Hamilton Rating Scale for Depression

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Hamilton Rating Scale for Depression
Purposemeasures severity of depressive symptoms

The Hamilton Rating Scale for Depression (HRSD),[1] also called the Hamilton Depression Rating Scale (HDRS), sometimes also abbreviated as HAM-D, is a multiple-item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery.[2] Max Hamilton originally published the scale in 1960[3] and revised it in 1966,[4] 1967,[5] 1969,[6] and 1980.[7] The questionnaire is designed for adults and is used to rate the severity of their depression by probing mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms.

The HRSD has been criticized for use in clinical practice as it places more emphasis on insomnia than on feelings of hopelessness, self-destructive thoughts, suicidal cognitions and actions.[8] An antidepressant may show statistical efficacy even when thoughts of suicide increase but sleep is improved, or for that matter, an antidepressant that as a side effect increase sexual and gastrointestinal symptom ratings may register as being less effective in treating the depression itself than it actually is.[9] Hamilton maintained that his scale should not be used as a diagnostic instrument.[10]

The original 1960 version contained 17 items (HDRS-17), but four other questions not added to the total score were used to provide additional clinical information. Each item on the questionnaire is scored on a 3 or 5 point scale, depending on the item, and the total score is compared to the corresponding descriptor. Assessment time is about 20 minutes.


The patient is rated by a clinician on 17 to 29 items (depending on version) scored either on a 3-point or 5-point Likert-type scale. For the 17-item version, a score of 0–7 is considered to be normal while a score of 20 or higher (indicating at least moderate severity) is usually required for entry into a clinical trial.[11] Questions 18–20 may be recorded to give further information about the depression (such as whether diurnal variation or paranoid symptoms are present), but are not part of the scale. A structured interview guide for the questionnaire is available.[12]

Although Hamilton's original scale had 17 items, other versions included up to 29 items (HRSD-29).[13][14][15][16]

Unstructured versions of the HDRS provide general instructions for rating items, while structured versions may provide definitions and/or specific interview questions for use. Structured versions of the HDRS show more reliability than unstructured versions with informed use.[17]

Levels of depression[edit]

The National Institute for Health & Clinical Excellence of the UK established the levels of depression in relation to the 17 item HRSD compared with those suggested by the APA.[18]

APA 2000 (NIHCE 2019):

  • Not depressed: 0–7
  • Mild (subthreshold): 8–13
  • Moderate (mild): 14–18
  • Severe (moderate): 19–22
  • Very severe (severe): >23

Other scales[edit]

Other scales include the Montgomery-Åsberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), the Zung Self-Rating Depression Scale, the Wechsler Depression Rating Scale,[19] the Raskin Depression Rating Scale,[20] the Inventory of Depressive Symptomatology (IDS), the Quick Inventory of Depressive Symptomatology (QIDS),[21] and other questionnaires.[22][23]

See also[edit]


