{"id":7889,"date":"2020-08-25T14:29:23","date_gmt":"2020-08-25T14:29:23","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=7889"},"modified":"2026-01-07T20:40:49","modified_gmt":"2026-01-07T20:40:49","slug":"hamilton-depression-scale","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/hamilton-depression-scale\/","title":{"rendered":"Hamilton Depression Rating Scale (HAM-D)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>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.<!--more--><\/p>\n<p>Method for scoring varies by version. For the HDRS17, a score of 0\u20137 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.<\/p>\n<p><strong>Hamilton Depression Rating Scale (HAM-D)<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>1. DEPRESSED MOOD<\/strong> (sadness, hopeless, helpless, worthless)<\/span><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| Absent.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| These feeling states indicated only on questioning.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| These feeling states spontaneously reported verbally.<\/span><br \/>\n<span style=\"font-size: 8pt;\">3 |__| Communicates feeling states non-verbally, i.e. through facial expression, posture, voice and tendency to weep.<\/span><br \/>\n<span style=\"font-size: 8pt;\">4 |__| Patient reports virtually only these feeling states in his\/her spontaneous verbal and non-verbal communication.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><strong><span style=\"font-size: 8pt;\">2. FEELINGS OF GUILT<\/span><\/strong><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| Absent.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Self reproach, feels he\/she has let people down.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Ideas of guilt or rumination over past errors or sinful deeds.<\/span><br \/>\n<span style=\"font-size: 8pt;\">3 |__| Present illness is a punishment. Delusions of guilt.<\/span><br \/>\n<span style=\"font-size: 8pt;\">4 |__| Hears accusatory or denunciatory voices and\/or experiences threatening visual hallucinations.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><strong><span style=\"font-size: 8pt;\">3. SUICIDE<\/span><\/strong><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| Absent.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Feels life is not worth living.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Wishes he\/she were dead or any thoughts of possible death to self.<\/span><br \/>\n<span style=\"font-size: 8pt;\">3 |__| Ideas or gestures of suicide.<\/span><br \/>\n<span style=\"font-size: 8pt;\">4 |__| Attempts at suicide (any serious attempt rate 4).<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><strong><span style=\"font-size: 8pt;\">4. INSOMNIA: EARLY IN THE NIGHT<\/span><\/strong><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| No difficulty falling asleep.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Complains of occasional difficulty falling asleep, i.e. more than \u00bd <\/span><span style=\"font-size: 8pt;\">hour.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Complains of nightly difficulty falling asleep.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><strong><span style=\"font-size: 8pt;\">5. INSOMNIA: MIDDLE OF THE NIGHT<\/span><\/strong><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| No difficulty.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Patient complains of being restless and disturbed during the night.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Waking during the night \u2013 any getting out of bed rates <\/span><span style=\"font-size: 8pt;\">2 (except for purposes of voiding).<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><strong><span style=\"font-size: 8pt;\">6. INSOMNIA: EARLY HOURS OF THE MORNING<\/span><\/strong><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| No difficulty.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Waking in early hours of the morning but goes back to sleep.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Unable to fall asleep again if he\/she gets out of bed.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>7. WORK AND ACTIVITIES<\/strong><\/span><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| No difficulty.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Thoughts and feelings of incapacity, fatigue or weakness related to activities, work or hobbies.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Loss of interest in activity, hobbies or work \u2013 either directly reported by the patient or indirect in listlessness, indecision and vacillation (feels he\/she has to push self to work or activities).<\/span><br \/>\n<span style=\"font-size: 8pt;\">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.<\/span><br \/>\n<span style=\"font-size: 8pt;\">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.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>8. RETARDATION<\/strong> (slowness of thought and speech, impaired ability to concentrate, decreased motor activity)<\/span><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| Normal speech and thought.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Slight retardation during the interview.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Obvious retardation during the interview.<\/span><br \/>\n<span style=\"font-size: 8pt;\">3 |__| Interview difficult.<\/span><br \/>\n<span style=\"font-size: 8pt;\">4 |__| Complete stupor.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>9. AGITATION<\/strong><\/span><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| None.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Fidgetiness.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Playing with hands, hair, etc.<\/span><br \/>\n<span style=\"font-size: 8pt;\">3 |__| Moving about, can\u2019t sit still.<\/span><br \/>\n<span style=\"font-size: 8pt;\">4 |__| Hand wringing, nail biting, hair-pulling, biting of lips.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>10. ANXIETY PSYCHIC<\/strong><\/span><\/td>\n<td style=\"width: 66.6666%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| No difficulty.