Hamilton Depression Rating Scale (HAM-D)

Hamilton Depression Rating Scale

1. DEPRESSED MOOD (sadness, hopeless, helpless, worthless)

Absent.

These feeling states indicated only on questioning.

These feeling states spontaneously reported verbally.

Communicates feeling states non-verbally (e.g., facial expression, posture, voice, weeping).

Patient reports virtually only these feeling states in spontaneous communication.

2. FEELINGS OF GUILT

Absent.

Self-reproach, feels they have let people down.

Ideas of guilt or rumination over past errors or sinful deeds.

Present illness is a punishment. Delusions of guilt.

Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations.

3. SUICIDE

Absent.

Feels life is not worth living.

Wishes they were dead or has thoughts of possible death to self.

Ideas or gestures of suicide.

Attempts at suicide (any serious attempt rates 4).

4. INSOMNIA: EARLY IN THE NIGHT

No difficulty falling asleep.

Complains of occasional difficulty falling asleep (i.e., more than 1/2 hour).

Complains of nightly difficulty falling asleep.

5. INSOMNIA: MIDDLE OF THE NIGHT

No difficulty.

Patient complains of being restless and disturbed during the night.

Waking during the night – any getting out of bed rates 2 (except for voiding).

6. INSOMNIA: EARLY HOURS OF THE MORNING

No difficulty.

Waking in early hours of the morning but goes back to sleep.

Unable to fall asleep again if they get out of bed.

7. WORK AND ACTIVITIES

No difficulty.

Thoughts and feelings of incapacity, fatigue, or weakness related to activities.

Loss of interest in activity, hobbies, or work.

Decrease in actual time spent in activities or decrease in productivity.

Stopped working because of present illness.

8. RETARDATION (slowness of thought and speech, impaired ability to concentrate, decreased motor activity)

9. AGITATION

10. ANXIETY PSYCHIC

No difficulty.

Subjective tension and irritability.

Worrying about minor matters.

Apprehensive attitude apparent in face or speech.

Fears expressed without questioning.

11. ANXIETY SOMATIC (physiological concomitants of anxiety)

12. SOMATIC SYMPTOMS GASTRO-INTESTINAL

None.

Loss of appetite but eating without staff encouragement. Heavy feelings in abdomen.

Difficulty eating without staff urging. Requires laxatives or medication for bowels or GI symptoms.

13. GENERAL SOMATIC SYMPTOMS

None.

Heaviness in limbs, back, or head. Backaches, headaches, muscle aches. Loss of energy and fatigability.

Any clear-cut symptom rates 2.

14. GENITAL SYMPTOMS (e.g., loss of libido, menstrual disturbances)

Absent.

Mild.

Severe.

15. HYPOCHONDRIASIS

16. LOSS OF WEIGHT

No weight loss.

Probable weight loss associated with present illness.

Definite (according to patient) weight loss.

17. INSIGHT

Acknowledges being depressed and ill.

Acknowledges illness but attributes cause to bad food, climate, overwork, virus, need for rest, etc.

Denies being ill at all.