Hamilton depression scale (A sample)

In this sample, we will present the Hamilton depression scale, its versions, scoring, and a sample of the scale.

What is Hamilton Depression Scale?

HDRS (Hamilton depression rating scale) is a clinical manual developed in 1960 by Max Hamilton (University of Leeds, UK) to quantify the status of patients with depressive disorders before, during, and after treatment (observation of clinical dynamics).

In addition to its widespread use in clinical practice, this scale is also used in clinical trials, which are the standard for determining the effectiveness of drugs in depressive disorders.

It is filled by a clinician experienced in assessing mental health.

The Versions of the Scale

The scale has been translated into several languages, such as German, French, Italian, and Thai.

The scale has different versions, such as an Interactive Voice Response version (IVR), a Seasonal Affective Disorder Version (SIGH-SAD), and a Structured Interview Version (HDS-SIV).

Numerous versions with varying lengths include the HDRS17, HDRS21, HDRS29, HDRS8, HDRS6, HDRS24, and HDRS7. 

Scoring of the Hamilton Depression Scale (HAM-D-17)

Below is presented the scoring of Hamilton depression scale:

• 0 – 7 = Normal
• 8 – 13 = Mild Depression
• 14-18 = Moderate Depression
• 19 – 22 = Severe Depression
• > 23 = Very Severe Depression

A HAM-D-17 Sample

DEPRESSED MOOD

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

• 0 = Absent
• 1 = Sadness, etc.
• 2 = Occasional weeping
• 3 = Frequent weeping
• 4 = Extreme symptoms

FEELINGS OF GUILT

• 0 = Absent
• 1 = Self-reproach, feels he/she has let people down
• 2 = Ideas of guilt
• 3 = Present illness is a punishment; delusions of guilt
• 4 = Hallucinations of guilt

SUICIDE

• 0 = Absent
• 1 = Feels life is not worth living
• 2 = Wishes he/she were dead
• 3 = Suicidal ideas or gestures
• 4 = Attempts at suicide

INSOMNIA – Initial

           (Difficulty in falling asleep)

• 0 = Absent
• 1 = Occasional
• 2 = Frequent

INSOMNIA – Middle

(Complains of being restless and disturbed during the night. Waking during the night.)

• 0 = Absent
• 1 = Occasional
• 2 = Frequent

INSOMNIA – Delayed

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

• 0 = Absent
• 1 = Occasional
• 2 = Frequent

WORK AND INTERESTS

• 0 = No difficulty
• 1 = Feelings of incapacity, listlessness, indecision, and vacillation
• 2 = Loss of interest in hobbies, decreased social activities
• 3 = Productivity decreased
• 4 = Unable to work. Stopped working because of present illness only.  (Absence from work after treatment or recovery may rate a lower score).

RETARDATION

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

• 0 = Absent
• 1 = Slight retardation at interview
• 2 = Obvious retardation at interview
• 3 = Interview difficult
• 4 = Complete stupor

AGITATION

           (Restlessness associated with anxiety.)

• 0 = Absent
• 1 = Occasional
• 2 = Frequent

ANXIETY – PSYCHIC

• 0 = No difficulty
• 1 = Tension and irritability
• 2 = Worrying about minor matters
• 3 = Apprehensive attitude
• 4 = Fears

ANXIETY – SOMATIC

Gastrointestinal, indigestion Cardiovascular, palpitation, Headaches, Respiratory, Genitourinary, and others.

• 0 = Absent
• 1 = Mild
• 2 = Moderate
• 3 = Severe
• 4 = Incapacitating

SOMATIC SYMPTOMS – GASTROINTESTINAL

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

• 0 = Absent
• 1 = Mild
• 2 = Severe

SOMATIC SYMPTOMS – GENERAL

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

• 0 = Absent
• 1 = Mild
• 2 = Severe

GENITAL SYMPTOMS

           (Loss of libido, menstrual disturbances)

• 0 = Absent
• 1 = Mild
• 2 = Severe

HYPOCHONDRIASIS

• 0 = Not present
• 1 = Self-absorption (bodily)
• 2 = Preoccupation with health
• 3 = Querulous attitude
• 4 = Hypochondriacal delusions

WEIGHT LOSS

• 0 = No weight loss
• 1 = Slight
• 2 = Obvious or severe

INSIGHT

(Insight must be interpreted in terms of the patient’s understanding and background.)

• 0 = No loss
• 1 = Partial or doubtful loss
• 2 = Loss of insight 

DIURNAL VARIATION

                (Symptoms worse in morning or evening. Note which it is. )

• 0 = No variation
• 1 = Mild variation; AM ( ) PM ( )
• 2 = Severe variation; AM ( ) PM ( )

DEPERSONALIZATION AND DEREALIZATION

                (Feelings of unreality, nihilistic ideas)

• 0 = Absent
• 1 = Mild
• 2 = Moderate
• 3 = Severe
• 4 = Incapacitating

PARANOID SYMPTOMS

                (Not with a depressive quality)

• 0 = None
• 1 = Suspicious
• 2 = Ideas of reference
• 3 = Delusions of reference and persecution
• 4 = Hallucinations, persecutory

OBSESSIONAL SYMPTOMS

           (Obsessive thoughts and compulsions against which the patient struggles)

• 0 = Absent
• 1 = Mild
• 2 = Severe

Recommended books and sources

1. HDI — Hamilton Depression Inventory: A self-report version of the Hamilton Depression Rating Scale (HDRS): professional manual
2. HFNE “ADHD and Depression”
3. HFNE “Agitated Depression”
4. The Bech, Hamilton and Zung Scales for Mood Disorders: Screening and Listening: A Twenty Years Update concerning DSM-IV and ICD-10
5. The Hamilton Scales (Psychopharmacology Series)

Conclusion

Hamilton depression scale is a clinical manual developed in 1960 by Max Hamilton (University of Leeds, UK) to quantify the status of patients with depressive disorders before, during, and after treatment.

However, it is also used in clinical trials, which are the standard for determining the effectiveness of drugs in depressive disorders.

There are various versions of the scale. However, we presented the sample of HAM-D-17 with its scoring.

Please feel free to comment on the content or ask any questions in the comments section below.

References

1. Hamilton M. A rating scale for depression. J Neurosurg, Psychiatry. 1960;23:56–62.
2. Hamilton Rating Scale for Depression