During the past four weeks, have you had any of the problems or side effects listed below?

Unsteadiness Always or often Sometimes Rarely Never

Tiredness Always or often Sometimes Rarely Never

Restlessness Always or often Sometimes Rarely Never

Feelings of aggression Always or often Sometimes Rarely Never

Nervousness and/or anxious Always or often Sometimes Rarely Never

Headache Always or often Sometimes Rarely Never

Hair loss Always or often Sometimes Rarely Never

Problems with skin, i.e. acne, rash Always or often Sometimes Rarely Never

Double or blurred vision Always or often Sometimes Rarely Never

Upset stomach Always or often Sometimes Rarely Never

Difficulty in concentrating Always or often Sometimes Rarely Never

Trouble with mouth or gums Always or often Sometimes Rarely Never

Shaky hands Always or often Sometimes Rarely Never

Weight gain Always or often Sometimes Rarely Never

Dizziness Always or often Sometimes Rarely Never

Sleepiness Always or often Sometimes Rarely Never

Depression Always or often Sometimes Rarely Never

Memory Problems Always or often Sometimes Rarely Never

Disturbed Sleep Always or often Sometimes Rarely Never