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Hamilton Rating Scale For Depression Descriptive Essay

Sadness, feeling down, having a loss of interest or pleasure in daily activities - these are symptoms familiar to all of us. But, if they persist and affect our life substantially, it may be depression.

According to the Centers for Disease Control and Prevention (CDC), 7.6 percent of people over the age of 12 have depression in any 2-week period. This is substantial and shows the scale of the issue.

According to the World Health Organization (WHO), depression is the most common illness worldwide and the leading cause of disability. They estimate that 350 million people are affected by depression, globally.

Fast facts on depression:
  • Depression seems to be more common among women than men.
  • Symptoms include lack of joy and reduced interest in things that used to bring a person happiness.
  • Life events, such as bereavement, produce mood changes that can usually be distinguished from the features of depression.
  • The causes of depression are not fully understood but are likely to be a complex combination of genetic, biological, environmental, and psychosocial factors.


Depression is a mood disorder characterized by persistently low mood and a feeling of sadness and loss of interest. It is a persistent problem, not a passing one, lasting on average 6 to 8 months.

Diagnosis of depression starts with a consultation with a doctor or mental health specialist. It is important to seek the help of a health professional to rule out different causes of depression, ensure an accurate differential diagnosis, and secure safe and effective treatment.

As for most visits to the doctor, there may be a physical examination to check for physical causes and coexisting conditions. Questions will also be asked - "taking a history" - to establish the symptoms, their time course, and so on.

Some questionnaires help doctors to assess the severity of depression. The Hamilton depression rating scale, for example, has 21 questions, with resulting scores describing the severity of the condition. The Hamilton scale is one of the most widely used assessment instruments in the world for clinicians rating depression.

What does not class as depression?

Depression is different from the fluctuations in mood that people experience as a part of normal life. Temporary emotional responses to the challenges of everyday life do not constitute depression.

Likewise, even the feeling of grief resulting from the death of someone close is not itself depression if it does not persist. Depression can, however, be related to bereavement - when depression follows a loss, psychologists call it a "complicated bereavement."

Signs and symptoms

Symptoms of depression can include:

  • depressed mood
  • reduced interest or pleasure in activities previously enjoyed, loss of sexual desire
  • unintentional weight loss (without dieting) or low appetite
  • insomnia (difficulty sleeping) or hypersomnia (excessive sleeping)
  • psychomotor agitation, for example, restlessness, pacing up and down
  • delayed psychomotor skills, for example, slowed movement and speech
  • fatigue or loss of energy
  • feelings of worthlessness or guilt
  • impaired ability to think, concentrate, or make decisions
  • recurrent thoughts of death or suicide, or attempt at suicide


The causes of depression are not fully understood and may not be down to a single source. Depression is likely to be due to a complex combination of factors that include:

  • genetics
  • biological - changes in neurotransmitter levels
  • environmental
  • psychological and social (psychosocial)

Some people are at higher risk of depression than others; risk factors include:

  • Life events: These include bereavement, divorce, work issues, relationships with friends and family, financial problems, medical concerns, or acute stress.
  • Personality: Those with less successful coping strategies, or previous life trauma are more suceptible.
  • Genetic factors: Having a first-degree relatives with depression increases the risk.
  • Childhood trauma.
  • Some prescription drugs: These include corticosteroids, some beta-blockers, interferon, and other prescription drugs.
  • Abuse of recreational drugs: Abuse of alcohol, amphetamines, and other drugs are strongly linked to depression.
  • A past head injury.
  • Having had one episode of major depression: This increases the risk of a subsequent one.
  • Chronic pain syndromes: These and other chronic conditions, such as diabetes, chronic obstructive pulmonary disease, and cardiovascular disease make depression more likely.


Depression is a treatable mental illness. There are three components to the management of depression:

  • Support, ranging from discussing practical solutions and contributing stresses, to educating family members.
  • Psychotherapy, also known as talking therapies, such as cognitive behavioral therapy (CBT).
  • Drug treatment, specifically antidepressants.


Psychological or talking therapies for depression include cognitive-behavioral therapy (CBT), interpersonal psychotherapy, and problem-solving treatment. In mild cases of depression, psychotherapies are the first option for treatment; in moderate and severe cases, they may be used alongside other treatment.

CBT and interpersonal therapy are the two main types of psychotherapy used in depression. CBT may be delivered in individual sessions with a therapist, face-to-face, in groups, or over the telephone. Some recent studies suggest that CBT may be delivered effectively through a computer

Interpersonal therapy helps patients to identify emotional problems that affect relationships and communication, and how these, in turn, affect mood and can be changed.

Antidepressant medications

Antidepressants are drugs available on prescription from a doctor. Drugs come into use for moderate to severe depression, but are not recommended for children, and will be prescribed only with caution for adolescents.

