Hamilton Depression Rating Scale (HDRS)

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

Rating Clinician-rated range (or in clinical remission), while a score of 20 or

higher (indicating at least moderate severity) is usually
Administration time 20–30 minutes
required for entry into a clinical trial.
Main purpose To assess severity of, and change in,
depressive symptoms
Versions
Population Adults
The scale has been translated into a number of languages
including French, German, Italian, Thai, and Turkish. As
Commentary well, there is an Interactive Voice Response version (IVR),
a Seasonal Affective Disorder version (SIGH-SAD, see
The HDRS (also known as the Ham-D) is the most wide-
page 55), and a Structured Interview Version (HDS-SIV).
ly used clinician-administered depression assessment scale.
Numerous versions with varying lengths include the
The original version contains 17 items (HDRS17) pertain-
HDRS17, HDRS21, HDRS29, HDRS8, HDRS6,
ing to symptoms of depression experienced over the past
HDRS24, and HDRS7 (see page 30).
week. Although the scale was designed for completion
after an unstructured clinical interview, there are now
semi-structured interview guides available. The HDRS
Additional references
was originally developed for hospital inpatients, thus the
emphasis on melancholic and physical symptoms of Hamilton M. Development of a rating scale for primary
depression. A later 21-item version (HDRS21) included 4 depressive illness. Br J Soc Clin Psychol 1967;
items intended to subtype the depression, but which are 6(4):278–96.
sometimes, incorrectly, used to rate severity. A limitation
Williams JB. A structured interview guide for the
of the HDRS is that atypical symptoms of depression
Hamilton Depression Rating Scale. Arch Gen Psychiatry
(e.g., hypersomnia, hyperphagia) are not assessed (see
1988; 45(8):742–7.
SIGH-SAD, page 55).

Address for correspondence

Scoring
The HDRS is in the public domain.
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)

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) 2 FEELINGS OF GUILT

0 |__| Absent. 0 |__| Absent.
1 |__| These feeling states indicated only on questioning. 1 |__| Self reproach, feels he/she has let people down.
2 |__| These feeling states spontaneously reported verbally. 2 |__| Ideas of guilt or rumination over past errors or sinful
3 |__| Communicates feeling states non-verbally, i.e. through deeds.
facial expression, posture, voice and tendency to weep. 3 |__| Present illness is a punishment. Delusions of guilt.
4 |__| Patient reports virtually only these feeling states in 4 |__| Hears accusatory or denunciatory voices and/or
his/her spontaneous verbal and non-verbal experiences threatening visual hallucinations.
communication.

28
3 SUICIDE 11 ANXIETY SOMATIC (physiological concomitants of
0 |__| Absent. anxiety) such as:
1 |__| Feels life is not worth living. gastro-intestinal – dry mouth, wind, indigestion, diarrhea,
2 |__| Wishes he/she were dead or any thoughts of possible cramps, belching
death to self. cardio-vascular – palpitations, headaches
3 |__| Ideas or gestures of suicide. respiratory – hyperventilation, sighing
4 |__| Attempts at suicide (any serious attempt rate 4). urinary frequency
sweating
4 INSOMNIA: EARLY IN THE NIGHT 0 |__| Absent.
0 |__| No difficulty falling asleep. 1 |__| Mild.
1 |__| Complains of occasional difficulty falling asleep, i.e. 2 |__| Moderate.
more than 1⁄2 hour. 3 |__| Severe.
2 |__| Complains of nightly difficulty falling asleep. 4 |__| Incapacitating.

5 INSOMNIA: MIDDLE OF THE NIGHT 12 SOMATIC SYMPTOMS GASTRO-INTESTINAL

0 |__| No difficulty. 0 |__| None.
1 |__| Patient complains of being restless and disturbed 1 |__| Loss of appetite but eating without staff
during the night. encouragement. Heavy feelings in abdomen.
2 |__| Waking during the night – any getting out of bed rates 2 |__| Difficulty eating without staff urging. Requests or
2 (except for purposes of voiding). requires laxatives or medication for bowels or
medication for gastro-intestinal symptoms.
6 INSOMNIA: EARLY HOURS OF THE MORNING
0 |__| No difficulty. 13 GENERAL SOMATIC SYMPTOMS
1 |__| Waking in early hours of the morning but goes back 0 |__| None.
to sleep. 1 |__| Heaviness in limbs, back or head. Backaches,
2 |__| Unable to fall asleep again if he/she gets out of bed. headaches, muscle aches. Loss of energy and
fatigability.
7 WORK AND ACTIVITIES 2 |__| Any clear-cut symptom rates 2.
0 |__| No difficulty.
1 |__| Thoughts and feelings of incapacity, fatigue or 14 GENITAL SYMPTOMS (symptoms such as loss of libido,
weakness related to activities, work or hobbies. menstrual disturbances)
2 |__| Loss of interest in activity, hobbies or work – either 0 |__| Absent.
directly reported by the patient or indirect in 1 |__| Mild.
listlessness, indecision and vacillation (feels he/she has 2 |__| Severe.
to push self to work or activities).
3 |__| Decrease in actual time spent in activities or decrease 15 HYPOCHONDRIASIS
in productivity. Rate 3 if the patient does not spend at 0 |__| Not present.
least three hours a day in activities (job or hobbies) 1 |__| Self-absorption (bodily).
excluding routine chores. 2 |__| Preoccupation with health.
4 |__| Stopped working because of present illness. Rate 4 if 3 |__| Frequent complaints, requests for help, etc.
patient engages in no activities except routine chores, 4 |__| Hypochondriacal delusions.
or if patient fails to perform routine chores unassisted.
16 LOSS OF WEIGHT (RATE EITHER a OR b)
8 RETARDATION (slowness of thought and speech, impaired a) According to the b) According to weekly
ability to concentrate, decreased motor activity) patient: measurements:
0 |__| Normal speech and thought. 0 |__| No weight loss. 0 |__| Less than 1 lb weight loss in
1 |__| Slight retardation during the interview. week.
2 |__| Obvious retardation during the interview. 1 |__| Probable weight 1 |__| Greater than 1 lb weight loss
3 |__| Interview difficult. loss associated with in week.
4 |__| Complete stupor. present illness.
2 |__| Definite (according 2 |__| Greater than 2 lb weight loss
9 AGITATION to patient) weight in week.
0 |__| None. loss.
1 |__| Fidgetiness. 3 |__| Not assessed. 3 |__| Not assessed.
2 |__| Playing with hands, hair, etc.
3 |__| Moving about, can’t sit still. 17 INSIGHT
4 |__| Hand wringing, nail biting, hair-pulling, biting of lips. 0 |__| Acknowledges being depressed and ill.
1 |__| Acknowledges illness but attributes cause to bad food,
10 ANXIETY PSYCHIC climate, overwork, virus, need for rest, etc.
0 |__| No difficulty. 2 |__| Denies being ill at all.
1 |__| Subjective tension and irritability.
2 |__| Worrying about minor matters. Total score: |__|__|
3 |__| Apprehensive attitude apparent in face or speech.
4 |__| Fears expressed without questioning.

This scale is in the public domain.

29