Hamilton Depression Rating Scale (HAMD-17)

Hamilton Depression Rating Scale (HDRS)

The Hamilton Depression Rating Scale (HDRS) is a 29-item clinician-rated scale that is used to measure the severity of depression. It was developed by Max Hamilton in 1960 and is one of the most widely used measures of depression.

The HDRS assesses the following symptoms of depression:

  • Somatic (physical) symptoms, such as loss of appetite, weight loss, fatigue, and sleep disturbance
  • Affective (mood) symptoms, such as sadness, hopelessness, and worthlessness
  • Cognitive (thinking) symptoms, such as difficulty concentrating, indecisiveness, and suicidal thoughts
  • Behavioral symptoms, such as social withdrawal, loss of interest in activities, and psychomotor agitation or retardation

The HDRS is scored by summing the item scores. The total score can range from 0 to 54, with higher scores indicating a greater severity of depression.

The HDRS has been shown to be a reliable and valid measure of depression. It has good internal consistency, test-retest reliability, and discriminant validity.

The HDRS is used in a variety of settings, including clinical trials, research studies, and clinical practice. It can be used to diagnose depression, assess the severity of depression, monitor treatment response, and predict treatment outcome.

The HDRS has a few limitations. It is not a diagnostic tool and should not be used to diagnose depression. It is also not a comprehensive measure of depression and does not assess all symptoms of depression. Finally, it can be time-consuming to administer.

Overall, the HDRS is a useful tool for assessing the severity of depression. It is reliable and valid, and it is used in a variety of settings.


  • Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry, 23, 56-62.
  • Guy, W. (1976). ECDEU Assessment Manual for Psychoactive Drugs. Rockville, MD: National Institute of Mental Health.
  • Zimmerman, M., & Coryell, W. (1989). Diagnostic efficiency of the Hamilton Depression Rating Scale. Archives of General Psychiatry, 46, 796-804.

Additional Information

The HDRS is a valuable tool for assessing the severity of depression. It is reliable and valid, and it is used in a variety of settings. However, it is important to be aware of the limitations of the HDRS. It is not a diagnostic tool and should not be used to diagnose depression. It is also not a comprehensive measure of depression and does not assess all symptoms of depression. Finally, it can be time-consuming to administer.

If you are concerned that you or someone you know may be experiencing depression, it is important to seek professional help. A mental health professional can help you to assess your symptoms and develop a treatment plan.

Here are some additional information about the HDRS:

  • The HDRS is a clinician-rated scale, which means that it is administered by a trained mental health professional.
  • The HDRS is a self-report scale, which means that the patient completes the scale on their own.
  • The HDRS is a structured interview, which means that the clinician asks the patient a series of specific questions.
  • The HDRS is a semi-structured interview, which means that the clinician can ask additional questions to clarify the patient’s responses.
  • The HDRS is a dimensional scale, which means that it measures the severity of depression on a continuum.
  • The HDRS is a continuous scale, which means that it can be used to measure changes in the severity of depression over time.
  • The HDRS is a reliable scale, which means that it produces consistent results when it is administered to the same patient on different occasions.
  • The HDRS is a valid scale, which means that it measures what it is intended to measure.
  • The HDRS is a sensitive scale, which means that it can detect small changes in the severity of depression.
  • The HDRS is a specific scale, which means that it measures depression and not other conditions.
  • The HDRS is a clinically useful scale, which means that it can be used to diagnose depression, assess the severity of depression, monitor treatment response, and predict treatment outcome.

Hamilton Depression Rating Scale (HAMD-17)