A number of classes of medication are available in the treatment of depression:

  • selective serotonin reuptake inhibitors (SSRIs)
  • monoamine oxidase inhibitors (MAOIs)
  • tricyclic antidepressants
  • atypical antidepressants
  • selective serotonin and norepinephrine reuptake inhibitors (SNRI)

Each class of antidepressant acts on a different neurotransmitter. The drugs should be continued as prescribed by the doctor, even after symptoms have improved, to prevent relapse.

A warning from the Food and Drug Administration (FDA) says that "antidepressant medications may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment."

Any concerns should always be raised with a doctor - including any intention to stop taking antidepressants.

Exercise and other therapies

Aerobic exercise may help against mild depression since it raises endorphin levels and stimulates the neurotransmitter norepinephrine, which is related to mood.

Brain stimulation therapies - including electroconvulsive therapy - are also used in depression. Repetitive transcranial magnetic stimulation sends magnetic pulses to the brain and may be effective in major depressive disorder.

Electroconvulsive therapy

Severe cases of depression that have not responded to drug treatment may benefit from electroconvulsive therapy (ECT); this is particularly effective for psychotic depression.


Unipolar and bipolar depression

If the predominant feature is a depressed mood, it is called unipolar depression. However, if it is characterized by both manic and depressive episodes separated by periods of normal mood, it is referred to as bipolar disorder (previously called manic depression).

Unipolar depression can involve anxiety and other symptoms - but no manic episodes. However, research shows that for around 40 percent of the time, individuals with bipolar disorder are depressed, making the two conditions difficult to distinguish.

Major depressive disorder with psychotic features

This condition is characterized by depression accompanied by psychosis. Psychosis can involve delusions - false beliefs and detachment from reality, or hallucinations - sensing things that do not exist.

Postpartum depression

Women often experience "baby blues" with a newborn, but postpartum depression - also known as postnatal depression - is more severe.

Major depressive disorder with seasonal pattern

Previously called seasonal affective disorder (SAD), this condition is related to the reduced daylight of winter - the depression occurs during this season but lifts for the rest of the year and in response to light therapy.

Countries with long or severe winters seem to be affected more by this condition.

The Hamilton Rating Scale for Depression (HRSD),[1] also called the Hamilton Depression Rating Scale (HDRS), abbreviated HAM-D, is a multiple item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery.[2]Max Hamilton originally published the scale in 1960[3] and revised it in 1966,[4] 1967,[5] 1969,[6] and 1980.[7] The questionnaire is designed for adults and is used to rate the severity of their depression by probing mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms.

The HRSD has been criticized for use in clinical practice as it places more emphasis on insomnia than on feelings of hopelessness, self-destructive thoughts, suicidal cognitions and actions.[8] An antidepressant may show statistical efficacy even when thoughts of suicide increase but sleep is improved, or for that matter, an antidepressant that as a side effect increase sexual and gastrointestinal symptom ratings may register as being less effective in treating the depression itself than it actually is.[9] Hamilton maintained that his scale should not be used as a diagnostic instrument.[10]

The original 1960 version contained 17 items (HDRS-17), but four other questions not added to the total score were used to provide additional clinical information. Each item on the questionnaire is scored on a 3 or 5 point scale, depending on the item, and the total score is compared to the corresponding descriptor. Assessment time is about 20 minutes.


The patient is rated by a clinician on 17 to 29 items (depending on version) scored either on a 3-point or 5-point Likert-type scale. For the 17-item version, a score of 0–7 is considered to be normal. Scores of 20 or higher indicate moderate, severe, or very severe depression.[11] Questions 18–20 may be recorded to give further information about the depression (such as whether diurnal variation or paranoid symptoms are present), but are not part of the scale. A structured interview guide for the questionnaire is available.[12]

Although Hamilton's original scale had 17 items, other versions included up to 29 items (HRSD-29).[13][14][15][16]

Other scales[edit]

Other scales include the Montgomery-Åsberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), the Zung Self-Rating Depression Scale, the Wechsler Depression Rating Scale,[17] the Raskin Depression Rating Scale,[18] the Inventory of Depressive Symptomatology (IDS), the Quick Inventory of Depressive Symptomatology (QIDS),[19] and other questionnaires.[20][21]

See also[edit]


