Hamilton Depression Scale (HAM-D) Assessment

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Depressed mood (sadness, hopeless, helpless, worthless)

How often have you felt sad or hopeless recently?

Absent

These feelings indicate only if asked

These feelings are spontaneously reported verbally

Communicated non-verbally (e.g., through facial expression, posture, voice)

Patient reports virtually only these feelings in spontaneous communication

Feelings of guilt

How often have you felt guilty or blamed yourself recently?

Absent

Self-reproach, feels he/she has let people down

Ideas of guilt or rumination over past errors or sinful deeds

Present illness is a punishment; delusions of guilt

Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations

Suicide

How often have you had thoughts of suicide or self-harm?

Absent

Feels life is not worth living

Wishes he/she were dead or any thoughts of possible death to self

Suicidal ideas or gestures

Attempts at suicide (any serious attempt rates 4)

Insomnia - Early in the night

Do you have difficulty falling asleep at night?

No difficulty falling asleep

Complaints of occasional difficulty falling asleep

Complaints of nightly difficulty falling asleep

Insomnia - Middle of the night

Do you wake up in the middle of the night and have trouble returning to sleep?

No difficulty

Patient complains of being restless and disturbed during the night

Waking during the night—any getting out of bed rates 2 (except for purposes of voiding)

Insomnia - Early hours of the morning

Do you wake up earlier than usual and can't get back to sleep?

No early morning awakening

Waking in early hours but goes back to sleep

Unable to fall asleep again if he/she gets out of bed

Work and activities

How much has your work or daily activities been affected by your mood?

No difficulty

Thoughts and feelings of incapacity, fatigue or weakness related to activities, work or hobbies

Loss of interest in activity, hobbies or work—either directly reported by patient, or indirect in listlessness, indecision and vacillation (feels he/she has to push self to work or activities)

Decrease in actual time spent in activities or decrease in productivity

Stopped working because of present illness

Retardation (slowness of thought and speech; impaired ability to concentrate, decreased motor activity)

Have you noticed any slowness in your thinking or movements?

Normal speech and thought

Slight retardation at interview

Obvious retardation at interview

Interview difficult

Complete stupor

Agitation

Have you felt restless or unable to sit still?

None

Fidgetiness

Playing with hands, hair, etc.

Moving about, can't sit still

Hand-wringing, nail biting, hair-pulling, biting of lips

Anxiety (psychic)

Have you experienced any psychological symptoms of anxiety, such as worry or tension?

No difficulty

Subjective tension and irritability

Worrying about minor matters

Apprehensive attitude apparent in face or speech

Fears expressed without questioning

Anxiety (somatic)

Have you experienced physical symptoms of anxiety, such as sweating, trembling, or rapid heartbeat?

None

Mild

Moderate

Severe

Somatic symptoms - Gastrointestinal

Have you had any gastrointestinal symptoms, such as loss of appetite, indigestion, or nausea?

None

Loss of appetite but eating without encouragement. Heavy feeling in abdomen.

Difficulty eating without help. Requests or requires laxatives or medication for bowels

Somatic symptoms - General

Have you had any general physical symptoms, such as fatigue or aches?

None

Heaviness in limbs, back or head; backaches, headaches, muscle aches; loss of energy and fatigability

Any clear-cut symptom

Genital symptoms

Have you experienced any changes in your sexual interest or function?

No symptoms

Loss of libido

Menstrual disturbances

Hypochondriasis

Are you excessively concerned about your health?

Not present

Self-absorption (bodily)

Preoccupation with health

Frequent complaints, requests for help, etc.

Hypochondriacal delusions

Loss of weight

Have you experienced any weight loss recently?

No weight loss

Probable weight loss associated with present illness

Definite (according to patient) weight loss

Not assessed

Insight

Do you recognize that you may be experiencing symptoms of depression?

Acknowledges being depressed and ill

Acknowledges illness but attributes cause to bad food, climate, overwork, virus, need for rest, etc.

Denies being ill at all

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