HAM-D Test — Hamilton Depression Rating Scale (17-Item Clinical Depression Assessment)
The clinician-administered depression severity gold standard since 1960. 17 items, 8 minutes, instant score bands. Free in the Mindtalk app.
Clinically reviewed by Dr. Rangapriya Raghavan, CCT (Old Age Psychiatry), MRCPsych. Last reviewed 2026-09-25.
Important safety information
The HAM-D / HDRS-17 includes a question about thoughts of self-harm (question 3). If you have had any such thoughts recently, please reach out for support before or instead of taking this assessment — you do not need to take a test to deserve help.
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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:
- Depressed mood (0-4) — sadness, hopelessness, gloomy attitude, tearfulness
- Feelings of guilt (0-4) — self-reproach, ideas of guilt, delusions of guilt
- Suicide (0-4) — feelings that life is not worth living, wishes for death, suicidal ideation, attempts (safety item — see crisis information above)
- Insomnia — initial (0-2) — difficulty falling asleep
- Insomnia — middle (0-2) — waking during the night
- Insomnia — late (0-2) — waking early and unable to return to sleep
- Work and activities (0-4) — thoughts of incapacity, decreased productivity
- Retardation (0-4) — slowness of thought, speech, movement
- Agitation (0-4) — restlessness, hand-wringing, hair-pulling
- Anxiety — psychic (0-4) — subjective tension, irritability, worrying about minor matters
- Anxiety — somatic (0-4) — physical anxiety symptoms (palpitations, GI, sweating)
- Somatic symptoms — gastrointestinal (0-2) — loss of appetite, heaviness, constipation
- Somatic symptoms — general (0-2) — heaviness in limbs, back, head; fatigability
- Genital symptoms (0-2) — loss of libido, menstrual disturbances
- Hypochondriasis (0-4) — self-absorption in body, preoccupation with health
- Loss of weight (0-2) — clear weight loss reported / observed
- Insight (0-2) — acknowledges being depressed / denies illness
Total ranges 0-52 (nine items scored 0-4 plus eight items scored 0-2).
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.
These bands are one widely used convention, not a universal standard. In a study of 627 outpatients with major depression, the cut-offs that best separated clinician-judged mild, moderate and severe depression were 17 and 24, higher than the bands above. Read your band as a guide to severity, not a diagnosis. For what depression is and how it is treated, see our depression guide.
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 became the most widely used outcome measure in antidepressant trials from the 1960s onward, across tricyclics, MAOIs, SSRIs, SNRIs and augmentation studies.
Standard treatment definitions use HAM-D: response = 50% reduction from baseline; remission = HAM-D of 7 or below. These definitions are widely used in depression research and clinical practice.
Validation and evidence
Max Hamilton published the scale in 1960 in the Journal of Neurology, Neurosurgery and Psychiatry as a way for clinicians to quantify the severity of depression in patients already diagnosed with it. For decades it was the reference standard, but a 2004 American Journal of Psychiatry review of 70 psychometric studies concluded that, while overall internal reliability is adequate, many items contribute poorly to measuring severity, some items have poor inter-rater and retest reliability, and content validity is poor; its factor structure also fails to replicate well across samples. Severity bands have been debated too: a 2013 study of 627 outpatients found that cut-offs of 17 (mild vs moderate) and 24 (moderate vs severe) best matched clinician global severity ratings. In India, psychiatrists writing about rating scales in Indian trials noted that the HAM-D's weight on somatic symptoms may fit patients who express depression physically, and recommended validated translations. We could not verify a published Indian-language validation of the HAM-D.
References
- Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56-62. PubMed
- Bagby RM, Ryder AG, Schuller DR, Marshall MB. The Hamilton Depression Rating Scale: has the gold standard become a lead weight? Am J Psychiatry. 2004;161(12):2163-2177. PubMed
- Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord. 2013;150(2):384-388. PubMed
- Kuruvilla PK, Chandran HS, Chengappa KN. A commentary on the use of depression rating scales in clinical trials conducted in India. Asian J Psychiatr. 2009;2(1):3-5. PubMed
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. Cognitive behavioural therapy (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.
How to take the HAM-D / HDRS-17
- 1
Open the HAM-D in the Mindtalk app
Tap "Take the HAM-D" to open the self-administered adaptation. You will need a free Mindtalk account — sign-in takes under a minute.
- 2
Answer the 17 items
Rate each depression symptom on the scale specified (0-4 or 0-2 depending on item) over the past week. Take your time on Item 3, which screens for suicidal ideation.
- 3
Get your total, subscale breakdown, and severity band
Receive a total 0-52 score, item-level breakdown, severity band, and a personalised next-step recommendation. If you flag Item 3, the app immediately surfaces same-day crisis support resources.
Related assessment guides
PHQ-9
A quick 3-minute self-check for depression using the PHQ-9 — the global clinical standard. Instant score, severity band, and next-step recommendation. Free in the Mindtalk app.
