The Hamilton Rating Scale for Depression (HRSD), also called the Hamilton Depression Rating Scale (HDRS), abbreviated HAM-D, is a multiple item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery.Max Hamilton originally published the scale in 1960 and revised it in 1966, 1967, 1969, and 1980. The questionnaire is designed for adults and is used to rate the severity of their depression by probing mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms.
Initially considered the "Gold Standard" for rating depression in clinical research, it is criticized as a test instrument for clinical practice in part because it places more emphasis on insomnia than on suicide ideas and gestures. An antidepressant may show statistical efficacy even when thoughts of suicide increase but sleep is improved. Hamilton maintained that his scale should not be used as a diagnostic instrument.
The original 1960 version contains 17 items to be rated (HRSD-17), but three other questions are not added to the total score and are used to provide additional clinical information. Each item on the questionnaire is scored on a 3 or 5 point scale, depending on the item, and the total score is compared to the corresponding descriptor. Assessment time is estimated at 20 minutes.
A score of 0-7 is considered to be normal. Scores of 20 or higher indicate moderate, severe, or very severe depression, and are usually required for entry into a clinical trial. Questions 18-20 may be recorded to give further information about the depression (such as whether diurnal variation or paranoid symptoms are present), but are not part of the scale. A structured interview guide for the questionnaire is available.
Although Hamilton's original scale had 17 items, other versions were developed to include up to 29 items (HRSD-29).
^Hamilton M (1966) Assessment of change in psychiatric state by means of rating scales. Proceedings of the Royal Society of Medicine59 (Suppl. 1): 10-13 PMID 5922401
^Hamilton, M (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology6: 278-96 PMID 6080235
^Hamilton, M (1969) Standardised assessment and recording of depressive symptoms. Psychiatria, Neurologia, Neurochirurgia.72:201-205 PMID 5792061
^Hamilton, M (1980) Rating depressive patients. Journal of Clinical Psychiatry.41: 21-24 PMID 7440521
^Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004). "The Hamilton Depression Rating Scale: has the gold standard become a lead weight?". American Journal of Psychiatry161 (12): 2163–77. doi:10.1176/appi.ajp.161.12.2163. PMID15569884.
^Berrios G E & Bulbena A (1990) The Hamilton Depression Scale and the Numerical Description of the Symptoms of Depression. In Bech P & Coppen A (ed) The Hamilton Scales, Heildeberg, Springer, pp80-92
^HRSD-29: Williams JBW, Link MJ, Rosenthal NE, Terman M, Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (SIGHSAD). New York Psychiatric Institute, New York, 1988
^Wechsler H, Grosser GH, Busfield BL Jr (1963) The depression rating scale: a quantitative approach to the assessment of depressive symptomatology. Archives of General Psychiatry.9: 334-343 PMID 14045262
^Raskin A, Schulterbrandt J, Reatig N, McKeon JJ (1969) Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives. Journal of Nervous and Mental Diseases148: 87-98 doi:10.1097/00005053-196901000-00010PMID 5768895