Hamilton Rating Scale for Depression

The Hamilton Rating Scale for Depression (HRSD) is one of a number of diagnostic tools that may be useful in helping to evaluate patients effectively when depression is an issue. Depression is not only a spectrum disorder but also a symptom caused by other mental health issues. Therefore, effective treatment starts with a thorough understanding of how and perhaps why depression is an issue for the patient. Using the Hamilton Rating Scale is one way to help pinpoint the most beneficial therapeutic tools in treatment.

The Hamilton Rating Scale

A study published in the Journal of Affective Disorders says that the Hamilton Rating Scale for Depression is one of the best ways to determine the severity of depression symptoms being experienced by a patient. Based on their score on the test, patients may be identified as follows:

  • No depression: a score of 0 to 7
  • Mild depression: a score of 8 to 16
  • Moderate depression: a score of 17 to 23
  • Severe depression: a score greater than 24


Because depression may co-occur with suicidal thoughts or actions, it is important to immediately stabilize the patient in recovery by defining a baseline of symptoms and then intervene with recommended treatment protocols and evidence-based therapies.

Later, the HRSD can be used again to assess progress in recovery. The Journal of Nervous and Mental Disease reports that the Hamilton Rating Scale for Depression is one of the most effective ways to determine whether or not antidepressants are working to help an individual patient heal. If symptoms have worsened or remained the same, it may be necessary to alter the treatment plan to improve results.

17 Variables

The Journal of Neurology, Neurosurgery, and Psychiatry with Practical Neurology details the 17 different possible symptoms assessed by the Hamilton Rating Scale for Depression:

  1. Depressed mood: Feelings of sadness, hopelessness, joylessness, etc.
  2. Guilt: Inability to forgive oneself or taking blame when not warranted
  3. Suicide: Thoughts or actions that embrace or glorify an early death
  4. Initial insomnia: Inability to fall asleep
  5. Middle insomnia: Problem with waking repeatedly throughout the night
  6. Delayed insomnia: Waking early in the morning and being unable to fall back to sleep
  7. Work and interests: Loss of interest in careers, hobbies and social interactions
  8. Retardation: Apathy; feeling unable to think clearly or make decisions
  9. Agitation: Restlessness accompanied by anxiety
  10. Psychic anxiety: Preoccupation with fears or worry over minor issues
  11. Somatic anxiety: Physical symptoms related to anxiety like indigestion, heart palpitations, headaches and others
  12. Gastrointestinal somatic symptoms: Symptoms that may include a loss of appetite, constipation and other issues
  13. General somatic symptoms: Feeling a lack of energy, back ache, fatigue, etc.
  14. Somatic genital symptoms: Issues with menstruation or a lack of libido
  15. Hypochondriasis: Preoccupation with health and illness, often manifesting as hypochondriacal delusions
  16. Insight: A patient’s level of understanding of their situation (e.g., whether or not they have a realistic insight into their experience)
  17. Weight loss: Extreme loss of weight with no other discernable cause

All of the above are rated on a three-point or five-point scale to allow for variability. Scores taken at the beginning of the patient’s treatment are compared against scores later in treatment to assess progress and determine how to proceed.

Depression Treatment Can Start Today

Oftentimes, depression symptoms co-occur with other mental health issues including anxiety, substance abuse disorders, process addictions and others. Contact us today to learn more about integrated Dual Diagnosis treatment that is necessary to help your loved one heal.

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