  1. ^"the ham-d scale"(PDF). Retrieved 29 November 2012. 
  2. ^Hedlund JL, Viewig BW (1979) The Hamilton rating scale for depression: a comprehensive review. Journal of Operational Psychiatry10:149–165
  3. ^Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry.23: 56–62 doi:10.1136/jnnp.23.1.56PMID 14399272
  4. ^Hamilton M (1966) Assessment of change in psychiatric state by means of rating scales. Proceedings of the Royal Society of Medicine59 (Suppl. 1): 10–13 PMID 5922401
  5. ^Hamilton, M (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology6: 278–96 PMID 6080235
  6. ^Hamilton, M (1969) Standardised assessment and recording of depressive symptoms. Psychiatria, Neurologia, Neurochirurgia.72:201–205 PMID 5792061
  7. ^Hamilton, M (1980) Rating depressive patients. Journal of Clinical Psychiatry.41: 21–24 PMID 7440521
  8. ^Firestone, R.W., & Firestone, L.A. (1996). Firestone Assessment of Self-Destructive Thoughts Manual. San Antonio, TX: Psychological Corporation.
  9. ^Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004). "The Hamilton Depression Rating Scale: has the gold standard become a lead weight?". American Journal of Psychiatry. 161 (12): 2163–77. doi:10.1176/appi.ajp.161.12.2163. PMID 15569884. 
  10. ^Berrios, G.E., & Bulbena, A. (1990). The Hamilton Depression Scale and the Numerical Description of the Symptoms of Depression. In Bech, P., & Coppen, A. (Eds.), The Hamilton Scales, Heidelberg: Springer, pp. 80–92
  11. ^HDRS-17: Hamilton Depression Rating Scale (HDRS) at University of Florida, College of Medicine. Additional Questions Retrieved December 12, 2011.
  12. ^Williams JBW (1989) A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry45: 742–747. PMID 3395203
  13. ^HRSD-7: 7-ITEM HAMILTON RATING SCALE FOR DEPRESSION: HAMD-7Archived 2007-07-05 at the Wayback Machine. inOfficial website of CANMAT: Canadian Network for Mood and Anxiety TreatmentsArchived 2008-06-24 at the Wayback Machine. Accessed June 30, 2008, and McIntyre R, Kennedy S, Bagby RM, Bakish DJ (2002) Assessing full remission. Journal of Psychiatry and Neuroscience27: 235–239 PMID 12174732
  14. ^HRSD-21: The Hamilton Rating Scale for Depression (to be administered by a health care professional) (presented as a service by GlaxoWellcome, February 1997) inUMass HealthNet: Consumer Health Resources for Massachusetts Residents: Official website of the Lamar Soutter Library, University of Massachusetts Medical School, Worcester, MA, 01655 USA. Retrieved June 27, 2008.
  15. ^HRSD-24: Hamilton Depression Rating Scale - 24 item (to be completed by a trained clinician) inFOCUS ON ALZHEIMER'S DISEASE: MEDAFILE; Site constructed and maintained by J. Wesson Ashford, M.D., Ph.D., Stanford / VA Alzheimer's Center, Palo Alto VA Hospital, 3801 Miranda Way, Palo Alto, CA 94304 USA. Retrieved June 27, 2008.
  16. ^HRSD-29: Williams JBW, Link MJ, Rosenthal NE, Terman M, Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (SIGHSAD). New York Psychiatric Institute, New York, 1988
  17. ^Wechsler H, Grosser GH, Busfield BL Jr (1963) The depression rating scale: a quantitative approach to the assessment of depressive symptomatology. Archives of General Psychiatry.9: 334–343 PMID 14045262
  18. ^Raskin A, Schulterbrandt J, Reatig N, McKeon JJ (1969) Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives. Journal of Nervous and Mental Diseases148: 87–98 doi:10.1097/00005053-196901000-00010PMID 5768895
  19. ^Inventory of Depressive Symptomatology (IDS) & Quick Inventory of Depressive Symptomatology (QIDS)inIDS/QIDS: Instruments in English and Multiple Translations by the University of Pittsburgh Epidemiology Data Center, 2008. Retrieved June 27, 2008.
  20. ^Psychiatric Rating Scales for Depressioninwww.neurotransmitter.net website by Shawn M. Thomas. Retrieved June 30, 2008.
  21. ^Boyle, G.J. (1985). Self report measures of depression: Some psychometric considerations. British Journal of Clinical Psychology, 24, 45–59.

External links[edit]

  • HRSD online calculator
  • "The Hamilton Rating Scale for Depression"(PDF).  (49.0 KB)
  • Clinically Useful Psychiatric Scales: HAM-D (Hamilton Depression Rating Scale). Accessed March 6, 2009.
  • Hamilton Depression Rating Scale - Original scientific paper published in 1960inPsychiatry out of Print website. Accessed June 27, 2008.
  • Commentary on the HRSD by Max Hamilton, July 10, 1981, in "This Week's Citation Classic", Current Contents33: 325 (August 17, 1981), inwebsite of Eugene Garfield, Ph.D.. Accessed June 27, 2008.
  • Side-by-side comparison of the MADRS and the HDRS-24 in"Description of the Hamilton Depression Rating Scale (HAMD) and the Montgomery-Asberg Depression Rating Scale (MADRS) by the U.S. Food and Drug Administration, 2007. Accessed June 27, 2008.

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