HAM-D Test — Hamilton Depression Rating Scale (17-Item Clinical Depression Assessment)

The 17 HAM-D items

The scale asks you to rate each symptom's severity over the past week. Items are scored on 0-4 or 0-2 scales, depending on the item.

The 17 items:

1. Depressed mood (0-4) — sadness, hopelessness, gloomy attitude, tearfulness
2. Feelings of guilt (0-4) — self-reproach, ideas of guilt, delusions of guilt
3. Suicide (0-4) — feelings that life is not worth living, wishes for death, suicidal ideation, attempts (safety item — see crisis information above)
4. Insomnia — initial (0-2) — difficulty falling asleep
5. Insomnia — middle (0-2) — waking during the night
6. Insomnia — late (0-2) — waking early and unable to return to sleep
7. Work and activities (0-4) — thoughts of incapacity, decreased productivity
8. Retardation (0-4) — slowness of thought, speech, movement
9. Agitation (0-4) — restlessness, hand-wringing, hair-pulling
10. Anxiety — psychic (0-4) — subjective tension, irritability, worrying about minor matters
11. Anxiety — somatic (0-4) — physical anxiety symptoms (palpitations, GI, sweating)
12. Somatic symptoms — gastrointestinal (0-2) — loss of appetite, heaviness, constipation
13. Somatic symptoms — general (0-2) — heaviness in limbs, back, head; fatigability
14. Genital symptoms (0-2) — loss of libido, menstrual disturbances
15. Hypochondriasis (0-4) — self-absorption in body, preoccupation with health
16. Loss of weight (0-2) — clear weight loss reported / observed
17. Insight (0-2) — acknowledges being depressed / denies illness

Total ranges 0-53.

HAM-D severity band table

Score	Severity	What it means	Suggested next step
0-7	No / minimal	Symptoms typical for everyday life	Continue self-monitoring
8-13	Mild	Symptoms present but functioning largely intact	Lifestyle, therapy if persistent; retake in 2-4 weeks
14-18	Moderate	Symptoms causing impairment	Clinical evaluation; CBT + consider antidepressant
19-22	Severe	Significant symptoms and impairment	Clinical evaluation this week; combination therapy usually indicated
23+	Very severe	Major symptoms, often impairing core function	Urgent clinical evaluation; intensive treatment

Special rule: any response other than 0 on Item 3 (suicide) requires same-day clinical contact regardless of total score. A HAM-D of 10 with Item 3 positive is more urgent than a HAM-D of 22 with Item 3 negative.

How the HAM-D was developed

The HAM-D was developed by Max Hamilton at the University of Leeds in 1960 — one of the earliest clinician-rated psychiatric severity scales. Hamilton designed it to standardise depression severity for the emerging RCT era of antidepressant pharmacotherapy. The 17-item structure with mixed 0-4 / 0-2 scoring reflects Hamilton's clinical judgment about which symptoms are most severity-differentiating.

The HAM-D has been the primary outcome measure in essentially every major antidepressant trial since the 1960s — TCAs (imipramine, amitriptyline), MAOIs, SSRIs (fluoxetine, sertraline, escitalopram, vortioxetine), SNRIs (venlafaxine, duloxetine), atypicals (mirtazapine, bupropion), and augmentation studies (lithium, quetiapine, aripiprazole).

Standard treatment definitions use HAM-D: response = 50% reduction from baseline; remission = HAM-D ≤ 7. These definitions from the HAM-D literature are used across depression treatment guidelines worldwide including the Indian Psychiatric Society and NIMHANS clinical protocols.

HAM-D vs other depression scales

Test	Items	Time	Administered by	Best for
HAM-D	17	8 min	Clinician (self-admin adapted)	Severity + antidepressant response tracking
MADRS	10	3 min	Clinician	Medication response — less confounded by somatic items
PHQ-9	9	3 min	Self-report	Screening + primary-care monitoring
BDI-II	21	5 min	Self-report	Cognitive depression severity
DASS-21 (Depression)	7	2 min	Self-report	Combined with anxiety + stress
EPDS	10	3 min	Self-report	Perinatal depression specifically

Use HAM-D for gold-standard severity and antidepressant tracking. Use MADRS instead if the patient has medical illness that would inflate HAM-D somatic items. Use PHQ-9 for weekly self-monitoring alongside clinician HAM-D review.

When to act on your HAM-D result

• 0-7: No action. Retake if life circumstances change.
• 8-13 (mild): Behavioural activation, sleep hygiene, mindfulness. The CBT Thought Record and Behavioural Activation are first-line. Retake in 2-4 weeks.
• 14-18 (moderate): Clinical evaluation. CBT is first-line; SSRI may be added. Book a Mindtalk psychiatrist or psychologist.
• 19-22 (severe): Clinical evaluation this week. Combined CBT + antidepressant often indicated. Consider the 90-day Depression-Anxiety-Stress journey programme.
• 23+ (very severe): Urgent clinical evaluation. Full assessment for MDD subtype, psychotic features, and treatment planning including inpatient consideration.
• Item 3 positive: Same-day clinical contact regardless of total. Crisis helplines listed at top.
• Rule out bipolar depression: If depression is severe or recurrent, pair HAM-D with MDQ to screen for bipolar spectrum. Antidepressant monotherapy in undetected bipolar depression can trigger switch to mania.

After the HAM-D

• Track over time. Retake every 2-4 weeks during treatment. Standard treatment targets: response = 50% reduction from baseline; remission = ≤7.
• Pair with self-report. Use PHQ-9 for weekly self-monitoring alongside HAM-D for monthly clinician review.
• Screen anxiety and mania. Take GAD-7 for anxiety (~60% comorbidity) and MDQ for bipolar spectrum if depression is recurrent or antidepressants have caused mixed features.
• Structured programme. The 90-day Emotional Reset programme suits HAM-D 8-18 range; Anxiety Loop Breaker for anxious depression.
• Book a specialist. Mindtalk's psychiatrists and psychologists treat depression across Bangalore, Hyderabad, Mysore, and online for anywhere in India.