1-     Depressed Mood (sadness‚ hopeless‚ helpless‚ worthless)
0.    Absent
1.    These feeling states indicated only on questioning
2.    These feeling states spontaneously reported verbally
3.    Communicates feeling states non-verbally – i.e.‚ through facial expression‚ posture‚ voice and tendency to weep
4.    Patient reports VIRTUALLY ONLY these feeling states in his spontaneous verbal and non-verbal communication
2-    Feelings of Guilt
0.    Absent.
1.    Self reproach‚ feels he has let people down
2.    Ideas of guilt or rumination over past errors or sinful deeds
3.    Present illness is a punishment. Delusions of guilt
4.    Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations
3-    Suicide
0.    Absent
1.    Feels life is not worth living
2.    Wishes he were dead or any thoughts of possible death to self
3.    Suicidal ideas or gesture
4.    Attempts at suicide (any serious attempt rates 4)
 4-    Insomnia Early
0.    No difficulty falling asleep
1.    Complains of occasional difficulty falling asleep – i.e.‚ more than 1/2 hour
2.    Complains of nightly difficulty falling asleep
 5-    Insomnia Middle
0.    No difficulty
1.    Patient complains of being restless and disturbed during the night
2.    Waking during the night – any getting out of bed rates 2 (except for purposes of voiding)
6-    Insomnia Late
0.    No difficulty
1.    Waking in early hours of the morning but goes back to sleep
2.    Unable to fall asleep again if he gets out of bed
7-    Work and Activities
0.    No difficulty
1.    Thoughts and feelings of incapacity‚ fatigue or weakness related to activities‚ work or hobbies
2.    Loss of interest in activity‚ hobbies or work – either directly reported by patient‚ or indirect in listlessness‚ indecision and vacillation (feels he has to push self to work oractivities)
3.    Decrease in actual time spent in activities or decrease in productivity
4.     Stopped working because of present illness
8-    Retardation: Psychomotor (slowness of thought and speech; impaired ability to concentrate; decreased motor activity)
0.    Normal speech and thought
1.    Slight retardation at interview
2.    Obvious retardation at interview
3.    Interview difficult
4.    Complete stupor
9-    Agitation
0.    None
1.    Fidgetiness
2.    Playing with hands‚ hair‚ etc.
3.    Moving about‚ can’t sit still.
4.    Hand wringing‚ nail biting‚ hair-pulling‚ biting of lips.
 10-Anxiety (psychological)
0.    No difficulty
1.    Subjective tension and irritability
2.    Worrying about minor matters
3.    Apprehensive attitude apparent in face or speech
4.    Fears expressed without questioning
11-Anxiety Somatic: Physiological concomitants of anxiety (i.e.‚ effects of autonomic over activity‚“butterflies‚” indigestion‚ stomach cramps‚ belching‚ diarrhea‚ palpitations‚ hyperventilation‚paresthesia‚ sweating‚ flushing‚ tremor‚ headache‚ urinary frequency). Avoid asking about possible medication side effects (i.e.‚ dry mouth‚ constipation)
0.    Absent
1.    Mild
2.    Moderate
3.    Severe
4.    Incapacitating
12-Somatic Symptoms (gastrointestinal)
0.    None.
1.    Loss of appetite but eating without encouragement from others. Food intake about normal
2.    Difficulty eating without urging from others. Marked reduction of appetite and food intake.
13-Somatic Symptoms General
0.    None
1.    Heaviness in limbs‚ back or head. Backaches‚ headache or muscle aches. Loss of energy and fatigability.
2.    Any clear-cut symptom rates “2”
14-Genital Symptoms (symptoms such as loss of libido; impaired sexual performance; menstrual disturbances)
0.    Absent
1.    Mild
2.    Severe
0.    Not present
1.    Self-absorption (bodily)
2.    Preoccupation with health
3.    Frequent complaints‚ requests for help‚ etc.
4.    Hypochondriacal delusions
16- Loss of Weight
0.    No weight loss
1.    Probable weight loss associated with present illness
2.    Definite (according to patient) weight loss
3.    Not assessed
0.    Acknowledges being depressed and ill
1.    Acknowledges illness but attributes cause to bad food‚ climate‚ overwork‚ virus‚ need for rest‚ etc.
2.    Denies being ill at all
18- Diurnal variation
0. None
1. Mild
2. Severe
19- Depersonalization and Derealization (such as: feeling of unreality; Nihilistic ideas)
0. Absent
1. Mild
2. Moderate
3. Severe
4. Incapacitating
20- Paranoid symptoms
0.    None
1.    Suspicious
2.    Ideas of reference
3.    Delusions of reference
21- Obsessional and Compulsive symptoms
0. Absent
1. Mild
2. Severe
18- Weight Gain
0.    No weight gain.
1.    Probable weight gain due to current depression.
2.    Definite (according to patient) weight gain due to depression.
19- Social Withdrawal
0.    Interacts with other people as usual.
1.    Less interested in socializing with others but continues to do so.
2.    Interacting less with other people in social (optional) situations.
3.    Interacting less with other people in work or family situations (i.e. where this is necessary).
4.    Marked withdrawal from others in family or work situations.
20- Appetite Increase
0.    No increase in appetite.
1.    Wants to eat a little more than usual.
2.    Wants to eat somewhat more than normal.
3.    Wants to eat much more than usual.
21- Increased Eating
0.    Is not eating more than usual.
1.    Is eating a little more than usual.
2.    Is eating somewhat more than usual.
3.    Is eating much more than normal.
22- Carbohydrate Craving
0.    No change in food preference or consumption.
1.    Craving or eating more carbohydrates (starches or sugars) than before.
2.    Craving or eating much more carbohydrates than before.
3.    Irresistible craving or eating of sweets or starches.
0.    No increase in sleep length.
1.    At least 1 hour increase in sleep length.
2.    2+ hour increase.
3.    3+ hour increase.
4.    4+ hour increase.
24- Fatigability
0.    Does not feel more fatigued than usual.
1.    Feels more fatigued than usual but this has not impaired function significantly; less frequent than in (2).
2.    More fatigued than usual; at least one hour a day; at least three days a week.
3.    Fatigued much of the time most days.
4.    Fatigued almost all the time.
This instrument can be found at: http://www.springer.com/978-1-58829-966-6
It is accepted by most clinicians that scores between 0 and 6 do not indicate the presence of depression‚ scores between 7 and 17 indicate mild depression‚ scores between 18 and 24 indicate moderate depression‚ and scores over 24 indicate severe depression.

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Hamilton M: Hamilton rating scale for Depression (Ham-D)‚ in Handbook of psychiatric measures. Washington DC‚ APA‚ 2000‚ pp 526–8

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