The HDRS (also known as the Ham-D) is the most widely used clinician-administered depression assessment scale. The original version contains 17 items (HDRS17) pertaining to symptoms of depression experienced over the past week.
Method for scoring varies by version. For the HDRS17, a score of 0–7 is generally accepted to be within the normal range (or in clinical remission), while a score of 20 or higher (indicating at least moderate severity) is usually required for entry into a clinical trial.
Hamilton Depression Rating Scale (HAM-D)
|1. DEPRESSED MOOD (sadness, hopeless, helpless, worthless)||0 |__| Absent.
1 |__| These feeling states indicated only on questioning.
2 |__| These feeling states spontaneously reported verbally.
3 |__| Communicates feeling states non-verbally, i.e. through facial expression, posture, voice and tendency to weep.
4 |__| Patient reports virtually only these feeling states in his/her spontaneous verbal and non-verbal communication.
|2. FEELINGS OF GUILT||0 |__| Absent.
1 |__| Self reproach, feels he/she has let people down.
2 |__| Ideas of guilt or rumination over past errors or sinful deeds.
3 |__| Present illness is a punishment. Delusions of guilt.
4 |__| Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations.
|3. SUICIDE||0 |__| Absent.
1 |__| Feels life is not worth living.
2 |__| Wishes he/she were dead or any thoughts of possible death to self.
3 |__| Ideas or gestures of suicide.
4 |__| Attempts at suicide (any serious attempt rate 4).
|4. INSOMNIA: EARLY IN THE NIGHT||0 |__| No difficulty falling asleep.
1 |__| Complains of occasional difficulty falling asleep, i.e. more than ½ hour.
2 |__| Complains of nightly difficulty falling asleep.
|5. INSOMNIA: MIDDLE OF THE NIGHT||0 |__| No difficulty.
1 |__| Patient complains of being restless and disturbed during the night.
2 |__| Waking during the night – any getting out of bed rates 2 (except for purposes of voiding).
|6. INSOMNIA: EARLY HOURS OF THE MORNING||0 |__| No difficulty.
1 |__| Waking in early hours of the morning but goes back to sleep.
2 |__| Unable to fall asleep again if he/she gets out of bed.
|7. WORK AND ACTIVITIES||0 |__| No difficulty.
1 |__| Thoughts and feelings of incapacity, fatigue or weakness related to activities, work or hobbies.
2 |__| Loss of interest in activity, hobbies or work – either directly reported by the patient or indirect in listlessness, indecision and vacillation (feels he/she has to push self to work or activities).
3 |__| Decrease in actual time spent in activities or decrease in productivity. Rate 3 if the patient does not spend at least three hours a day in activities (job or hobbies) excluding routine chores.
4 |__| Stopped working because of present illness. Rate 4 if patient engages in no activities except routine chores, or if patient fails to perform routine chores unassisted.
|8. RETARDATION (slowness of thought and speech, impaired ability to concentrate, decreased motor activity)||0 |__| Normal speech and thought.
1 |__| Slight retardation during the interview.
2 |__| Obvious retardation during the interview.
3 |__| Interview difficult.
4 |__| Complete stupor.
|9. AGITATION||0 |__| None.
1 |__| Fidgetiness.
2 |__| Playing with hands, hair, etc.
3 |__| Moving about, can’t sit still.
4 |__| Hand wringing, nail biting, hair-pulling, biting of lips.
|10. ANXIETY PSYCHIC||0 |__| No difficulty.
1 |__| Subjective tension and irritability.
2 |__| Worrying about minor matters.
3 |__| Apprehensive attitude apparent in face or speech.
4 |__| Fears expressed without questioning.
|11. ANXIETY SOMATIC (physiological concomitants of anxiety) such as: gastro-intestinal (dry mouth, wind, indigestion, diarrhea, cramps, belching), cardio-vascular (palpitations, headaches), respiratory (hyperventilation, sighing), urinary, frequency sweating||0 |__| Absent.
1 |__| Mild.
2 |__| Moderate.
3 |__| Severe.
4 |__| Incapacitating.
|12. SOMATIC SYMPTOMS GASTRO-INTESTINAL||0 |__| None.
1 |__| Loss of appetite but eating without staff encouragement. Heavy feelings in abdomen.
2 |__| Difficulty eating without staff urging. Requests or requires laxatives or medication for bowels or medication for gastro-intestinal symptoms
|13. GENERAL SOMATIC SYMPTOMS||0 |__| None.
1 |__| Heaviness in limbs, back or head. Backaches, headaches, muscle aches. Loss of energy and fatigability.
2 |__| Any clear-cut symptom rates 2.
|14. GENITAL SYMPTOMS (symptoms such as loss of libido, menstrual disturbances)||0 |__| Absent.
1 |__| Mild.
2 |__| Severe.
|15. HYPOCHONDRIASIS||0 |__| Not present.
1 |__| Self-absorption (bodily).
2 |__| Preoccupation with health.
3 |__| Frequent complaints, requests for help, etc.
4 |__| Hypochondriacal delusions.
|16. LOSS OF WEIGHT (RATE EITHER a OR b)||a) According to the patient:
0 |__| No weight loss.
1 |__| Probable weight loss associated with present illness.
2 |__| Definite (according to patient) weight loss.
3 |__| Not assessed.
|b) According to weekly measurements:
0 |__| Less than 1 lb (500 g) weight loss in week.
1 |__| Greater than 1 lb (500 g) weight loss in week.
2 |__| Greater than 2 lb (1 kg) weight loss in week.
3 |__| Not assessed.
|17. INSIGHT||0 |__| Acknowledges being depressed and ill.
1 |__| Acknowledges illness but attributes cause to bad food,
climate, overwork, virus, need for rest, etc.
2 |__| Denies being ill at all.
- Rohan KJ, Rough JN, Evans M, et al. A protocol for the Hamilton Rating Scale for Depression: Item scoring rules, Rater training, and outcome accuracy with data on its application in a clinical trial. J Affect Disord. 2016;200:111-118. [Medline]
- Carrozzino D, Patierno C, Fava GA, Guidi J. The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions. Psychother Psychosom. 2020;89(3):133-150. [Medline]
Created Aug 21, 2020.