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. |
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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. |
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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). |
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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. |
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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). |
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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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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 |
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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. |
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14. GENITAL SYMPTOMS (symptoms such as loss of libido, menstrual disturbances) | 0 |__| Absent. 1 |__| Mild. 2 |__| Severe. |
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15. HYPOCHONDRIASIS | 0 |__| Not present. 1 |__| Self-absorption (bodily). 2 |__| Preoccupation with health. 3 |__| Frequent complaints, requests for help, etc. 4 |__| Hypochondriacal delusions. |
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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. |
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Total score: | |__|__| |
References:
- 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.