The Hamilton Depression Scale (also known as the Ham-D) was introduced by Max Hamilton in the 1960's as a way to measure the severity of depression in patients. It is today the most widely used test in clinical practice for not only diagnosing depression, but rating the effectiveness of treatment. It is also the standard test used in pharmacologic trials to rate the effectivness of antidepressants.

The test itself was not laid out with specific questions, but rather areas of symptoms of depressed patients. While the original test by Hamilton had 17 areas to question, I've seen modern variations with up to 21 questions. The questions may be answered directly by the patient, such as by asking them about their thoughts and feelings, or they may be answered by observing the patients behavior during the interview. In general, a higher score indicated more severe depression. For each test, there are scoring ranges for mild, moderate, and severe depression, although these ranges will vary depending on the number of questions and the point scale used for each.

The best example I could find is from the Wellbutrin website, featuring 21 questions. The scale was not given, however this test requires a trained doctor to administer the test in order to observe behavior and non-verbal communication, so the score is not too important here.

  1. Depressed Mood - Sadness, hopelessness, helpless, worthless
    0 - absent
    1 - admits feelings only when asked
    2 - feelings are reported without asking
    3 - feelings are apparent non-verbally - through facial expressions, voice, crying, etc
    4 - patient focuses on these feelings at length in both verbal and non-verbal communication
  2. Feelings of Guilt
    0 - absent
    1 - self reproach, feelings of letting people down
    2 - ideas of guilt over past deeds
    3 - feels present illness and depression are a punishment for past deeds, delusions of guilt
    4 - experiences threatening hallucinations, accusatory voices, etc
  3. Suicide
    0 - abset
    1 - feels life is not worth living
    2 - patient wishes they were dead, thoughts of death
    3 - suicidal thoughts or gestures
    4 - attempts suicide
  4. Early Insomnia
    0 - no difficulty falling asleep
    1 - occasionaly difficulty falling asleep
    2 - frequent, nightly difficulty falling asleep
  5. Middle Insomnia
    0 - no difficulty
    1 - restless and disturbed during the night
    2 - waking during the night, getting up in the middle of the night
  6. Late Insomnia
    0 - no difficulty
    1 - waking up early, but usually goes back to sleep
    2 - waking up early, unable to get back to sleep, get up early
  7. Work and Activities
    0 - no difficulty
    1 - thoughts and feelings of incapacity, fatigue related to activities, work or hobbies
    2 - loss of interest in activities and hobbies, listlessness, feels like it takes a lot of effort to work or perform activities
    3 - decrease in actual time spent working or in activities, decreased productivity
    4 - no longer capable of working or social activities
  8. Retardation - psychomotor - slowness of thought or speech, impaired concentration, decreased motor activity
    0 - normal
    1 - slight retardation in interview
    2 - obvious retardation in interview
    3 - interview difficult
    4 - complete stupor
  9. Agitation
    0 - none
    1 - fidgeting
    2 - playing with hands, hair, etc
    3 - can't sit still
    4 - nail biting, hair pulling, constant movement
  10. Anxiety - Psychological
    0 - none
    1 - subjective tension and irritability
    2 - worrying about minor issues, such as finances
    3 - apprehensive attitude apparent in interview
    4 - fears expressed without being asked
  11. Anxiety - Somatic - indigestion, palpitations, hyperventilation, sweating, tremors, other physical symptoms of anxiety
    0 - none
    1 - mild
    2 - moderate
    3 - severe
    4 - incapacitating
  12. Somatic Symptoms - Gastrointestinal
    0 - none
    1 - loss of appetite, but still relatively normal food intake
    2 - difficulty eating, reduced food intake
  13. Somatic Symptoms - General
    0 - none
    1 - heaviness in limbs/back/head, backache, headaches, muscle aches and tension, loss of energy
    2 - any clear somatic symptom
  14. Genital Symptoms - loss of libido, imparied sexual performance
    0 - none
    1 - mild
    2 - severe
  15. Hypochondriasis
    0 - not present
    1 - self-absorption with body
    2 - preoccupation with health
    3 - frequent complaints, requests for help, trips to doctor, etc
    4 - hypochondriacal delusions, believes dying or has a serious medical problem
  16. Loss of Weight
    0 - none
    1 - probably weight loss associated with present illness
    2 - definite weight loss
  17. Insight
    0 -acknowledges being depressed and ill
    1 - acknowledges illness but attributes cause to bad food, climate, overwork, etc
    2 - denies being ill and depressed
  18. Diurnal Variation
    0 - no variation
    1 - symptoms worse in A.M.
    2 - symptoms worse in P.M.

    If present, mark severity of variation
    0 - none
    1 - mild
    2 - severe
  19. Depersonalization and Derealization - feelings of unreality, feeling like a robot going through the motions, feeling like observing self from outside the body, etc
    0 - absent
    1 - mild
    2 - moderate
    3 - severe
    4 - incapacitating
  20. Paranoid Symptoms
    0 - none
    1 - suspicious
    2 - ideas of reference
    3 - delusions of persecution
  21. Obsessive and Compulsive Symptoms
    0 - absent
    1 - mild
    2 - severe

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