THE HAMILTON RATING SCALE FOR DEPRESSION
(to be administered by a health care professional)

Patient’s Name
Date of Assessment
To rate the severity of depression in patients who are already diagnosed as depressed, administer this questionnaire. The higher the score, the more severe the depression.
For each item, write the correct number on the line next to the item. (Only one response per item)
1.

DEPRESSED MOOD (Sadness, hopeless, helpless, worthless)
0=
1=
2=
3=

Absent
These feeling states indicated only on questioning
These feeling states spontaneously reported verbally
Communicates feeling states non-verbally—i.e., 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.

FEELINGS OF GUILT
0=
1=
2=
3=
4=

3.

SUICIDE
0=
1=
2=
3=
4=

4.

Absent
Self reproach, feels he has 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 Absent
Feels life is not worth living
Wishes he were dead or any thoughts of possible death to self
Suicidal ideas or gesture
Attempts at suicide (any serious attempt rates 4)

INSOMNIA EARLY
0= No difficulty falling asleep
1= Complains of occasional difficulty falling asleep —i.e., more than 1/2 hour
2= Complains of nightly difficulty falling asleep

5.

INSOMNIA MIDDLE
0= No difficulty
1= Patient complains of being restless and disturbed during the night
2= Waking during the night—any getting out of bed rates 2 (except for purposes of voiding)

Adapted from Hedlung and Vieweg, The Hamilton rating scale for depression, Journal of Operational Psychiatry, 1979;10(2):149-165.

6.

INSOMNIA LATE
0= No difficulty
1= Waking in early hours of the morning but goes back to sleep
2= Unable to fall asleep again if he 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 self to work or activities) 3= Decrease in actual time spent in activities or decrease in productivity
4= Stopped working because of present illness

8.

RETARDATION: PSYCHOMOTOR (Slowness of thought and speech; impaired ability to concentrate; decreased motor activity)
0=
1=
2=
3=
4=

9.

Normal speech and thought
Slight retardation at interview
Obvious retardation at interview
Interview difficult
Complete stupor

AGITATION
0=
1=
2=
3=
4=

None
Fidgetiness
Playing with hands, hair, etc.
Moving about, can’t sit still
Hand wringing, nail biting, hair-pulling, biting of lips

10. ANXIETY (PSYCHOLOGICAL)
0=
1=
2=
3=
4=

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, (i.e., effects of autonomic overactivity, “butterflies,” indigestion, stomach cramps, belching, diarrhea, palpitations, hyperventilation, paresthesia, sweating, flushing, tremor, headache, urinary frequency).
Avoid asking about possible medication side effects (i.e., dry mouth, constipation)
0=
1=
2=
3=
4=

Absent
Mild
Moderate
Severe
Incapacitating

12. SOMATIC SYMPTOMS (GASTROINTESTINAL)
0= None
1= Loss of appetite but eating without encouragement from others. Food intake about normal
2= Difficulty eating without urging from others. Marked reduction of appetite and food intake
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. GENITAL SYMPTOMS (Symptoms such as: loss of libido; impaired sexual performance; menstrual disturbances)
0= Absent
1= Mild
2= Severe
15. HYPOCHONDRIASIS
0=
1=
2=
3=
4=

Not present
Self-absorption (bodily)
Preoccupation with health
Frequent complaints, requests for help, etc.
Hypochondriacal delusions

16. LOSS OF WEIGHT
A. When rating by history:
0= No weight loss
1= Probably weight loss associated with present illness
2= Definite (according to patient) weight loss
3= Not assessed
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
A. Note whether symptoms are worse in morning or evening. If NO diurnal variation, mark none
0= No variation
1= Worse in A.M.
2= Worse in P
.M.
B. When present, mark the severity of the variation. Mark “None” if NO variation
0= None
1= Mild
2= Severe

19. DEPERSONALIZATION AND DEREALIZATION (Such as: Feelings of unreality;
Nihilistic ideas)
0=
1=
2=
3=
4=

Absent
Mild
Moderate
Severe
Incapacitating

20. PARANOID SYMPTOMS
0=
1=
2=
3=

None
Suspicious
Ideas of reference
Delusions of reference and persecution

21. OBSESSIONAL AND COMPULSIVE SYMPTOMS
0= Absent
1= Mild
2= Severe
Total Score ______________

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WEL056R0

February 1997