Hamilton Depression Rating Scale (HDRS or HAM-D)

Evaluates the severity of depression based on typical symptoms.

Refer to the text below the calculator for more information about the scale, its interpretation and usage.


The Hamilton Depression Rating Scale (HDRS), also known as the HAM-D is a widely used clinician-administered screening of severity depression.

The scale is also being used to measure the effectiveness of antidepressant medication in clinical trials.


HAM-D score Depression status
0 - 7 Normal
8 - 13 Mild depression
14 - 18 Moderate depression
19 - 22 Severe depression
≥ 23 Very severe depression

1

Depressed Mood

(Gloomy attitude, pessimism about the future, feeling of sadness, tendency to weep)
2

Feelings of Guilt

3

Suicide

4

Insomnia – Initial

(Difficulty falling asleep)
5

Insomnia – Middle

(Complains of being restless and disturbed during the night, waking at night)
6

Insomnia – Delayed

(Waking in early hours of the morning and unable to fall asleep again)
7

Work and Interests

(Absence from work after treatment or recovery may rate a lower score)
8

Retardation

(Slowness of thought, speech, and activity; apathy; stupor)
9

Agitation

(Restlessness associated with anxiety)
10

Anxiety – Psychic

11

Anxiety – Somatic

(Gastrointestinal, indigestion, cardiovascular, palpitation, headaches, respiratory, genito-urinary, etc.)
12

Somatic Symptoms – Gastrointestinal

(Loss of appetite, heavy feeling in abdomen, constipation)
13

Somatic Symptoms – General

(Heaviness in limbs, back or head; diffuse backache; loss of energy and fatiguability)
14

Genital Symptoms

(Loss of libido, menstrual disturbances)
15

Hypochondriasis

16

Weight Loss

17

Insight

(Insight must be interpreted in terms of patient’s understanding and background)
Note: The original HAM-D has 21 items, but its scoring is based only on the first 17. Refer to the text below the scale for the other 4 items.
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Hamilton Depression Rating Scale Explained

The Hamilton Depression Rating Scale (HDRS), also known as the HAM-D is a widely used clinician-administered screening of severity depression.

The scale is also being used to measure the effectiveness of antidepressant medication in clinical trials.

The original HAM-D has 21 items, but its scoring is based only on the sum of the responses to the first 17 items:

HAM-D score Depression status
0 - 7 Normal
8 - 13 Mild depression
14 - 18 Moderate depression
19 - 22 Severe depression
≥ 23 Very severe depression

The scale has shown a sensitivity of 86.4% and a specificity of 92.2%.

The author, Hamilton himself recommended, that for scoring the result, only the first 17 items of the HAM-D be used, since the last 4 symptoms (i.e., diurnal variation, depersonalization/derealization, paranoid and obsessional/compulsive symptoms) were either not considered part of the disease, or they were relatively uncommon, or did not have a sufficient relation to depression severity.

The remaining 4 items of the HAM-D are:

HAM-D items 18 - 21 Description Answer choices
18. Diurnal Variation Symptoms worse in morning or evening. Note which it is. No variation (0)
Mild variation; AM ( ) PM ( ) (1)
Severe variation; AM ( ) PM ( ) (2)
19. Depersonalization and Derealization Feelings of unreality, nihilistic ideas Absent (0)
Mild (1)
Moderate (2)
Severe (3)
Incapacitating (4)
20. Paranoid Symptoms Not with a depressive quality None (0)
Suspicious (1)
Ideas of reference (2)
Delusions of reference and persecution (3)
Hallucinations, persecutory (4)
21. Obsessional Symptoms Obsessive thoughts and compulsions against which the patient struggles Absent (0)
Mild (1)
Severe (2)

One of the criticisms of the scale is that it misses out on (DSM-IV) diagnostic criteria such as feelings of worthlessness and anhedonia, due to it being developed before the advent of the DSM-IV.

 

References

Original references

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23:56-62.

Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6(4):278–96.

Validation

Williams JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry 1988; 45(8):742–7.

Worboys M. The Hamilton Rating Scale for Depression: The making of a “gold standard” and the unmaking of a chronic illness, 1960–1980. Chronic Illness. 2013; 9(3):202-219. doi:10.1177/1742395312467658.

Sharp R. The Hamilton Rating Scale for Depression. Occup Med (Lond). 2015; 65(4):340.


Specialty: Psychiatry

Objective: Screening

Year Of Study: 1960

Abbreviation: HDRS / HAM-D

Article By: Denise Nedea

Published On: July 10, 2020

Last Checked: July 10, 2020

Next Review: July 10, 2025