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Subjective tension and irritability.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Worrying about minor matters.<\/span><br \/>\n<span style=\"font-size: 8pt;\">3 |__| Apprehensive attitude apparent in face or speech.<\/span><br \/>\n<span style=\"font-size: 8pt;\">4 |__| Fears expressed without questioning.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>11. ANXIETY SOMATIC<\/strong> (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<\/span><\/td>\n<td style=\"width: 31.621%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| Absent.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Mild.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Moderate.<\/span><br \/>\n<span style=\"font-size: 8pt;\">3 |__| Severe.<\/span><br \/>\n<span style=\"font-size: 8pt;\">4 |__| Incapacitating.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>12. SOMATIC SYMPTOMS GASTRO-INTESTINAL<\/strong><\/span><\/td>\n<td style=\"width: 31.621%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| None.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Loss of appetite but eating without staff encouragement. Heavy feelings in abdomen.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Difficulty eating without staff urging. Requests or requires laxatives or medication for bowels or medication for gastro-intestinal symptoms<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>13. GENERAL SOMATIC SYMPTOMS<\/strong><\/span><\/td>\n<td style=\"width: 31.621%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| None.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Heaviness in limbs, back or head. Backaches, headaches, muscle aches. Loss of energy and fatigability.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Any clear-cut symptom rates 2.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>14. GENITAL SYMPTOMS<\/strong> (symptoms such as loss of libido, menstrual disturbances)<\/span><\/td>\n<td style=\"width: 31.621%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| Absent.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Mild.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Severe.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>15. HYPOCHONDRIASIS<\/strong><\/span><\/td>\n<td style=\"width: 31.621%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| Not present.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Self-absorption (bodily).<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Preoccupation with health.<\/span><br \/>\n<span style=\"font-size: 8pt;\">3 |__| Frequent complaints, requests for help, etc.<\/span><br \/>\n<span style=\"font-size: 8pt;\">4 |__| Hypochondriacal delusions.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>16. LOSS OF WEIGHT (RATE EITHER a OR b)<\/strong><\/span><\/td>\n<td style=\"width: 31.621%;\"><span style=\"font-size: 8pt;\">a) According to the patient:<\/span><br \/>\n<span style=\"font-size: 8pt;\">0 |__| No weight loss.\u00a0<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Probable weight <span style=\"font-size: 10.6667px;\">loss associated with\u00a0<span style=\"font-size: 10.6667px;\">present illness.<\/span><br \/>\n<\/span><\/span><span style=\"font-size: 8pt;\">2 |__| Definite (according <\/span><span style=\"font-size: 8pt;\"><span style=\"font-size: 10.6667px;\">to patient)\u00a0<\/span>weight loss.<br \/>\n<\/span><span style=\"font-size: 8pt;\">3 |__| Not assessed.\u00a0<\/span><\/td>\n<td style=\"width: 35.0456%;\"><span style=\"font-size: 10.6667px;\">b) According to weekly measurements:<br \/>\n<\/span><span style=\"font-size: 10.6667px;\">0 |__| Less than 1 lb (500 g) weight loss in week.<br \/>\n<\/span><span style=\"font-size: 10.6667px;\">1 |__| Greater than 1 lb (500 g) weight loss in week.<br \/>\n<\/span><span style=\"font-size: 10.6667px;\">2 |__| Greater than 2 lb (1 kg) weight loss in week.<br \/>\n<\/span><span style=\"font-size: 10.6667px;\">3 |__| Not assessed.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><strong style=\"font-size: 10.6667px;\">17. INSIGHT<\/strong><\/td>\n<td style=\"width: 31.621%;\" colspan=\"2\"><span style=\"font-size: 8pt;\">0 |__| Acknowledges being depressed and ill.<\/span><br \/>\n<span style=\"font-size: 8pt;\">1 |__| Acknowledges illness but attributes cause to bad food,<\/span><br \/>\n<span style=\"font-size: 8pt;\">climate, overwork, virus, need for rest, etc.<\/span><br \/>\n<span style=\"font-size: 8pt;\">2 |__| Denies being ill at all.<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.3333%;\"><span style=\"font-size: 8pt;\"><strong>Total score:<\/strong><\/span><\/td>\n<td style=\"width: 31.621%;\"><strong style=\"font-size: 10.6667px;\">|__|__|<\/strong><\/td>\n<td style=\"width: 35.0456%;\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>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. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27130960\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>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. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32289809\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Aug 21, 2020.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[76],"tags":[878,1258,452,2240,2239,464,457],"class_list":["post-7889","post","type-post","status-publish","format-standard","hentry","category-psychiatry","tag-depresion","tag-depression","tag-escala","tag-ham-d","tag-hamilton","tag-rating","tag-scale"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/7889","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=7889"}],"version-history":[{"count":18,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/7889\/revisions"}],"predecessor-version":[{"id":9405,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/7889\/revisions\/9405"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=7889"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=7889"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=7889"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}