Report Viewer

NINDS CDE Notice of Copyright
Hamilton Depression Rating Scale (HDRS)
Please visit this website for more information about the instrument: Hamilton Depression Rating Scale
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a measure of psychological status.
Supplemental: Huntington's Disease (HD), Mitochondrial Disease (Mito), Parkinson's Disease (PD)
Exploratory: Amyotrophic Lateral Sclerosis (ALS)
Short Description of Instrument
The Hamilton Depression Rating Scale (HDRS) is considered the gold standard in depression research and is widely used. It is commonly used in antidepressant drug clinical trials.
The HDRS is a 21-item rater-administered instrument and is the most widely used rating scale in depression research. It is in the public domain and available in many languages and there are semi-structured versions available.
Comments/Special Instructions
Huntington's Disease-specific
Huntington's disease (HD) patients often suffer from psychiatric symptoms including affective disorder, psychosis, irritability, and apathy, which may be present in all stages of the disease (Holl et al., 2010).
NeuroRehab-Specific: Historical "gold standard" measure but does not correspond to current diagnostic nomenclature and may lack sensitivity to change especially in patients with comorbid medical or neurological conditions. Designed to be administered by trained clinician.
Scoring and Psychometric Properties
Scoring: Scores range from 0-54, with higher scores indicating increasing severity of depression. Scoring is completed by a trained interviewer.
Psychometric Properties:
Feasibility: Low feasibility, requires trained interviewer and 20-30 minutes of interview.
Reliability: Less than optimal since completed by interviewer which may result in variability.
Validity: As sensitive to detecting effect size in clinical trials as Montgomery-Asberg Depression Rating Scale and Clinical Impressions Rating Scale.
Sensitivity to Change: Santen found that not all items of the Hamilton Depression (HAM-D) are equally sensitive to detect responding patients in a clinical trial.
Strengths: Widely used, items somewhat consistent with diagnostic criteria for Major Depressive Disorder, considered the gold standard in antidepressant trials for diagnosis of depression.
Weaknesses: There are no publications on use of this scale in ALS studies. Several items assess somatic symptoms (psychomotor retardation, anxiety: somatic, somatic: GI, somatic: general, genital symptoms, hypochondriasis, loss of weight) which may result in over-diagnosis of depression. Rickard and colleagues (2011) found that the Hamilton Rating Scale for Depression had limited use in the Huntington's Disease population.
Mitochondrial Disease-Specific:
Strengths: Fairly brief, reliable measure of depressive symptomatology. Widely used and reliable.
Weaknesses: The instrument has not been specifically used in studies with mitochondrial disorders. Several items tap somatic symptoms which may be elevated as a consequence of mitochondrial disorder rather than specific to depression and cut scores must therefore be used with caution in populations with co-occurring physical symptoms (Reijinders et al., 2010; Bech et al., 2014).
Key References:
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62.
Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6(4):278-96.
Additional References:
Bech P, Allerup P, Larsen ER, Csillag C, Licht RW. The Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Scale (MADRS). A psychometric re-analysis of the Europena Genome-Based Therapeutic Drugs for Depression Study using Rasch analysis. Psych Res. 2014;217:226-32.
Holl AK, Wilkinson L, Painold A, Holl EM, Bonelli RM. Combating depression in Huntington's disease: effective antidepressive treatment with venlafaxine XR. Int Clin Psychopharmacol. 2010 Jan;25(1):46-50.
Reijnders JSAM, Lousberg R, Leentjens AFG. Assessment of depression I Parkinson's disease: the contribution of somatic symptoms to the clinimetric performance of the Hamilton and Montgomery-Asberg rating scales. J Psychosomatic Res. 2010;68:561-5.
Rickards H, De Souza J, Crooks J, van Walsem MR, van Duijn E, Landwehrmeyer B, Squitieri F, Simpson SA; European Huntington's Disease Network. Discriminant analysis of Beck Depression Inventory and Hamilton Rating Scale for Depression in Huntington's disease. J Neuropsychiatry Clin Neurosci. 2011 Fall;23(4):399-402.
Santen G. Sensitivity of the individual items of the Hamilton depression rating scale to response and its consequences for the assessment of efficacy. J Psychiatr Res. 2008;42(12):1000-9.
Soliveri P, Paridi D, Del Sorbo F, Tramacere I, Girotti F. Negative symptoms in Huntington's disease. Neurol Sci. 2022 Jun;43(6):3695-3701.
Williams JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry. 1988;45(8):742-7.
Document last updated June 2024