Hamilton Depression Rating Scale (HAM-D)

Stratifies severity of depression, similar to PHQ-9.

The original HAM-D has 21 items, but scoring is based only on the first 17.

Depressed mood

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

Feelings of guilt

Suicide

Initial insomnia

Difficulty falling asleep

Insomnia during the night

Restless, disturbed, waking at night

Delayed insomnia

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

Work and interests

Absence from work after treatment or recovery may rate <4

Retardation

Slowness of thought, speech, and activity; apathy; stupor

Agitation

Restlessness associated with anxiety

Psychiatric anxiety

Somatic anxiety

Gastrointestinal, indigestion, cardiovascular, palpitations, headaches, respiratory, genitourinary, etc.

Gastrointestinal somatic symptoms

Loss of appetite, heavy feeling in abdomen, constipation

General somatic symptoms

Heaviness in limbs, back, or head; diffuse backache; loss of energy and fatigability

Genital symptoms

Loss of libido, menstrual disturbances

Hypochondriasis

Weight loss

Insight

Must be interpreted in terms of patient’s understanding and background

Result:

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Advice

Higher scores indicate more severe depression and may warrant more aggressive treatment.
A response to treatment is typically defined by studies as a score decrease of >50%.
Remission is commonly defined to be a score ≤7.
Based on changes in HAM-D scores over time, adjust treatments (e.g., medications, psychotherapy) to optimize outcomes.
If scores do not improve as expected, consider revising the treatment plan or conducting additional diagnostic evaluations to rule out other underlying conditions.
Depression evaluations and management require clinical judgment; scores should be interpreted in the context of a comprehensive clinical assessment.

Instructions