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Montgomery-Åsberg Depression Rating Scale (MADRS)

The Montgomery-Åsberg Depression Rating Scale (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 Montgomery-Åsberg Depression Rating Scale (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
Administration Method: Clinician-report
Time to administer: 15 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 to 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 The 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.9,16 The MADRS cannot be used to discern between depressive symptoms due to major depressive disorder versus bipolar disorder.3,9
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Footnotes:

Supporting references for the filters are as follows:
Disease States: Bipolar disorder,1-5 Major depressive disorder1,3,4; Validated Uses: Treatment Monitoring & Evaluation,1,6 Symptom Severity6,7; Administration Method: Clinician-report1,5; Time to administer: 15 minutes8; Commonly used in: Clinical Trials & Research2,5,9-11
 

This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient. 
 

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References:

  1. Montgomery SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382-389. doi:10.1192/bjp.134.4.382 
  2. Tohen M, Bowden CL, Nierenberg AA, Geddes JR. Clinical Trial Design Challenges in Mood Disorders. Elsevier; 2015. 
  3. Benazzi F. Course and outcome of bipolar II disorder: a retrospective study. Psychiatry Clin Neurosci. 1999;53:429-431. doi:10.1046/j.1440-1819.2001.00786.x 
  4. Bondolfi G, Jermann F, Van der Linden M, et al. Depression relapse prophylaxis with mindfulness-based cognitive therapy: replication and extension in the Swiss health care system. J Affect Disord. 2010;121(3):268-272. 
  5. Rating scales and safety measurements in bipolar disorder and schizophrenia - a reference guide. Psychopharmacol Bull. 2017;47(3):77-109. 
  6. Davidson J, Turnbull CD, Stickland R, Miller R, Graves K. The Montgomery-Asberg Depression Scale: reliability and validity. Acta Psychiatr Scand. 1986;73(5):544-548. doi:10.1111/j.1600-0447.1986.tb02723.x 
  7. Müller M, Himmerich H, Kienzle B, Szegedi A. Differentiating moderate and severe depression using the Montgomery-Asberg depression rating scale (MADRS). J Affect Disord. 2003;77(3):255-260. doi:1 0.1016/s0165-0327(02)00120-9 
  8. Carmody T, Rush AJ, Bernstein I, et al. The Montgomery Äsberg and the Hamilton ratings of depression: a comparison of measures. Eur Neuropsychopharmacol. 2006;16(8):601-611. doi:10.1016/j.euroneuro.2006.04.008 
  9. Carneiro AM, Fernandes F, Moreno RA. Hamilton depression rating scale and montgomery–asberg depression rating scale in depressed and bipolar I patients: psychometric properties in a Brazilian sample. Health Qual Life Outcomes. 2015;13:42. doi:10.1186/s12955-015-0235-3 
  10. American Psychiatric Association. Practice Guideline for the Treatment of Patients With Major Depressive Disorder. American Psychiatric Association; 2010. 
  1. Major Depressive Disorder: Developing Drugs for Treatment (Guidance for Industry). Food and Drug Administration; 2018.
  2. Fantino B, Moore N. The self-reported Montgomery-Åsberg depression rating scale is a useful evaluative tool in major depressive disorder. BMC Psychiatry. 2009;9:26. doi: 10.1186/1471-244X-9-26 
  3. Williams JB, Kobak KA. Development and reliability of a structured interview guide for the Montgomery Asberg Depression Rating Scale (SIGMA). Br J Psychiatry. 2008;192(1):52-58. doi:10.1192/bjp.bp.106.032532 
  4. Torres Soler C, Olofsdotter S, Vadlin S, Ramklint M, Nilsson KW, Sonnby K. Diagnostic accuracy of the Montgomery-Åsberg Depression Rating Scale parent report among adolescent psychiatric outpatients. Nord J Psychiatry. 2018;72(3):184-190. doi:10.1080/08039488.2017.1414873 
  5. Svanborg P, Asberg M. A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS). J Affect Disord. 2001;64(2-3):203-216. doi 10.1016/s0165-0327(00)00242-1 
  6. Berk M, Malhi GS, Mitchell PB, et al. Scale matters: the need for a Bipolar Depression Rating Scale (BDRS). Acta Psychiatr Scand Suppl. 2004(422):39-45. doi:10.1111/j.1600-0447.2004.00412.x 

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