HAM-D: Hamilton Depression Rating Scale (17-item)

Rate each item on the basis of the clinical interview, covering the past week. Choose the description that best fits the patient.

1. 1Depressed moodSadness, hopelessness, helplessness, worthlessness

   0Absent1These feeling states indicated only on questioning2These feeling states spontaneously reported verbally3Communicates these feelings non-verbally — facial expression, posture, voice, tendency to weep4Reports virtually only these feelings in spontaneous verbal and non-verbal communication
2. 2Feelings of guilt

   0Absent1Self-reproach; feels he or she has let people down2Ideas of guilt or rumination over past errors or sinful deeds3Present illness is a punishment; delusions of guilt4Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations
3. 3Suicide

   0Absent1Feels life is not worth living2Wishes he or she were dead, or any thoughts of possible death to self3Suicidal ideas or gestures4Attempts at suicide (any serious attempt rates 4)

   Suicidal ideation recorded. Complete a full suicide risk assessment and document the plan.

4. 4Insomnia: early (initial)

   0No difficulty falling asleep1Occasional difficulty falling asleep, i.e. more than half an hour2Nightly difficulty falling asleep
5. 5Insomnia: middle

   0No difficulty1Restless and disturbed during the night2Waking during the night — any getting out of bed rates 2 (except to void)
6. 6Insomnia: late (early morning waking)

   0No difficulty1Waking in the early hours of the morning but goes back to sleep2Unable to fall asleep again if he or she gets out of bed
7. 7Work and activities

   0No difficulty1Thoughts and feelings of incapacity, fatigue or weakness related to activities, work or hobbies2Loss of interest in activities, hobbies or work — reported directly, or shown as listlessness, indecision and vacillation3Decrease in actual time spent in activities or decrease in productivity4Stopped working because of present illness
8. 8Psychomotor retardationSlowness of thought and speech, impaired concentration, decreased motor activity

   0Normal speech and thought1Slight retardation during the interview2Obvious retardation during the interview3Interview difficult4Complete stupor
9. 9Agitation

   0None1Fidgetiness2Playing with hands, hair, etc.3Moving about; cannot sit still4Hand-wringing, nail-biting, hair-pulling, biting of lips
10. 10Anxiety: psychic

    0No difficulty1Subjective tension and irritability2Worrying about minor matters3Apprehensive attitude apparent in face or speech4Fears expressed without questioning
11. 11Anxiety: somaticPhysiological concomitants: dry mouth, indigestion, diarrhoea, cramps, belching, palpitations, headaches, hyperventilation, sighing, urinary frequency, sweating

    0Absent1Mild2Moderate3Severe4Incapacitating
12. 12Somatic symptoms: gastrointestinal

    0None1Loss of appetite but eating without encouragement; heavy feelings in abdomen2Difficulty eating without urging; requests or requires laxatives or medication for GI symptoms
13. 13Somatic symptoms: general

    0None1Heaviness in limbs, back or head; backaches, headaches, muscle aches; loss of energy and fatigability2Any clear-cut symptom rates 2
14. 14Genital symptomsLoss of libido, menstrual disturbances

    0Absent1Mild2Severe
15. 15Hypochondriasis

    0Not present1Self-absorption (bodily)2Preoccupation with health3Frequent complaints, requests for help, etc.4Hypochondriacal delusions
16. 16Loss of weightRate by history, or by weekly measurement where available

    0No weight loss (or under about 0.5 kg in the week)1Probable weight loss associated with present illness (or more than about 0.5 kg in the week)2Definite weight loss according to the patient (or more than about 1 kg in the week)
17. 17Insight

    0Acknowledges being depressed and ill1Acknowledges illness but attributes cause to bad food, climate, overwork, virus, need for rest, etc.2Denies being ill at all