MADRS Test — Montgomery-Åsberg Depression Rating Scale (10-Item Clinical Assessment)
The clinician-administered depression scale designed to detect medication response — 10 items, 5 minutes, instant clinical 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 MADRS includes a question about thoughts of self-harm (question 10). 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 10 MADRS items
Each item is scored 0-6, with anchor descriptions at 0, 2, 4, and 6 to guide the rater. Scores in between (1, 3, 5) are used when severity falls between anchors.
The 10 items:
- Apparent sadness — observed sadness reflected in speech, facial expression, and posture
- Reported sadness — reports of depressed mood, low spirits, hopelessness
- Inner tension — feelings of ill-defined discomfort, edginess, inner turmoil, mental pain
- Reduced sleep — reduced sleep compared to normal — shorter duration or shallower
- Reduced appetite — feeling of loss of appetite compared to normal
- Concentration difficulties — difficulty collecting thoughts, focusing, needing to re-read
- Lassitude — difficulty getting started or slowness in initiating daily activities
- Inability to feel — reduced interest in the surroundings, activities that normally give pleasure
- Pessimistic thoughts — guilt, self-reproach, self-depreciation, sinfulness, remorse, ruin
- Suicidal thoughts — the feeling that life is not worth living, thoughts of suicide, preparations (safety item — see crisis information above)
Total ranges 0-60.
MADRS severity band table
| Score | Severity | What it means | Suggested next step |
|---|---|---|---|
| 0-6 | Normal / no depression | Symptoms typical for everyday life | Continue self-monitoring |
| 7-19 | Mild depression | Symptoms present but functioning largely intact | Lifestyle, therapy if persistent; retake in 2-4 weeks |
| 20-34 | Moderate depression | Symptoms causing impairment | Clinical evaluation; therapy + consider medication |
| 35-60 | Severe depression | Significant symptoms and impairment | Urgent clinical evaluation; intensive treatment |
Special rule: any response above 0 on Item 10 (suicidal thoughts) requires same-day clinical contact regardless of total score.
These grades describe severity; they are not a diagnosis. For what depression is and the treatment options, read our depression guide.
How the MADRS was developed
The MADRS was developed by Stuart Montgomery and Marie Åsberg and published in the British Journal of Psychiatry in 1979. Their goal was a depression scale that was particularly sensitive to treatment effects, so that clinical trials could detect whether an antidepressant was working.
They started from ratings of English and Swedish patients on a 65-item psychopathology scale, identified the 17 symptoms that occurred most often in depression, and then kept the 10 items that showed the largest change with treatment. This makes MADRS particularly useful for medication trials and treatment monitoring, and it has become a common primary outcome in modern antidepressant research, including trials of rapid-acting treatments.
Validation and evidence
In the 1979 development study, inter-rater reliability was high, MADRS scores correlated significantly with the Hamilton Rating Scale, and the MADRS distinguished antidepressant responders from non-responders better than the Hamilton scale, which is why it is described as more sensitive to change. The severity grades used on this page (0-6, 7-19, 20-34, 35+) come from grade scores published by Snaith and colleagues in 1986. A 2017 equipercentile-linking analysis of 22 mirtazapine trials (3,288 patients) tied MADRS scores to clinicians' global ratings: a 48-57% reduction from baseline corresponded to much improved, and near-complete absence of symptoms corresponded to a total below 8. In India, a commentary on rating scales in Indian trials suggested the MADRS's emphasis on mood and cognitive symptoms may suit urban patients and called for validated translations; we could not verify a published Indian-language validation.
References
- Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382-389. PubMed
- Snaith RP, Harrop FM, Newby DA, Teale C. Grade scores of the Montgomery-Asberg Depression and the Clinical Anxiety Scales. Br J Psychiatry. 1986;148:599-601. PubMed
- Leucht S, Fennema H, Engel RR, et al. What does the MADRS mean? Equipercentile linking with the CGI using a company database of mirtazapine studies. J Affect Disord. 2017;210:287-293. 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
MADRS vs other depression scales
| Test | Items | Time | Administered by | Best for |
|---|---|---|---|---|
| MADRS | 10 | 5 min | Clinician (self-admin adapted) | Medication response tracking — early sensitivity |
| HAM-D | 17 | 8 min | Clinician | Severity + historical continuity with older literature |
| 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 |
Use MADRS when medication response tracking is the goal, especially in patients with physical comorbidities. Use HAM-D for historical continuity. Use PHQ-9 for self-report weekly tracking.
When to act on your MADRS result
- 0-6: No action. Retake if life circumstances change.
- 7-19 (mild): Behavioural activation, sleep hygiene, mindfulness. Talk therapy for depression and the CBT Thought Record are good starting points. Retake in 2-4 weeks.
