What Is the Hamilton Depression Scale?

The first version of the HAM-D was developed in 1960 by Max Hamilton. Since that time, it’s become the most widely-used clinical interview assessment tool for determining how severe a person’s depression is.

Many different versions of the HAM-D exist. The original contains 17 areas of assessment, but there’s a later version that contains 21 questions.

The additional four areas are considered uncommon and unrelated to clinical depression severity. They were included, however, as a means of additional insight.

There are other modified versions, as well, ranging from just six assessments of core features to versions with more than 30 different scoring areas.

Despite the different versions available, the 17-symptom HAM-D remains the most commonly used.

The HAM-D scores specific features of depression, including:

1. depressed mood
2. feelings of guilt
3. suicide
4. insomnia when falling asleep
5. insomnia during the night
6. insomnia during the morning
7. work and interests
8. psychomotor impairment
9. agitation
10. psychological anxiety
11. physical symptoms of anxiety
12. gastrointestinal symptoms (appetite change)
13. general physical symptoms
14. sexual symptoms
15. hypochondriasis
16. weight loss
17. insight (awareness of depression)

In addition to these 17 areas, the original HAM-D looked at the following:

• diurnal variation (morning versus evening symptom severity)
• depersonalization and derealization (detachment from body)
• paranoia
• obsessions and compulsions

Each section of the HAM-D has a rating scale, some ranging from 0–4 and others ranging from 0–2.

While lower numbers do align with milder symptoms, how numbers are determined in each section depends on specific features present or absent during the interview.

Under “depressed mood,” for example, you’re assessed on how you communicate feelings of hopelessness, worthlessness, sadness, and helplessness.

You score a 1 if you agree you are experiencing these symptoms when questioned, and you score a 2 if you bring them up unprompted.

Nonverbal communication, like bouts of crying, may warrant a score of 3 or 4. If you communicate your symptoms both verbally and through nonverbal cues, you will still likely score a 4.

The assessment areas of the HAM-D are designed to be guided by a mental health professional. They require an advanced understanding of depression symptoms.

At the end of the assessment, your individual section scores are tallied:

• Score 0–7: No depression
• Score 8–12: Possible depression
• Score 13–17: Mild depression
• Score 18–24: Moderate depression
• Score 25–52: Severe depression

When is the HAM-D used?

The HAM-D is used after a diagnosis of depression.

It helps mental health professionals determine the severity of your depression and can be used to create individualized treatment plans and track progress.

The HAM-D is evidence-based, meaning the scientific literature backs it as an effective way to measure depression.

The HAM-D is considered effective “across the lifespan,” which means it can be used for people of all ages.

Because the symptoms of depression can appear differently in children, however, youth-specific rating scales are often used instead.

The Children’s Depression Rating Scale (CDRS), for instance, was adapted from the original HAM-D. It still covers 17 symptom areas but is intended for children ages 6–12.

The HAM-D is administered by a clinician, meaning the interview is performed by a mental health professional.

Clinical psychologists, clinical social workers, and licensed professional counselors are examples of mental health professionals who may regularly use the HAM-D. However, in some states, only doctoral-level clinicians (i.e., clinical psychologists) may be eligible to conduct these interviews.

Depression treatment often involves medication, psychotherapy, or a combination. Additionally, many people benefit from support groups and community services.

The type of psychotherapy used for depression treatment depends on your individual needs. Cognitive behavioral therapy (CBT) is a well-studied, effective therapeutic method in many depression treatment programs.

CBT helps you identify unhelpful thoughts and behaviors and then teaches you how to restructure your thinking into more beneficial patterns.

Other common psychotherapies for depression include interpersonal therapy and behavioral activation therapy.

If your symptoms are significantly impairing and affecting your daily life, or you’re experiencing suicidal ideation or thoughts of self-harm, medications can also help.

You may be prescribed:

• antidepressants
• antipsychotics
• mood stabilizers
• anti-anxiety medications

The HAM-D is a depression severity assessment used by mental health professionals to help guide your treatment and track progress.

Assessments like the HAM-D are supportive tools that help your therapist understand your unique experience of depression, which then helps determine which therapeutic approaches are best.