Hamilton Depression Rating Scale (HDRS-17)

The Hamilton Depression Rating Scale (HDRS-17) remains a foundational instrument in psychiatric practice and clinical trials for quantifying the severity of…

Questions: 17
Duration: 20 min
Original title: HDRS-17 — Hamilton Depression Rating Scale
Adaptation: Hamilton Depression Rating Scale (HDRS-17)
Authors: Hamilton, M.
Created: 1960

The Hamilton Depression Rating Scale (HDRS-17) remains a foundational instrument in psychiatric practice and clinical trials for quantifying the severity of depressive illness. Originally developed by Max Hamilton in 1960, this clinician-rated measure captures both the psychological and somatic manifestations of depression, offering a comprehensive snapshot of a patient's clinical state over the past week. By structuring the assessment of neurovegetative shifts, mood alterations, and psychomotor changes, it ensures consistency in symptom tracking across different treatment settings.

Unlike self-report measures that rely on subjective patient insight, the HDRS-17 leverages the clinician's objective observation and structured interviewing skills. It is highly sensitive to treatment-induced change, making it an excellent standard for evaluating the efficacy of pharmacotherapy or psychotherapeutic interventions. By anchoring depression symptoms to concrete behavioral and somatic markers, it provides a reliable, repeatable metric to guide clinical decision-making.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

24/ 52

Reference clinician-administered rating scale, administered by a clinician during a semi-structured interview, designed to quantify the severity of depressive symptoms in an adult with an already identified depressive disorder. It is used to evaluate the initial severity of the episode, monitor its course over time, and assess treatment response (particularly to antidepressants). Scoring covers the past 7 days and relies on clinical observation and the practitioner's judgment.

0–7

Absence of depression

8–16

Mild depression

17–23

Moderate depression

24–52

Severe depression

Maximized the sum of sensitivity and specificity for the comparison of moderate vs. severe depression.

Scoring

Sum of the 17 items, total score from 0 to 52, item scoring varies depending on the item (see each question).

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What the test measures

The HDRS-17 evaluates the overall severity of a major depressive episode by capturing both psychological distress and somatic neurovegetative signs.

Affective symptoms: Persistent low mood, feelings of hopelessness, and observable signs of emotional distress.
Cognitive features: Excessive guilt, automatic thoughts of worthlessness, suicidal ideation, and lack of clinical insight.
Neurovegetative shifts: Early, middle, and late insomnia, as well as distinct changes in appetite, weight, and libido.
Psychomotor changes: Observable retardation in speech and thought, or conversely, physical agitation and physical tension.
Somatic anxiety: Gastrointestinal, cardiovascular, and respiratory manifestations of anxiety, along with heightened hypochondriasis.

This scale is primarily designed for adults already experiencing a major depressive episode, particularly in inpatient or specialized outpatient settings where somatic symptoms are prominent.

When and why to use it

Clinicians rely on the HDRS-17 to transform qualitative clinical impressions into a structured, trackable severity metric.

Establishing baseline severity: Quantifies the initial depth of the depressive episode to inform treatment planning and case formulation.
Monitoring treatment response: Tracks symptom changes over time, particularly the neurovegetative and psychomotor shifts that often precede subjective mood improvements.
Guiding behavioral interventions: Highlights specific deficits in work, interests, and energy to help establish targeted behavioral activation goals.
Differentiating symptom profiles: Separates true melancholic features from alternative presentations, such as identifying a bipolar disorder prodrome when mood lability is high but physical retardation is low.

Anchoring subjective distress to a validated clinical score allows professionals to objectify remission criteria and adjust coping strategies or biological treatments effectively.