  1. ^ "the ham-d scale" (PDF). Retrieved 29 November 2012.
  2. ^ Hedlund JL, Viewig BW (1979). "The Hamilton rating scale for depression: a comprehensive review". Journal of Operational Psychiatry. 10: 149–165.
  3. ^ Hamilton M (1960). "A rating scale for depression". Journal of Neurology, Neurosurgery, and Psychiatry. 23 (1): 56–62. doi:10.1136/jnnp.23.1.56. PMC 495331. PMID 14399272.
  4. ^ Hamilton M (1966). "Assessment of change in psychiatric state by means of rating scales". Proceedings of the Royal Society of Medicine. 59 (Suppl 1): 10–13. PMC 1900655. PMID 5922401.
  5. ^ Hamilton M (1967). "Development of a rating scale for primary depressive illness". British Journal of Social and Clinical Psychology. 6 (4): 278–96. doi:10.1111/j.2044-8260.1967.tb00530.x. PMID 6080235.
  6. ^ Hamilton M (1969). "Standardised assessment and recording of depressive symptoms". Psychiatria, Neurologia, Neurochirurgia. 72 (2): 201–205. PMID 5792061.
  7. ^ Hamilton, M (1980). "Rating depressive patients". Journal of Clinical Psychiatry. 41 (12 Pt 2): 21–24. PMID 7440521.
  8. ^ Firestone, R.W., & Firestone, L.A. (1996). Firestone Assessment of Self-Destructive Thoughts Manual. San Antonio, TX: Psychological Corporation.
  9. ^ Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004). "The Hamilton Depression Rating Scale: has the gold standard become a lead weight?". American Journal of Psychiatry. 161 (12): 2163–77. doi:10.1176/appi.ajp.161.12.2163. PMID 15569884.
  10. ^ Berrios, G.E., & Bulbena, A. (1990). The Hamilton Depression Scale and the Numerical Description of the Symptoms of Depression. In Bech, P., & Coppen, A. (Eds.), The Hamilton Scales, Heidelberg: Springer, pp. 80–92
  11. ^ HDRS-17: Hamilton Depression Rating Scale (HDRS) at University of Florida, College of Medicine. Additional Questions Retrieved December 12, 2011.
  12. ^ Williams JB (1989). "A structured interview guide for the Hamilton Depression Rating Scale". Archives of General Psychiatry. 45 (8): 742–747. doi:10.1001/archpsyc.1988.01800320058007. PMID 3395203.
  13. ^ HRSD-7: 7-ITEM HAMILTON RATING SCALE FOR DEPRESSION: HAMD-7 Archived 2007-07-05 at the Wayback Machine in Official website of CANMAT: Canadian Network for Mood and Anxiety Treatments Archived 2008-06-24 at the Wayback Machine Accessed June 30, 2008, and McIntyre R, Kennedy S, Bagby RM, Bakish D (July 2002). "Assessing full remission". J Psychiatry Neurosci. 27 (4): 235–9. PMC 161657. PMID 12174732.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ HRSD-21: The Hamilton Rating Scale for Depression Archived 2007-11-20 at the Wayback Machine (to be administered by a health care professional) (presented as a service by GlaxoWellcome, February 1997) in UMass HealthNet: Consumer Health Resources for Massachusetts Residents: Official website of the Lamar Soutter Library, University of Massachusetts Medical School, Worcester, MA, 01655 USA Archived 2017-08-29 at the Wayback Machine . Retrieved June 27, 2008.
  15. ^ HRSD-24: Hamilton Depression Rating Scale - 24 item (to be completed by a trained clinician) in FOCUS ON ALZHEIMER'S DISEASE: MEDAFILE; Site constructed and maintained by J. Wesson Ashford, M.D., Ph.D., Stanford / VA Alzheimer's Center, Palo Alto VA Hospital, 3801 Miranda Way, Palo Alto, CA 94304 USA. Retrieved June 27, 2008.
  16. ^ HRSD-29: Williams JBW, Link MJ, Rosenthal NE, Terman M, Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (SIGHSAD). New York Psychiatric Institute, New York, 1988
  17. ^ Carrozzino, Danilo; Patierno, Chiara; Fava, Giovanni A.; Guidi, Jenny (2020-04-14). "The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions". Psychotherapy and Psychosomatics. 89 (3): 133–150. doi:10.1159/000506879. ISSN 1423-0348. PMID 32289809.
  19. ^ Wechsler H, Grosser GH, Busfield BL (October 1963). "Jr (1963) The depression rating scale: a quantitative approach to the assessment of depressive symptomatology". Archives of General Psychiatry. 9: 334–343. doi:10.1001/archpsyc.1963.01720160024003. PMID 14045262.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ^ Raskin A, Schulterbrandt J, Reatig N, McKeon JJ (1969). "Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives". Journal of Nervous and Mental Disease. 148 (1): 87–98. doi:10.1097/00005053-196901000-00010. PMID 5768895. S2CID 39730272.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  21. ^ Inventory of Depressive Symptomatology (IDS) & Quick Inventory of Depressive Symptomatology (QIDS) Archived 2007-06-26 at the Wayback Machine in IDS/QIDS: Instruments in English and Multiple Translations by the University of Pittsburgh Epidemiology Data Center, 2008. Retrieved June 27, 2008.
  22. ^ Psychiatric Rating Scales for Depression in www.neurotransmitter.net website by Shawn M. Thomas. Retrieved June 30, 2008.
  23. ^ Boyle GJ (1985). "Self report measures of depression: Some psychometric considerations". British Journal of Clinical Psychology. 24: 45–59. doi:10.1111/j.2044-8260.1985.tb01312.x. PMID 3971068. S2CID 27521019.

External links[edit]