The Hamilton Depression (HAM-D) Rating Scale is the most popular research scale for measuring depression.  It is completed by the psychiatrist or therapist during and after an interview.  (Click on the Beck Depression Inventory for the patient self-rating scale).  Ideally, the HAM-D is completed before treatment is started and then periodically during treatment.  Adding up the scores: 10 - 13 mild depression; 14-17 mild to moderate depression; >17 moderate to severe depression.

    1. Depressed Mood (sadness, hopelessness, helpless, worthless)

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 expressions, posture, voice, tendency to weep

4 = Patient reports virtually only these feeling states in his spontaneous verbal and non-verbal communication

    2. Feelings of Guilt

0 = Absent; 1 = Self reproach. Feels he has let people down

2 = Ideas of guilt of 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: 0 = Absent; 1 = Feels life is not worth living

2 = Wishes he were dead or any thoughts of possible death to self

3 = Suicidal ideas of gestures; 4 = Attempts at suicide (Any serious attempts rates a 4)

    4. Insomnia – early: 0 = No difficulty in falling asleep; 1 = Complains of occasionally difficulty in falling asleep, i.e. more than ½ hour; 2 = Complains of nightly difficulty in 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 a 2 except for voiding

    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 activities; hobbies or work – either directly reported by patient or indirectly by listlessness, indecision, or vacillation (feels he has to push himself to work or activities)

3 = Decrease in actual time spent in activities or decrease in productivity

4 = Stopped work because of present illness

    8. Retardation: Psychomotor (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 = Complete stupor

    9. Agitation: 0 = None; 1 = Fidgetiness; 2 = Plays with hands, hair, etc.

3 = Moving about, can’t sit still; 4 = Hand wringing, nail biting, hair-pulling, biting of lips

    10. Anxiety (Psychological): 0 = No difficulty; 1 = Subjective tension and irritability; 2 = Worrying about minor matters

3 = Apprehensive attitude apparent in face or speech; 4 = Fear 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 (dry mouth, constipation)

0 = Absent; 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Incapacitating