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Montgomery-Åsberg Depression Rating Scale (MADRS)

The MADRS is a 10-item, clinician-rated questionnaire used to evaluate the severity of depressive episodes in patients given a diagnosis of a mood disorder.
Description: The MADRS is a 10-item, clinician-rated questionnaire used to evaluate the severity of depressive episodes in patients given a diagnosis of a mood disorder.
Disease States: Bipolar disorder, 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
Detailed Description: The MADRS is a clinician-rated scale used to measure emotional and depressive symptoms in patients with mood disorders, including major depressive disorder and bipolar depressive episodes.1,5,7 The scale includes 10 symptom-based items assessing apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts.1,5 Each item is rated on a scale from 0–6.4,5 Scores are then summed to yield a total score ranging from 0 (none/absent) to 60 (most severe).4,5 Designed to be sensitive to change, the MADRS total score should be tracked longitudinally over time as a measurement of treatment response.1 A score of 12 or less has been used to identify patients in remission.12
Scale Validity: In a validation study of 51 patients with mood disorders, the MADRS demonstrated high inter-rater reliability, ranging from 0.71 to 0.93 for all 10 items.13
Alternative Versions: The MADRS has been modified for use in pediatric and adolescent populations.14 This version was designed to be filled out by parents and is commonly known as the MADRS-P.14 A 9-item, self-report version of the MADRS (MADRS-S) has also been developed.4,12,15 MADRS-S has demonstrated utility in both bipolar disorder and major depressive disorder and is recommended for monitoring antidepressant treatment effects.12,15
Cited Limitations: A limitation of the MADRS is its failure to include common depressive symptoms such as feelings of worthlessness, anhedonia, and motor retardation.16 Atypical symptoms of major depressive disorder such as hyperphagia or hypersomnia are similarly not included,16 which may make the MADRS less appropriate for assessing bipolar depression.8,16 MADRS cannot be used to discern between depressive symptoms due to major depressive disorder versus bipolar disorder.3,8

Footnotes:

Supporting references for the filters are as follows:
Disease States: Bipolar disorder1-5, Major depressive disorder1,3,4; Validated Uses: Treatment Monitoring & Evaluation1,6, Symptom Severity6,7; Populations: Adult1,3,4,7,8, Geriatric9; Administration Method: Clinician-report1,5; Time to administer: 16–30 minutes; Commonly used in: Clinical Trials & Research2,5,10,11

References:

  1. Montgomery, SA & Asberg, M. Br J Psychiatry. 1979;134:382-389.
  2. Tohen, M et al. Clinical trial design challenges in mood disorders.  (Elsevier Inc., 2015).
  3. Benazzi, F. Psychiatry and Clin Neurosciences. 1999;53:429-431.
  4. Bondolfi, G et al. J Affect Disord. 2010;121(3):268-272.
  5. Psychopharmacol Bull. 2017;47(3):77-109.
  6. Davidson, J et al. Acta Psychiatr Scand. 1986;73(5):544-548.
  7. Müller, M. Journal of Affective Disorders. 2003;77(3):255-260.
  8. Carneiro, AM et al. Health Qual Life Outcomes. 2015;13:42.
  9. Heo, M et al. Am J Geriatr Psychiatry. 2007;15(10):899-905.
  10. American Psychiatric Association. 2010. Practice Guideline for the Treatment of Patients With Major Depressive Disorder
  1. Major Depressive Disorder: Developing Drugs for Treatment (Guidance for Industry). 2018. Food and Drug Administration. Silver Spring, MD.
  2. Fantino, B & Moore, N. BMC Psychiatry. 2009;9:26.
  3. Williams, JB & Kobak, KA. Br J Psychiatry. 2008;192(1):52-58.
  4. Torres Soler, C et al. Nord J Psychiatry. 2018;72(3):184-190.
  5. Svanborg, P & Asberg, M. J Affect Disord. 2001;64(2-3):203-216.
  6. Berk, M et al. Acta Psychiatr Scand Suppl. 2004(422):39-45.

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