Hamilton Depression Scale


Are you depressed? Check the numbers


Depression is measured with a scale developed in the 1960s by psychiatrist Max Hamilton of the University of Leeds in England. Like any test that relies on interviews, the "Ham-D scale" is somewhat impressionistic. But in general, the Ham-D is seen as a reliable way to assess the existence and severity of depression.

Here are the 17 basic items scored on the scale and the point range for each. The maximum score is 52, but a Ham-D score of 20 or higher indicates major depressive illness.

  1. Depression (0-4). Interviewers are told to look for a gloomy attitude, pessimism, feelings of hopelessness, and a tendency to weep. General sadness gets 1 point; occasional weeping, 2; frequent weeping, 3; and extreme symptoms, 4.
  2. Guilt (0-4). Feelings of self-reproach count 1 point; delusions of guilt with or without hallucinations merit 4 points.
  3. Suicide (0-4). Sliding scale ranges from feelings that life is not worth living to suicide attempts.
  4. Insomnia, initial (0-2). Difficulties falling asleep.
  5. Insomnia, middle (0-2). Restless sleeping and waking during the night.
  6. Insomnia, delayed (0-2). Waking in the early hours and being unable to fall asleep again.
  7. Work and interests (0-4). Sliding scale ranges from feelings of incapacity to loss of interest in hobbies and decreased social activities to inability to work.
  8. Retardation (0-4). Slight flattening of affect and fixity of expression, 1 point; Monotonous voice, delay in answering questions, and a tendency to sit motionless, 2 points. When retardation makes the interview extremely prolonged and almost impossible to complete, 3 points. When an interview is impossible to complete, 4 points.
  9. Agitation (0-4). Sliding scale ranges from fidgetiness to having to conduct the interview "'on the run,' with the patient pacing up and down, picking at his face, and tearing at his clothes."
  10. Anxiety, psychic symptoms (0-4). Items to consider include tension, difficulty in relaxing, irritability, worry over trivial matters, apprehension and feelings of panic, fear, difficulty concentrating and forgetfulness, and "feeling jumpy."
  11. Anxiety, somatic symptoms (0-4). Overactivity in the respiratory, cardiovascular, gastrointestinal, and urinary systems.
  12. Gastrointestinal symptoms (0-2). Loss of appetite, constipation, "heavy feelings" in abdomen.
  13. General somatic symptoms (0-2). Interviewers look for fatigue and diffuse-muscular aches. The latter are often ill-defined and difficult to locate but frequently occur in the back and sometimes in the limbs.
  14. Loss of libido (0-2). In men, interviewers look for a deterioration in sexual activity related to the patient's illness. In women, loss of libido manifests itself as increasing frigidity, progressing to active dislike of sexual intercourse.
  15. Hypochondria (0-4). Sliding scale from bodily self-absorption to preoccupation with health, querulous attitude, and hypochondriacal delusions.
  16. Loss of insight (0-2). Hamilton notes that "loss of insight is not necessarily present when the patient denies that he is suffering from mental disorder." In case of doubt, interviewers are told to query patients further about their symptoms of guilt and hypochondria.
  17. Weight loss (0-2).