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.
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.
How the MADRS was developed
The MADRS was developed by Stuart Montgomery and Marie Åsberg at St George's Hospital London in 1979 (British Journal of Psychiatry, 1979). It was designed as a deliberate improvement on the HAM-D — Montgomery and Åsberg noticed that HAM-D's heavy weighting of somatic and sleep items made it insensitive to medication response, because these items don't change much in the first 2-3 weeks of antidepressant treatment while mood and cognitive items do.
The 10 items were selected from a pool of 65 by identifying which items were most likely to change with successful treatment. This makes MADRS particularly useful for medication trials and early treatment monitoring.
Subsequent validation confirmed that MADRS detects antidepressant response 1-2 weeks earlier than HAM-D and shows larger effect sizes for treatment vs placebo across most modern antidepressant classes. It has become the preferred outcome measure in modern depression trials — every major ketamine, esketamine, and psilocybin depression trial uses MADRS as primary outcome.
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. The CBT Thought Record is first-line. 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 early sensitivity makes it particularly useful for identifying non-response by week 4.
After the MADRS
- Track over time. Retake every 2 weeks during medication initiation. MADRS response often visible by week 2 — earlier than PHQ-9 or HAM-D.
- 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.
Frequently Asked Questions
- How accurate is the MADRS?
- The MADRS has excellent psychometric properties — internal consistency around 0.85-0.90, high inter-rater reliability (intraclass correlations 0.90+ when raters are trained), and demonstrated sensitivity to antidepressant response. Multiple studies show MADRS detects medication response 1-2 weeks earlier than HAM-D. It has been used in essentially every SSRI and SNRI trial since the 1990s and is the preferred outcome measure in ketamine and psilocybin depression trials of the current era.
- 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?
- Yes. The MADRS has been used in Indian psychiatric practice and research since the 1990s, with validated translations in Hindi, Kannada, Tamil, and Marathi. It is used at NIMHANS, AIIMS, and Cadabams — particularly in medication trials and specialist depression clinics where sensitivity to early response matters.
- 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.