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The questions

Rate each item based on the patient's clinical state during the past 7 days, using information gathered from the clinical interview and clinical observation. Choose the level that best describes the observed symptomatology.
1. Depressed mood (sadness, hopelessness, helplessness, feelings of worthlessness)
Evaluates the pervasive nature of the patient's low mood and whether it is communicated spontaneously or only upon targeted questioning.
- Absent
- These feelings are reported only when asked
- These feelings are spontaneously reported verbally
- Communicates these feelings non-verbally (facial expression, posture, voice, tendency to cry)
- Expresses these feelings almost exclusively, both verbally and non-verbally
2. Feelings of guilt
Assesses the presence and intensity of self-reproach, rumination over past errors, and delusional guilt.
- Absent
- Self-reproach, feels they have let people down
- Ideas of guilt or ruminates over past errors or sinful deeds
- Present illness is a punishment; delusional ideas of guilt
- Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations
3. Suicide
Probes the spectrum of suicidality, ranging from passive death wishes to active ideation and recent suicide attempts.
- Absent
- Feels life is not worth living
- Wishes they were dead or has any thoughts of possible death
- Suicidal ideas or gestures
- Attempts at suicide (any serious attempt)
4. Insomnia: early night
Captures difficulties with sleep onset and the latency period before falling asleep.
- No difficulty falling asleep
- Complains of occasional difficulty falling asleep (more than 30 minutes)
- Complains of difficulty falling asleep every night
5. Insomnia: middle night
Measures sleep continuity and the frequency of nocturnal awakenings.
- No difficulty
- Patient complains of being restless and disturbed during the night
- Waking during the night (any getting out of bed, except for urination)
6. Insomnia: early morning
Identifies terminal insomnia, where the patient wakes prematurely and cannot return to sleep.
- No difficulty
- Waking in the early hours of the morning but goes back to sleep
- Unable to fall asleep again if they get out of bed
7. Work and activities
Evaluates the impact of depressive symptoms on the patient's daily functioning, occupational capacity, and engagement in hobbies.
- No difficulty
- Thoughts and feelings of incapacity, fatigue or weakness related to activities, work or hobbies
- Loss of interest in activities, hobbies, or work, reported directly by the patient or indirectly through apathy, indecision, and hesitation
- Decrease in time spent on activities or decreased productivity
- Has stopped working because of present illness
8. Retardation (slowness of thought and speech, impaired ability to concentrate, decreased motor activity)
Observes the objective slowing of psychomotor functions, speech latency, and cognitive processing during the interview.
- Normal speech and thought
- Slight retardation at interview
- Obvious retardation at interview
- Interview difficult
- Complete stupor
9. Agitation
Detects physical restlessness, inability to sit still, and overt expressions of motor tension.
- None
- Fidgetiness
- Playing with hands, hair, etc.
- Moving about, cannot sit still
- Wringing hands, biting nails, pulling hair, biting lips
10. Anxiety: psychic
Assesses the subjective experience of inner tension, irritability, and unprompted cognitive worry.
- No difficulty
- Subjective tension and irritability
- Worrying about minor matters
- Apprehensive attitude apparent in face or speech
- Fears expressed without being asked
11. Anxiety: somatic (physical concomitants of anxiety: gastrointestinal, cardiovascular, respiratory, sweating, etc.)
Measures the presence and severity of physiological arousal and somatic manifestations tied to anxiety.
- Absent
- Mild
- Moderate
- Severe
- Incapacitating
12. Somatic symptoms: gastrointestinal
Inquires about depressive impacts on digestion and eating behaviors, beyond simple weight loss.
- None
- Loss of appetite but eats without encouragement; feeling of heaviness in abdomen
- Difficulty eating without encouragement; requests or requires laxatives or medication for bowels or stomach
13. Somatic symptoms: general
Captures diffuse physical complaints often associated with depression, such as heavy limbs, backaches, and general fatigability.
- None
- Heaviness in limbs, back or head; backaches, headaches, muscle aches; loss of energy and fatigability
- Any clear-cut symptom
14. Genital symptoms (loss of libido, menstrual disturbances)
Explores alterations in sexual drive and normal reproductive functioning.
- Absent
- Mild
- Severe
15. Hypochondriasis
Evaluates the patient's degree of somatic preoccupation, ranging from bodily self-absorption to outright hypochondriacal delusions.
- Absent
- Self-absorption (bodily)
- Preoccupation with health
- Frequent complaints, requests for help, etc.
- Hypochondriacal delusions
16. Weight loss (rate according to clinician's assessment over the past week)
Assesses objective or subjectively reported reductions in body mass linked to the current episode.
- No weight loss
- Probable weight loss associated with present illness
- Definite weight loss (according to the patient)
17. Insight
Assesses the patient's recognition of their depressive symptoms and their understanding of it as a clinical illness.
- Acknowledges being depressed and ill
- Acknowledges being ill but attributes it to food, climate, overwork, a virus, need for rest, etc.
- Denies being ill