We’re listening

Your Name

First

Last

Your Email Address for Contact

Name One What

Phone

Your number will remain confidential. Contact will be made by text first.

Your Antidepressant Experience Story

Antidepressant

Important Data About Your Antidepressant Experience (timeline, side effects, withdrawal, benefits)

You can include timeline, side effects, how long it took to see the changes and how your life changed

Testimony You Are Willing To Share With Lawmakers

We are asking for this form to be filled out as BP has said they can't find the Adverse reactions people so we are going to help them. Our team will reach out to you with any questions. All will be anonymous unless you elect to be public.

Consent to Being Contacted About Your Responses and Sharing Stories and Data

I understand this form is collecting stories and data that may be shared in aggregate and/or as testimony to lawmakers in the future.
By submitting I consent to being contacted about my responses, including by phone call or text if I have provided my phone number.
I prefer that my story and data are shared anonymously.

Why were you started on antidepressants?

Choose

What was your experience?

Share your experience on how Antidepressants/SSRI/SNRI changed your life.

Informed Consent About Antidepressant Use

Yes, I was clearly informed about potential benefits, risks, withdrawal effects, and alternative options before starting or changing my antidepressant(s).
Partially, I received some information but important aspects (such as withdrawal difficulties, long-term effects, or alternative approaches) were not clearly explained.
No, I do not feel I was given meaningful informed consent about benefits, risks, withdrawal, or alternative options.

Were Loved Ones Informed or Involved

Yes, my loved ones or close supports were contacted or informed about possible changes to expect or monitor.
Partially, my loved ones received some information but not enough to understand what to expect or what to watch for.
No, my loved ones or close supports were not contacted or meaningfully informed about changes to expect or monitor.
Not applicable (I did not have or did not wish to involve loved ones).

In Memory of

To honor those we have lost due to Antidepressant Harm. Please include their name and year of loss.

Relationship to Loved One

For those who are leaving names in Memory Of

File Upload

Drag & Drop Files, Choose Files to Upload

Include any files you would like attached to your story.

What advice would you like to give?

Leave your best tips on tapering, special notes for your medical providers, biggest lessons. You can write whatever your heart desire. We appreciate sharing your experience so we can help others.