Read the guide →BDI-II (explained) → PHQ-9 (alternative)
The Beck Depression Inventory — the classic 21-item depression measure. Learn what it is, when to use it, and take the free PHQ-9 alternative in the Mindtalk app.
Read the guide →DASS-21
Measure depression, anxiety, and stress in a single 21-item scale. 4 minutes, three scores, instant clinical bands. Free in the Mindtalk app.
Read the guide →EPDS
The gold-standard postnatal depression screener. 10 questions, 3 minutes, instant score with clinical context. Free in the Mindtalk app.
Read the guide →MADRS
The clinician-administered depression scale designed to detect medication response — 10 items, 5 minutes, instant clinical bands. Free in the Mindtalk app.
Read the guide →MDQ
The Mood Disorder Questionnaire — the standard 13-item screener for bipolar spectrum. 3 minutes, instant screen result. Free in the Mindtalk app.
Read the guide →Frequently Asked Questions
- How accurate is the HAM-D?
- Its overall internal reliability is adequate, but a 2004 review of 70 psychometric studies found that several items contribute little to measuring severity, some have weak inter-rater or retest reliability, and content validity is poor. That is why many newer trials pair it with, or replace it by, the MADRS. It works best when rated by a trained clinician; self-administered adaptations are a guide, not a clinical rating. It remains useful for tracking change over time.
- HAM-D vs PHQ-9 vs MADRS — when to use which?
- PHQ-9: 9 items, 2-3 min, self-report, screener + treatment monitor for primary care. HAM-D: 17 items, 8 min, clinician-administered, severity + antidepressant response gold standard. MADRS: 10 items, 3 min, clinician-administered, more sensitive to medication response than HAM-D and less confounded by somatic symptoms — many recent trials use MADRS instead. Rule of thumb: PHQ-9 for screening, HAM-D or MADRS for formal severity, MADRS if the patient has physical illness that would inflate HAM-D somatic items.
- What are the HAM-D severity bands?
- Standard 17-item bands are: 0-7 no depression, 8-13 mild, 14-18 moderate, 19-22 severe, 23+ very severe. Clinical remission is typically defined as HAM-D ≤ 7; treatment response as 50% reduction from baseline. Different versions exist (HAM-D-6, HAM-D-21, HAM-D-24) with different score ranges — the 17-item is the most widely used and referenced.
- Why is Item 3 (suicide) so important?
- Item 3 asks about suicidal ideation and self-harm. It is scored 0-4: 0 = absent, 1 = feels life is not worth living, 2 = wishes for death, 3 = suicidal ideation or gesture, 4 = attempts at suicide. Any positive response requires same-day clinical contact regardless of total HAM-D score. A HAM-D of 10 with Item 3 = 3 is more clinically urgent than a HAM-D of 22 with Item 3 = 0. Also note: some antidepressants (SSRIs in adolescents, mixed evidence in adults) can transiently increase suicidal ideation in the first 2 weeks — track Item 3 weekly if starting or changing medication.
- Is the HAM-D validated in India?
- The HAM-D is widely used in Indian psychiatric practice and clinical trials, including at Cadabams. Because it is clinician-rated, it is usually administered by interview in the patient's own language. A commentary from Indian psychiatrists noted that its emphasis on physical symptoms may suit patients who describe depression in bodily terms, and called for formal translations to improve trial quality. We could not verify a published Indian-language validation study.
- Should I take the HAM-D if I already take a self-report scale like PHQ-9?
- Only if the additional information would change treatment planning. HAM-D adds richer somatic-symptom detail and a clinician-style severity rating. If you're starting or changing an antidepressant, HAM-D at baseline + week 2 + week 4 is a stronger signal than PHQ-9 alone. If treatment is stable and PHQ-9 shows clear response, HAM-D adds little.
- How do you score the HAM-D?
- Add the 17 item scores. Nine items are scored 0-4 and eight are scored 0-2, so the total runs from 0 to 52. Commonly used bands: 0-7 none, 8-13 mild, 14-18 moderate, 19-22 severe, 23+ very severe. Other published schemes differ slightly. In treatment, response usually means a 50% fall from the starting score and remission a score of 7 or below.
- What is the difference between HAM-D 17 and HAM-D 21?
- Hamilton's original scale had 21 items. The extra four describe the type of depression (for example, diurnal variation and paranoid or obsessional symptoms) rather than its severity, so standard scoring uses the first 17 items. Mindtalk's adaptation uses the 17-item version.
- How do I take the HAM-D?
- Click 'Take the HAM-D'. Complete the 17 items (6-8 minutes for the self-administered version), receive your total + item-level breakdown + severity band, and get a personalised next-step recommendation. Free in the Mindtalk app.
Need a clinician's read on your results?
A high score is a signal, not a diagnosis. Mindtalk's psychiatrists and clinical psychologists can interpret your results and recommend next steps — same-day appointments available.