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.
- 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.
- Guilt (0-4). Feelings of self-reproach count 1 point; delusions of
guilt with or without hallucinations merit 4 points.
- Suicide (0-4). Sliding scale ranges from feelings that life is not
worth living to suicide attempts.
- Insomnia, initial (0-2). Difficulties falling asleep.
- Insomnia, middle (0-2). Restless sleeping and waking during the night.
- Insomnia, delayed (0-2). Waking in the early hours and being unable
to fall asleep again.
- Work and interests (0-4). Sliding scale ranges from feelings of incapacity
to loss of interest in hobbies and decreased social activities to inability
- 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.
- 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."
- 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."
- Anxiety, somatic symptoms (0-4). Overactivity in the respiratory,
cardiovascular, gastrointestinal, and urinary systems.
- Gastrointestinal symptoms (0-2). Loss of appetite, constipation,
"heavy feelings" in abdomen.
- 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.
- 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.
- Hypochondria (0-4). Sliding scale from bodily self-absorption to
preoccupation with health, querulous attitude, and hypochondriacal delusions.
- 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.
- Weight loss (0-2).