Montgomery-Asberg Depression Rating Scale (MADRS) Score

MADRS Explained

The Montgomery-Asberg Depression Rating Scale (MADRS) was developed in 1979 by a multinational group of British and Swedish researchers to stratify the severity of depressive episodes in adults with suspected depression.

Compared to the Hamilton Rating Scale for Depression (HAM-D), the MADRS is more sensitive to changes brought on by antidepressants and other forms of treatment. Unlike the HAM-D, the

MADRS does not focus predominately on the somatic symptoms of depression, but addresses core mood symptoms such as sadness, tension, pessimistic thoughts, and suicidal thoughts.

The MADRS is a screening not a diagnosis tool so whilst it can supplement clinical assessment, it is not meant to diagnose depression. The scale has high interrater reliability which makes it useful in clinical and research.

The MARDS it is administrable to adults of 18 years and over and is rated based on a clinical interview with the patient. Nine of the items are based upon patient report, whilst the tenth is based upon observation by the administrator during the rating interview.

Each of the 10 items evaluates core symptoms of depression and has 4 defined scale steps (scored 0, 2, 4 and 6 points) and 3 in-between steps (scored 1, 3 and 5) denoted as “Worsening symptoms”.

1. Apparent sadness - Representing despondency, gloom and despair (more than just ordinary transient low spirits), reflected in speech, facial expression, and posture. Rate by depth and inability to brighten up.
2. Reported sadness - Representing reports of depressed mood, regardless of whether it is reflected in appearance or not. Includes low spirits, despondency or the feeling of being beyond help and without hope.
3. Inner tension - Representing feelings of ill-defined discomfort, edginess, inner turmoil, mental tension mounting to either panic, dread or anguish. Rate according to intensity, frequency, duration and the extent of reassurance called for.
4. Reduced sleep - Representing the experience of reduced duration or depth of sleep compared to the subject's own normal pattern when well.
5. Reduced appetite- Representing the feeling of a loss of appetite compared with when-well. Rate by loss of desire for food or the need to force oneself to eat.
6. Concentration difficulties - Representing difficulties in collecting one's thoughts mounting to an incapacitating lack of concentration. Rate according to intensity, frequency, and degree of incapacity produced.
7. Lassitude - Representing difficulty in getting started or slowness in initiating and performing everyday activities.
8. Inability to feel - Representing the subjective experience of reduced interest in the surroundings, or activities that normally give pleasure. The ability to react with adequate emotion to circumstances or people is reduced.
9. Pessimistic thought - Representing thoughts of guilt, inferiority, self-reproach, sinfulness, remorse and ruin.
10. Suicidal thoughts - Representing the feeling that life is not worth living, that a natural death would be welcome, suicidal thoughts, and preparations for suicide. Suicide attempts should not in themselves influence the rating.

MADRS Interpretation From Müller (2000)

The original study evaluated 54 English and 52 Swedish patients on a 65-item comprehensive psychopathology scale which resulted in identifying 17 commonly occurring symptoms in depressive illness.

Ratings on these 17 items for 64 patients participating in four antidepressant drug studies were refined to reach the 10 items which showed the largest changes with treatment and the highest correlation to overall change.

The correlation (on clinical assessments of severity of depression) for the MADRS was 0.71, slightly higher than for the Hamilton Rating Scale for Depression (0.65). Inter-rater reliability ranged in studies from 0.89 to 0.97 and intraclass coefficients fell between 0.66 and 0.82.

Schulte-van Maaren et al. found the sensitivity of the MADRS for detecting any depressive episode with a cutoff of ten points to be 0.95, with an AUC of 0.99.

References

Original reference

Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134:382-389.

Other references

Müller MJ, Szegedi A, Wetzel H, Benkert O. Moderate and severe depression. Gradations for the Montgomery-Asberg Depression Rating Scale. J Affect Disord. 2000; 60(2):137-40.

Müller-Thomsen T, Arlt S, Mann U, Mass R, Ganzer S. Detecting depression in Alzheimer's disease: evaluation of four different scales. Arch Clin Neuropsychol. 2005; 20(2):271-276.

Montgomery SA, Asberg M: Montgomery-Asberg depression rating scale, in Handbook of psychiatric measures. Washington, DC, APA, 2000, pp 531–33.

Schulte-van Maaren YW, Carlier IV, Zitman FG, et al. Reference values for major depression questionnaires: the Leiden Routine Outcome Monitoring Study. J Affect Disord. 2013; 149(1-3):342-9.