- 20-34 (moderate): Clinical evaluation. CBT + consider antidepressant. Book a Mindtalk psychiatrist or psychologist. Consider the 90-day Emotional Reset programme.
- 35-60 (severe): Urgent clinical evaluation. Full assessment for MDD subtype, treatment planning, and consideration of intensive treatment options.
- Item 10 positive: Same-day clinical contact regardless of total. Crisis helplines listed at top.
- Elevated MADRS despite on-medication: consider dose adjustment, augmentation, or switch. MADRS's sensitivity to change makes it useful for spotting non-response early.
After the MADRS
- Track over time. Retake every 2 weeks during medication initiation so your clinician can see the trend.
- Pair with self-report. Use PHQ-9 for weekly self-monitoring alongside MADRS for bi-weekly clinician review.
- Screen bipolar spectrum. If depression is recurrent or antidepressants haven't worked, take MDQ to screen for bipolar depression — antidepressant monotherapy in undetected bipolar can trigger mania.
- Structured programme. The 90-day Emotional Reset programme suits MADRS 15-30 range.
- Book a specialist. Mindtalk's psychiatrists with medication-response expertise treat depression across Bangalore, Hyderabad, Mysore, and online for anywhere in India.
How to take the MADRS
- 1
Open the MADRS in the Mindtalk app
Tap "Take the MADRS" to open the self-administered adaptation. You will need a free Mindtalk account — sign-in takes under a minute.
- 2
Answer the 10 items
Rate each of the 10 items on a 0-6 scale over the past week. Each item has anchor descriptions at 0, 2, 4, and 6 to guide scoring. Take your time on Item 10, which screens for suicidal thoughts.
- 3
Get your total, item-level breakdown, and severity band
Receive a total 0-60 score, item-level breakdown, severity band, and a personalised next-step recommendation. If you flag Item 10, 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 →HAM-D / HDRS-17
The clinician-administered depression severity gold standard since 1960. 17 items, 8 minutes, instant score 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 MADRS?
- In the original 1979 study, inter-rater reliability was high, scores correlated significantly with the Hamilton scale, and the MADRS separated antidepressant responders from non-responders better than the Hamilton scale did. A 2017 analysis of 22 drug trials (3,288 patients) found that a 50% drop in MADRS score matched what clinicians rate as much improved. It is designed for trained clinician raters; self-administered adaptations are a guide, not a clinical rating.
- MADRS vs HAM-D — which should I take?
- MADRS is preferred when: (1) you have physical illness that would inflate HAM-D's somatic items (thyroid, chronic pain, GI conditions, cardiovascular disease); (2) you're tracking early treatment response and want the more sensitive scale; (3) research or clinical protocols require MADRS specifically (increasingly common). HAM-D is preferred when: (1) you want the historical continuity with 60 years of trial literature; (2) somatic symptoms of depression are a key clinical target; (3) your clinician team is more trained on HAM-D.
- What are the MADRS severity bands?
- Standard bands are: 0-6 = normal / no depression, 7-19 = mild depression, 20-34 = moderate depression, 35+ = severe depression. Clinical remission is defined as MADRS ≤ 10; treatment response as 50% reduction from baseline. These definitions are used in most modern antidepressant trials and treatment guidelines.
- Why is Item 10 (suicidal thoughts) so important?
- Item 10 asks about suicidal ideation, scored 0 = enjoys life or takes it as it comes, 2 = weary of life, only fleeting thoughts, 4 = probably better off dead, considers suicide but no specific plans, 6 = explicit plans for suicide when opportunity arises. Any response above 0 requires same-day clinical contact regardless of total MADRS score. A MADRS of 12 with Item 10 = 4 is more clinically urgent than a MADRS of 28 with Item 10 = 0.
- Is the MADRS validated in India?
- The MADRS is used in Indian psychiatric practice and in antidepressant trials run in India, including at Cadabams. Indian psychiatrists writing on rating scales suggested its focus on mood and thinking symptoms may suit urban patients, while the HAM-D's physical-symptom focus may suit others, and called for validated translations. We could not verify a published Indian-language validation study.
- How do you calculate a MADRS score?
- Rate each of the 10 items from 0 to 6, using the descriptions at 0, 2, 4 and 6 as anchors, then add them up for a total of 0 to 60. Grade scores: 0-6 normal, 7-19 mild, 20-34 moderate, 35-60 severe. The Mindtalk app does the calculation for you and shows the item breakdown.
- Should I take MADRS if I already track PHQ-9?
- MADRS adds value when you're on medication and want earlier detection of response than PHQ-9 alone. PHQ-9 is a self-report screener designed for primary care; MADRS is clinician-administered and more sensitive to early antidepressant effect. Recommended combination: PHQ-9 weekly for self-tracking + MADRS at each clinical visit for treatment planning.
- How do I take the MADRS?
- Click 'Take the MADRS'. Complete the 10 items (4-5 minutes), 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.