0 Hamilton
Rating Scale
For
Depression
(HAM-D)
HAM-D was introduced and developed by Max Hamilton in 1960 to
monitor the severity of major depression, with a focus on somatic
symptomatology. The version in most common use has 17 items, although
versions with different numbers of items, including the 24-item version,
have been used in many studies as well. Items on the HAM-D are scored 0
to 2 or 0 to 4, with total scores on the 17-item version raging from 0 to 50:
scores of 7 or less may be considered normal; 8 to 13, mild; 14 to 18,
moderate; 19 to 22, severe; and 23 and above very severe. Ratings are
completed by the examiner on the basis of patient interview and
observations. This scale is now extended with 24 items and includes other
parameters like diurnal variation, paranoia and OCD etc. A structured
interview guide has been developed to improve reliability. The rating can
be completed in 15 to 20 minutes. Reliability is good to excellent, including
internal consistency and interrater assessments. Validity appears good
based on correlation with other depression symptom measures. The HAM-
D has been used extensively to evaluate change in response to
pharmacological and other interventions.
Hamilton Rating Scale for Depression Name :
For each item select the “cue”, which best characterizes the patient. Date :
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 nonverbally-ie, through facial expression, posture,
voice, and tendency to weep
4 Patient reports VIRTUALLY ONLY these feeling states in his spontaneous verbal
and nonverbal communication
2: Feeling 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 Feeling life is worth living
2 Wishes he were dead or any thoughts of possible death to self
3 Suicide 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 – ie, more than ¼ hour
2 Complains of nightly falling asleep
5: Insomnia middle
0 No difficulty
1 Patient complains of being restless and disturbed during the night
2 Walking during the night-any getting out of bed rates 2(expect for purpose of
voiding)
6: Insomnia late
0 No difficulty
1 Walking in early hours of the morning but back to sleep
2 Unable to fall asleep again if 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 to work)
3 Decrease in actual time spent in activities or decrease in productivity. In hospital,
rate 3 if patient does not spend at least three hours a day in activities (hospital job or
hobbies) exclusive of ward chores
4 Stopped working because of present illness. In hospital, rate 4 if patient engages
in no activities except ward chores, or if patient fails to perform ward chores
unassisted
8: Retardation (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 “Playing with “hands, hair, etc.
2 Hand-writing , nail biting, hair pulling, biting of lips
10: Anxiety psychic
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, such as: Gastrointestinal – Dry mouth, wind,
indigestion, diarrhea, cramps, belching. Cardiovascular – Palpitations, headaches.
Respiratory – Hyperventilation, sighing. Urinary frequency. Sweating)
0 Absent
1 Mild
2 Moderate
3 Severe
4 Incapacitating
12: Somatic symptoms gastrointestinal
0 None
1 Loss of appetite but eating without staff encouragement, Heavy feelings in abdomen
2 Difficulty eating without staff urging. Requests or requires laxatives or medication
for bowels or medication for G.I
3 Interview difficult
4 Complete stupor
13: Somatic symptoms general
0 None
1 Heaviness in Limbs, back or head. Backaches, headache, muscle aches. Loss of
energy and fatigability
2 Any clear cut symptom rates 2
14: General symptoms (Symptoms such as: Loss of libido, Menstrual disturbances)
0 Absent
1 Mild
2 Severe
15: Hypochondriasis
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
A: When rating by history
0 No weight loss
1 Probable weight loss associated with present illness
2 Definite (according to patient) weight loss
B: On weekly ratings by ward psychiatrist, when actual weight changes are
measured
0 Less than 1 1b weight loss in week
1 Greater than 1 lb weight loss in week
2 Greater than 2 lb in week
17: Insight
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
(If symptoms are worse in the morning or evening, note which it is and rate severity
of variation.)
AM PM
0 0 Absent
1 1 Mild
2 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 1
2 Suspiciousness
3 Ideas of reference
4 Delusions of reference and persecution
21: Obsessional and compulsive symptoms
0 Absent
1 Mild
2 Severe
22: Helplessness
0 Not present
1 Subjective feelings which are elicited only by inquiry
2 Patient volunteers his helpless feelings
3 Requires urging, guidance, and reassurance to accomplish ward chores or personal
hygiene
23: Hopelessness
0 Not present
1 Intermittently doubts that “things will improve” but can be reassured
2 Consistently feels “hopeless” but accepts reassurances
3 Expresses feelings of discouragement, despair, pessimism about future, which cannot
be dispelled
4 Spontaneously and inappropriately perseverates “I”ll never get well” or its
equivalent
24: Worthlessness (Ranges from mild loss of esteem feeling of inferiority, self-
depression to delusional notions of worthlessness
0 Not present
1 Indicates feelings of worthlessness(loss of self-esteem) only on questioning
2 Spontaneously indicates feelings of worthlessness (loss of self-esteem)
3 Different from 2 by degree. Patient volunteers that he is “no good”, “inferior”. Etc.
4 Delusional notions of worthlessness – ie, “I am a heap of garbage” or its
equivalent
