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 |
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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 · 12:00 AM
Last Checked: July 10, 2020
Next Review: July 10, 2025