Montgomery-Asberg Depression Rating Scale

Questions

10

Duration

15 min

Original title

MADRS — Montgomery–Åsberg Depression Rating Scale

Adaptation

Montgomery-Asberg Depression Rating Scale

Authors

Montgomery, S.A. & Åsberg, M.

Created

1979

Example result

What the test measures

When and why to use it

The questions

1. The rating should be based on a clinical interview moving from broadly phrased questions about symptoms to more detailed ones which allow a precise rating of severity. The rater must decide whether the rating lies on the defined scale steps (0, 2, 4, 6) or between them (1, 3, 5). It is important to remember that it is only on rare occasions that a depressed patient is encountered who cannot be rated on the items in the scale. If definite answers cannot be elicited from the patient, all relevant clues as well as information from other sources should be used as a basis for the rating in line with customary clinical practice. Tick the box corresponding to the most appropriate number for each item.
   1. Apparent Sadness — Represents despondency, gloom, and despair (more than just passing blues) reflected in speech, facial expression, and posture. Rate according to depth and inability to brighten up. 0: No sadness; 2: Looks despondent but can brighten up without difficulty; 4: Appears sad and unhappy most of the time; 6: Looks miserable all the time, extremely despondent.
   This item assesses the outward, observable signs of depressed mood in the patient's demeanor and nonverbal communication.
   • 0
   • 1 (intermediate)
   • 2
   • 3 (intermediate)
   • 4
   • 5 (intermediate)
   • 6
2. 2. Reported Sadness — Represents reports of a depressed mood, regardless of whether it is apparent. Includes feeling down, despondent, or a feeling of hopeless distress. Rate according to intensity, duration, and the extent to which mood is said to be influenced by events. 0: Occasional sadness in keeping with the circumstances; 2: Sad or down, but brightens up without difficulty; 4: Pervasive feeling of sadness or depression; mood is still influenced by external circumstances; 6: Continuous or unvarying sadness, despair, or despondency.
   This item evaluates the patient's subjective description of their own low mood and sense of hopelessness.
   • 0
   • 1 (intermediate)
   • 2
   • 3 (intermediate)
   • 4
   • 5 (intermediate)
   • 6
3. 3. Inner Tension — Represents feelings of ill-defined discomfort, irritability, inner turmoil, and nervous tension ranging to panic, dread, or anguish. Rate according to intensity, frequency, duration, and the need for reassurance. 0: Calm, only passing inner tension; 2: Occasional feelings of irritability and ill-defined discomfort; 4: Continuous feelings of inner tension or intermittent panic that the patient can only master with difficulty; 6: Unrelenting dread or anguish, overwhelming panic.
   This item gauges the intensity of the patient's internal psychological distress, anxiety, and dread.
   • 0
   • 1 (intermediate)
   • 2
   • 3 (intermediate)
   • 4
   • 5 (intermediate)
   • 6
4. 4. Reduced Sleep — Represents a reduction in sleep duration or depth compared to the patient's sleep when not ill. 0: Sleeps as usual; 2: Slight difficulty falling asleep or slightly reduced, light, or restless sleep; 4: Sleep reduced or interrupted by at least two hours; 6: Less than two or three hours of sleep.
   This item measures the extent to which the patient's sleep duration or depth has decreased compared to their healthy baseline.
   • 0
   • 1 (intermediate)
   • 2
   • 3 (intermediate)
   • 4
   • 5 (intermediate)
   • 6
5. 5. Reduced Appetite — Represents the feeling of a loss of appetite compared to usual. Rate the absence of a desire for food or the need to force oneself to eat. 0: Normal or increased appetite; 2: Slightly reduced appetite; 4: No appetite, food is tasteless; 6: Eats only if persuaded.
   This item captures the degree of appetite loss and the physical effort required for the patient to consume food.
   • 0
   • 1 (intermediate)
   • 2
   • 3 (intermediate)
   • 4
   • 5 (intermediate)
   • 6
6. 6. Concentration Difficulties — Represents difficulties in gathering one's thoughts up to an inability to concentrate. Rate the intensity, frequency, and degree of incapacity. 0: No difficulties concentrating; 2: Occasional difficulties in gathering one's thoughts; 4: Difficulties in concentrating and sustaining attention, which reduces the ability to read or hold a conversation; 6: Unable to read or converse without great difficulty.
   This item probes the cognitive impact of depression by evaluating the patient's ability to focus, read, or sustain a conversation.
   • 0
   • 1 (intermediate)
   • 2
   • 3 (intermediate)
   • 4
   • 5 (intermediate)
   • 6
7. 7. Lassitude — Represents a difficulty getting started or slowness in initiating and performing daily activities. 0: Hardly any difficulty getting started, no slowness; 2: Difficulties starting activities; 4: Difficulties starting routine activities which are continued with effort; 6: Great lassitude, unable to do anything without help.
   This item focuses on psychomotor retardation and the subjective difficulty the patient experiences when initiating daily tasks.
   • 0
   • 1 (intermediate)
   • 2
   • 3 (intermediate)
   • 4
   • 5 (intermediate)
   • 6
8. 8. Inability to Feel — Represents the subjective experience of reduced interest in the surroundings or in activities that normally give pleasure. The ability to react with appropriate emotion to circumstances or people is reduced. 0: Normal interest in the surroundings and in people; 2: Reduced ability to enjoy usual interests; 4: Loss of interest in the surroundings, loss of feeling for friends and acquaintances; 6: Feeling emotionally paralyzed, unable to feel anger, grief, or pleasure, and a complete or even painful inability to feel anything for close relatives and friends.
   This item evaluates affective flattening and the loss of emotional resonance regarding normally pleasurable activities or close relationships.
   • 0
   • 1 (intermediate)
   • 2
   • 3 (intermediate)
   • 4
   • 5 (intermediate)
   • 6
9. 9. Pessimistic Thoughts — Represents ideas of guilt, inferiority, self-reproach, sin, remorse, or ruin. 0: No pessimistic thoughts; 2: Intermittent ideas of failure, self-reproach, or self-deprecation; 4: Persistent self-accusations, or specific but still rational ideas of guilt or sin; growing pessimism about the future; 6: Delusions of ruin, remorse, or unpardonable sin; absurd or unshakable self-accusations.
   This item assesses the presence and rigidity of depressive cognitive distortions, including guilt, self-reproach, and perceived ruin.
   • 0
   • 1 (intermediate)
   • 2
   • 3 (intermediate)
   • 4
   • 5 (intermediate)
   • 6
10. 10. Suicidal Thoughts — Represents the feeling that life is not worth living, that a natural death would be welcome, suicidal thoughts, and preparations for suicide. Suicide attempts themselves should not influence the rating. 0: Enjoys life or takes it as it comes; 2: Tired of life, only fleeting suicidal thoughts; 4: It would be better to be dead; suicidal thoughts are common, and suicide is considered a possible solution but without any specific plan or intent; 6: Explicit plans for suicide if the opportunity arises; suicide preparations.
    This item determines the imminence and severity of suicidal ideation, ranging from a passive wish for death to active planning.
    • 0
    • 1 (intermediate)
    • 2
    • 3 (intermediate)
    • 4
    • 5 (intermediate)
    • 6