HAMILTON RATING SCALE FOR DEPRESSION
Activity
Patient Name: ____________________________ Rater Name: ____________________________ Date: ____________________________ Score
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Depressed mood Sad, hopeless, helpless, worthless 0 = Absent 1 = Gloomy attitude, pessimism, hopelessness 2 = Occasional weeping 3 = Frequent weeping 4 = Patient reports highlight these feelings states in his/her spontaneous verbal and non-verbal communication. Feelings of guilt 0 = Absent 1 = Self-reproach, feels he/she has let people down 2 = Ideas of guilt or rumination over past errors or sinful deeds 3 = Present illness is punishment 4 = Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations. Delusions of guilt. Suicide 0 = Absent 1 = Feels life is not worth living 2 = Wishes he/she were dead, or any thoughts of possible death to self 3 = Suicide, ideas or half-hearted attempt 4 = Attempts at suicide (any serious attempt rates 4) Insomnia, early 0 = No difficulty falling asleep 1 = Complaints of occasional difficulty in falling asleep i.e. more than half-hour 2 = Complaints of nightly difficulty falling asleep 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 (except voiding bladder) Insomnia, late 0 = No difficulty 1 = Waking in the early hours of the morning but goes back to sleep 2 = Unable to fall asleep again if he/she gets out of bed
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Page 1 Score
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Work and activities 0 = No difficulty 1 = Thoughts and feelings of incapacity related to activities: work or hobbies 2 = Loss of interest in activity hobbies or work either directly reported by patient or indirectly seen in listlessness, in decisions and vacillation (feels he/she has to push self to work or activities) 3 = Decrease in actual time spent in activities or decrease in productivity. In hospital, rate 3 if patient does not spend at leas three hours a day in activities 4 = Stopped working because of present illness. In hospital rate 4 if patient engages in no activities except supervised ward chores 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 = Interview impossible Agitation 0 = None 1 = Fidgetiness 2 = Playing with hands, hair, obvious restlessness 3 = Moving about; cant sit still 4 = Hand wringing, nail biting, hair pulling, biting of lips, patient is on the run Anxiety, psychic Demonstrated by: subjective tension and irritability, loss of concentration worrying about minor matters apprehension fears expressed without questioning feelings of panic feeling jumpy 0 = Absent 1 = Mild 2 = Moderate 3 = Severe 4 = Incapacitating
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Page 2 Score
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Anxiety, somatic Physiological concomitants of anxiety such as: gastrointestinal: dry mouth, wind, indigestion, diarrhea, cramps, belching cardiovascular: palpations, headaches respiratory: hyperventilation, sighing urinary frequency sweating giddiness, blurred vision tinnitus 0 = Absent 1 = Mild 2 = Moderate 3 = Severe 4 = Incapacitating Somatic symptoms: gastrointestinal 0 = None 1 = Loss of appetite but eating without encouragement 2 = Difficulty eating without urging. Requests or requires laxatives or medication for GI symptoms
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Somatic symptoms: general _______ 0 = None 1 = Heaviness in limbs, back or head; backaches, headaches, muscle aches, loss of energy, fatigability 2 = Any clear-cut symptom rates 2 General Symptoms Symptoms such as: loss of libido, menstrual disturbances 0 = Absent 1 = Mild 2 = Severe Hypochondriasis 0 = Not present 1 = Self-absorption (bodily) 2 = Preoccupation with health 3 = Strong conviction of some bodily illness 4 = Hypochondrial delusions
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Page 3 Score
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Loss of Weight Rate either A or B: 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 Actual weight changes (weekly): 0 = Less than 1 lb (0.5 kg) weigh loss in one week 1 = 1-2 lb (0.5 kg-1.0 kg) weight loss in week 2 = Greater than 2 lb (1 kg) weight loss in week 3 = Not assessed Insight 0 = Acknowledges being depressed and ill 1 = Acknowledges illness but attributes cause to bad food, overwork, virus, need for rest, etc. 2 = Denies being ill at all _______
Page 4 Score
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TOTAL Score ______
Reference
Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6:278-296.
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