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Hamilton Depression Rating Scale, 17 item (HAM-D-17)

The HAM-D-17 is a simple, clinician-administered tool used to assess symptoms of depression experienced by a patient in the past week. The HAM-D-17 is one of the most widely used depression severity rating scales in the world.
Description: The HAM-D-17 is a simple, clinician-administered tool used to assess symptoms of depression experienced by a patient in the past week. The HAM-D-17 is one of the most widely used depression severity rating scales in the world.
Disease States: Major depressive disorder
Validated Uses: Treatment Monitoring & Evaluation, Symptom Severity
Populations: Adult, Geriatric
Administration Method: Clinician-report
Time to administer: 16–30 minutes
Commonly used in: Clinical Trials & Research, Clinical Practice
Detailed Description: The original and most widely used version of the Hamilton Depression Scale consists of 17 items, each rated on a 0–2 or 0–4 scale according to severity.1,4 Originally developed for use in hospital inpatients, the HAM-D-17 emphasizes the melancholic and physical symptoms of depressive disorders.5 The scale is not intended for diagnostic purposes, but rather to quantify the severity of symptoms present in a patient who already has a depressive disorder diagnosis.1 For the HAM-D-17, a score of 0–7 is generally accepted as within normal limits (or in clinical remission).5 A score of 20 or higher indicates at least moderate severity and is usually required for entry into a clinical trial.3,5 While the scale was originally designed for completion after an unstructured clinical interview, there are now semi-structured interview guides available.1,5,7

hamilton-depression-scale-17-(1).png
Scale Validity: According to a validation study conducted in 70 adult patients with depressive symptoms, inter-rater reliability of the HAM-D-17 is approximately 90%.1
Alternative Versions: Numerous versions with varying lengths exist, including HAM-D-17 (described here), HAM-D-21, HAM-D-24, HAM-D-29, HAM-D-6, HAM-D-7, and HAM-D-8.5 The 21-item version (HAM-D-21) includes 4 additional items intended to subtype the depression: diurnal variation, derealization, paranoid symptoms, and obsessional symptoms.13 The 24-item version includes the same 21 items, along with items assessing helplessness, hopelessness, and worthlessness.13 Please note that the HAM-D and all its iterations are sometimes referred to by the acronym HDRS.5
Cited Limitations: Despite its universal use and the widespread belief that the HAM-D-17 is the “gold standard” for measuring depression severity, some researchers claim that the tool is both conceptually and psychometrically flawed.9 For example, because of its emphasis on somatic symptoms, the HAM-D-17 can exaggerate depression severity in patients who have a concurrent medical illness.4,14 Additional limitations of the HAM-D-17 include its failure to assess atypical symptoms of depression (e.g., hypersomnia, hyperphagia)5 and its tendency to confound the intensity and frequency of symptoms.1 Finally, the HAM-D-17 is not well suited to use in bipolar depression due to the atypical symptom presentation that sometimes occurs in these patients.5,15

Footnotes:

Although the original 17-item version of the HAM-D is described here, we include information about alternative versions for your general awareness and convenience. You may see these alternative versions used by different practitioners or in clinical trial or research settings.

Supporting references for the filters are as follows:
Disease States: Major depressive disorder1-3; Validated Uses: Treatment Monitoring & Evaluation1,3-5, Symptom Severity3-5; Populations: Adult3,5-7, Geriatric8; Administration Method: Clinician-report1,3,5; Time to administer: 16–30 minutes5; Commonly used in: Clinical Trials & Research9-11, Clinical Practice6,9,12

References:

  1. Hamilton, M. J Neurol Neurosurg Psychiatry. 1960;23:56-62.
  2. Hamilton, M. Br J Soc Clin Psychol. 1967;6(4):278-296.
  3. Zimmerman, M et al. J Affect Disord. 2013;150(2):384-388.
  4. Rush, AJ et al. Handbook of Psychiatric Measures.  (American Psychiatric Publishing, Inc., 2008).
  5. Lam, R et al. Assessment Scales in Depression, Mania and Anxiety.  (Taylor & Francis Group, 2005).
  6. Trivedi, MH et al. Am J Psychiatry. 2006;163(1):28-40.
  7. Williams, JB. Arch Gen Psychiatry. 1988;45(8):742-747.
  8. Onega, LL & Abraham, IL. Int J Geriatr Psychiatry. 1997;12(7):760-764.
  9. Bagby, RM et al. Am J Psychiatry. 2004;161(12):2163-2177.
  10. Major Depressive Disorder: Developing Drugs for Treatment (Guidance for Industry). 2018. Food and Drug Administration. Silver Spring, MD.
  1. American Psychiatric Association. 2010. Practice Guideline for the Treatment of Patients With Major Depressive Disorder
  2. Malhi, GS et al. Acta Psychiatr Scand Suppl. 2009(439):8-26.
  3. Williams, JB. Eur Arch Psychiatry Clin Neurosci. 2001;251 Suppl 2:II6-12.
  4. Linden, M et al. Acta Psychiatr Scand. 1995;92:150-154.
  5. Sung, G et al. J Affect Disord. 2012;136(3):425-429.

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