Hamilton Depression Rating Scale

1. Depressed Mood (sadness, hopelessness, helplessness, worthlessnes) *This question is required.

• 0 - Absent
• 1 - These feeling states indicated only on questioning
• 2 - These feeling states spontaneously reported verbally
• 3 - 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 non-verbal communication

2. Feelings of Guilt *This question is required.

• 0 - Absent
• 1 - Self reproach, feels he has let people down
• 2 - Ideas of guilt or rumination over past errors or sinful deeds
• 3 - Present illness is a punishment. Delusions of guilt
• 4 - Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations

3. Suicide *This question is required.

• 0 - Absent
• 1 - Feels life is not worth living
• 2 - Wishes he were dead or any thoughts of possible death to self
• 3 - Suicide ideas or gesture
• 4 - Attempts at suicide (any serious attempt rates a 4)

4. Insomnia (early) *This question is required.

• 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 *This question is required.

• 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}

6. Insomnia Late *This question is required.

• 0 - Absent
• 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 *This question is required.

• 0 - No difficulty
• 1 - Thoughts and feelings of incapacity, fatigue or weakness related to activities;
• 2 - Loss of interest in activity; hobbies or work-either directly reported by patient, or indirectly in listlessness, indecision and vacillation (feels he has to push self in 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 least three hours a day in activities {hospital job or hobbies} exclusive of ward chores
• 4 - Stopped working because of present illness. In hospital, rate 4 if patient engages in no activities except ward chores, or if patient fails to perform ward chores unassisted

8. Retardation *This question is required.

• 0 - Normal speech and thought
• 1 - Slight retardation at interview
• 2 - Obvious retardation at interview
• 3 - Interview difficult
• 4 - Complete stupor

9. Agitation *This question is required.

• 0 - None
• 1 - Fidgetiness
• 2 - Playing with hands, hair, etc.
• 3 - Moving about, can't sit still
• 4 - Hand wringing, nail biting, hair pulling, biting of lips

10. Anxiety Psychic *This question is required.

• 0 - No difficulty
• 1 - Subjective tension and irritability
• 2 - Worrying about minor matters
• 3 - Apprehensive attitude apparent in face or speech
• 4 - Fears expressed without questioning

11. Anxiety - Somatic *This question is required.Physiological concomitants of anxiety, such as: Gastrointestinal-dry mouth, wind, indigestion, diarrhea, cramps, belchlng Cardiovascular-palpitations, headaches Respiratory-hyperventilation, sighing Urinary frequency Sweating

• 0 - Absent
• 1 - Mild
• 2 - Moderate
• 3 - Severe
• 4 - Incapacitating

12. Somatic Symptoms - Gastrointestinal

• 0 - None
• 1 - Loss of appetite but eating without staff encouragement. Heavy feelings in abdomen
• 2 - Difficulty eating without staff urging. Requests or requires laxatives or medication for bowels or medication for G. I. symptoms

13. Somatic Symptoms General *This question is required.

• 0 - None
• 1 - Heaviness in limbs, back or head, backaches, headache, muscle aches. Loss of energy and fatigabilily
• 2 - Any clear-cut symptom rates 2

14. Genital Symptoms *This question is required.Symptoms such as: Loss of libido; menstrual disturbances

• 0 - Absent
• 1 - Mild
• 2 - Severe

15. Hypochondriasis *This question is required.

• 0 - Not present
• 1 - Self-absorption (bodily)
• 2 - Preoccupation with health
• 3 - Frequent complaints, requests for help, etc.
• 4 - Hypochondriacal delusions

16. Loss of Weight *This question is required.

• 0 - No weight loss
• 1 - Probable 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 (Part 1) *This question is required.

• 0 - No variation
• 1 - Worse in A.M.
• 2 - Worse in P.M.

Diurnal variation (Part 2) *This question is required.

• 0 - None
• 1 - Mild
• 2 - Severe

19. Depersonalization and Derealization *This question is required.

• 0 - Absent
• 1 - Mild
• 2 - Moderate
• 3 - Severe
• 4 - Incapacitating

20. Paranoid Symptoms *This question is required.

• 0 - None
• 1 - Suspicious
• 2 - Ideas of reference
• 3 - Delusions of reference and persecution

21. Obsessional and Compulsive Symptoms *This question is required.

• 0 - Absent
• 1 - Mild
• 2 - Severe