HAMILTON DEPRESSION RATING SCALE (HAM-D)
(To be administered by a health care professional)
Patient Name _________________________________________ Today’s Date __________________
The HAM-D is designed to rate the severity of depression in patients. Although it contains 21 areas‚ calculate the patient’s score on the first 17 answers.
1. 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
2. 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
3. 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
4. INSOMNIA - Initial
(Difficulty in falling asleep)
0 = Absent
1 = Occasional
2 = Frequent
5. INSOMNIA - Middle
(Complains of being restless and disturbed during the night. Waking during the night.)
0 = Absent
1 = Occasional
2 = Frequent
6. INSOMNIA - Delayed
(Waking in early hours of the morning and unable to fall asleep again)
0 = Absent
1 = Occasional
2 = Frequent
7. 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).
8. 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
9. AGITATION
(Restlessness associated with anxiety.)
0 = Absent
1 = Occasional
2 = Frequent
10. ANXIETY - PSYCHIC
0 = No difficulty
1 = Tension and irritability
2 = Worrying about minor matters
3 = Apprehensive attitude
4 = Fears
11. ANXIETY - SOMATIC
Gastrointestinal‚ indigestion Cardiovascular‚ palpitation‚ Headaches Respiratory‚ Genito-urinary‚ etc.
0 = Absent
1 = Mild
2 = Moderate
3 = Severe
4 = Incapacitating
12. SOMATIC SYMPTOMS - GASTROINTESTINAL
(Loss of appetite ‚ heavy feeling in abdomen; constipation)
0 = Absent
1 = Mild
2 = Severe
13. SOMATIC SYMPTOMS - GENERAL
(Heaviness in limbs‚ back or head; diffuse backache; loss of energy and fatiguability)
0 = Absent
1 = Mild
2 = Severe
14. GENITAL SYMPTOMS
(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 = Querulous attitude
4 = Hypochondriacal delusions
16. WEIGHT LOSS
0 = No weight loss
1 = Slight
2 = Obvious or severe
17. INSIGHT
(Insight must be interpreted in terms of patient’s understanding and background.)
0 = No loss
1 = Partial or doubtfull loss
2 = Loss of insight
TOTAL ITEMS 1 TO 17: _______________
0 - 7 = Normal
8 - 13 = Mild Depression
14-18 = Moderate Depression
19 - 22 = Severe Depression
> 23 = Very Severe Depression
18. 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 ( )
19. DEPERSONALIZATION AND DEREALIZATION
(feelings of unreality‚ nihilistic ideas)
0 = Absent
1 = Mild
2 = Moderate
3 = Severe
4 = Incapacitating
20. PARANOID SYMPTOMS
(Not with a depressive quality)
0 = None
1 = Suspicious
2 = Ideas of reference
3 = Delusions of reference and persecution
4 = Hallucinations‚ persecutory
21. OBSESSIONAL SYMPTOMS
(Obsessive thoughts and compulsions against
which the patient struggles)
0 = Absent
1 = Mild
2 = Severe
* Adapted from Hamilton‚ M. Journal of Neurology‚ Neurosurgery‚ and Psychiatry. 23:56-62‚ 1960.
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