you have claustrophobia?
* must provide value
Yes
No
Unsure
On average, how often do you drink alcohol per week?
* must provide value
I never drink alcohol Less than once per week 1-2 times per week 3-4 times per week 5-6 times per week Daily
On a typical day that you drink alcohol, how many drinks do you have?
1-2 3-4 5-6 7 or more
Do you smoke or use tobacco?
Yes
No
In the LAST 6 months, have you used any recreational (aka street) drugs or gotten hooked on a prescribed medicine or taken a lot more of it than you were supposed to?
* must provide value
Yes
No
What recreational drugs/prescription medication have you used in the LAST 6 months?
Marijuana
Cocaine
Stimulants/Uppers (e.g., amphetamine, speed, meth, etc)
Opioids (e.g., heroin, codeine, oxycodone, morphine, etc.)
Hallucinogens (e.g., LSD or acid, mushrooms, MDMA or ecstasy, etc.)
PCP or Ketamine
Sedatives/Downers (e.g., Valium, roofies, Ambien, Ativan, Lunesta, etc.)
Other
How frequently do you use this drug?
Less than once per week 1-2 times per week 3-4 times per week 5-6 times per week Daily
How frequently do you use marijuana?
Less than once per week 1-2 times per week 3-4 times per week 5-6 times per week Daily
How frequently do you use cocaine?
Less than once per week 1-2 times per week 3-4 times per week 5-6 times per week Daily
How frequently do you use stimulants or uppers?
Less than once per week 1-2 times per week 3-4 times per week 5-6 times per week Daily
How frequently do you use opioids?
Less than once per week 1-2 times per week 3-4 times per week 5-6 times per week Daily
How frequently do you use hallucinogens?
Less than once per week 1-2 times per week 3-4 times per week 5-6 times per week Daily
Have you ever been treated for drug or alcohol abuse?
Yes
No
Please briefly describe.
Have you donated blood or plasma in the last 6 weeks?
Yes
No
Do you have any problems with blood draws?
Yes
No
Fear of needles? Difficulties getting blood drawn or fainting? Etc.
What are these problems with blood draws?
What is your height? (In inches)
Inches (Feet x 12 + inches = total inches) 5 ft = 60 inches; 6 ft = 72 inches
What is your approximate weight? (In pounds)
Have you ever participated in research in the past?
Yes
No
Are you currently participating in any other research studies?
Yes
No
Thank you for your interest!
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