Hamilton Depression Rating Scale (HDRS)
Reference: Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;
23:56–62
Rating Clinician-rated
Administration time 20–30 minutes
Main purpose To assess severity of, and change in,
depressive symptoms
Population Adults
Commentary
The HDRS (also known as the Ham-D) is the most wide
ly used clinician-administered depression assessment scale.
The original version contains 17 items (HDRS17
) pertain
ing to symptoms of depression experienced over the past
week. Although the scale was designed for completion
after an unstructured clinical interview, there are now
semi-structured interview guides available. The HDRS
was originally developed for hospital inpatients, thus the
emphasis on melancholic and physical symptoms of
depression. A later 21-item version (HDRS21
) included 4
items intended to subtype the depression, but which are
sometimes, incorrectly, used to rate severity. A limitation
of the HDRS is that atypical symptoms of depression
(e.g., hypersomnia, hyperphagia) are not assessed (see
SIGH-SAD, page 55).
Scoring
Method for scoring varies by version. For the HDRS17
, a
score of 0–7 is generally accepted to be within the normal
Hamilton Depression Rating Scale (HDRS)
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.
Versions
The scale has been translated into a number of languages
including French, German, Italian, Thai, and Turkish. As
well, there is an Interactive Voice Response version (IVR),
a Seasonal Affective Disorder version (SIGH-SAD, see
page 55), and a Structured Interview Version (HDS-SIV).
Numerous versions with varying lengths include the
HDRS17, HDRS21, HDRS29, HDRS8, HDRS6,
HDRS24, and HDRS7 (see page 30).
Additional references
Hamilton M. Development of a rating scale for primary
depressive illness. Br J Soc Clin Psychol 1967;
6(4):278–96.
Williams JB. A structured interview guide for the
Hamilton Depression Rating Scale. Arch Gen Psychiatry
1988; 45(8):742–7.
Address for correspondence
The HDRS is in the public domain.
PLEASE COMPLETE THE SCALE BASED ON A STRUCTURED INTERVIEW
Instructions: for each item select the one “cue” which best characterizes the patient. Be sure to record the answers in the appropriate spaces
(positions 0 through 4).
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.
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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). 4 INSOMNIA: EARLY IN THE NIGHT 0 || No difficulty falling asleep.
1 || Complains of occasional difficulty falling asleep, i.e. more than 1⁄2 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 b) According to weekly patient: 0 || No weight loss.
1 || Probable weight loss associated with measurements: 0 || Less than 1 lb weight loss in
week.
1 || Greater than 1 lb weight loss in week. present illness. 2 || Definite (according 2 || Greater than 2 lb weight loss to patient) weight in week. loss. 3 || Not assessed.
17 INSIGHT
3 || Not assessed. 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.
Total score: |||
This scale is in the public domain.
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