Hamilton Rating Scale for Depression

The Hamilton Rating Scale for Depression (HRSD), also known as the Hamilton Depression Rating Scale (HDRS) or abbreviated to HAM-D, is a multiple choice questionnaire that clinicians may use to rate the severity of a patient's major depression.^[1] Max Hamilton originally published the scale in 1960^[2] and reviewed and evaluated it in 1966,^[3] 1967,^[4] 1969,^[5] and 1980.^[6] The questionnaire, which is designed for adult patients and is in the public domain, rates the severity of symptoms observed in depression such as low mood, insomnia, agitation, anxiety and weight loss. It is presently one of the most commonly used scales for rating depression in medical research.

Initially considered the "Gold Standard", there is increased criticism that it is flawed both as a test instrument and in its conceptual basis.^[7] It is also the case that users often disregard the constraints and instructions specified by Hamilton himself who was very clear about the fact that his scale could not be used as a diagnostic instrument.^[8]

The clinician must choose the possible responses to each question by interviewing the patient and by observing the patient's symptoms. Each question has between 3-5 possible responses which increase in severity. In the original scale published in 1960, the first 17 questions contribute to the total score (HRSD-17). Administration time is about 20-30 minutes. A score of 0-7 is considered to be normal, scores of 20 or higher indicate moderately severe depression and are usually required for entry into a clinical trial.^[9] Questions 18-21 may be recorded to give further information about the depression (such as whether diurnal variation or paranoid symptoms are present), but are not part of the scale. A structured interview guide for the questionnaire is available.^[10]

Although Hamilton's original scale had 17 questions, others later developed HRSD scales with different numbers of questions, the greatest of which is 29 (HRSD-29).^{[11][12][13][14]} Clinicians can use the HRSD in place of, or in conjunction with, the Montgomery-Åsberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), the Zung Self-Rating Depression Scale, the Wechsler Depression Rating Scale,^[15] the Raskin Depression Rating Scale,^[16] the Inventory of Depressive Symptomatology (IDS), the Quick Inventory of Depressive Symptomatology (QIDS),^[17] and other questionnaires.^[18]

Notes

See also

• Diagnostic classification and rating scales used in psychiatry
• Diagnostic and Statistical Manual of Mental Disorders
• List of psychology topics
• Receiver operating characteristic

External links

• The Hamilton Rating Scale for DepressionPDF (49.0 KB)
• Clinically Useful Psychiatric Scales: HAM-D (Hamilton Depression Rating Scale). Accessed March 6, 2009.
• Hamilton Depression Rating Scale - Original scientific paper published in 1960 in Psychiatry out of Print website. Accessed June 27, 2008.
• Commentary on the HRSD by Max Hamilton, July 10, 1981, in "This Week's Citation Classic", Current Contents 33: 325 (August 17, 1981), in website of Eugene Garfield, Ph.D.. Accessed June 27, 2008.
• Side-by-side comparison of the MADRS and the HDRS-24 in "Description of the Hamilton Depression Rating Scale (HAMD) and the Montgomery-Asberg Depression Rating Scale (MADRS) by the U.S. Food and Drug Administration, 2007. Accessed June 27, 2008.