1. Depressed Mood (Sadness, Hopelessness, Helplessness, Worthlessness)

0 — Absent+01 — Only on questioning (gloomy attitude, pessimistic about future)+12 — Spontaneously expressed in speech+23 — Communicated nonverbally (facial expression, posture, voice, crying)+34 — Almost exclusively communicated this way; spontaneous and persistent+4

2. Guilt

0 — Absent+01 — Self-reproach; feels they have let others down+12 — Ideas of guilt or rumination over past errors/sinful behavior+23 — Present illness is a punishment; delusions of guilt+34 — Hears accusatory/denunciatory voices; experiences visual threatening hallucinations+4

3. Suicidal Ideation

0 — Absent+01 — Feels life is not worth living+12 — Wishes they were dead or thinks about possible death to self+23 — Suicidal ideas or gesture+34 — Serious attempt at suicide+4

4. Insomnia — Early Night (Difficulty Falling Asleep)

0 — No difficulty+01 — Occasional difficulty (> 30 min to fall asleep)+12 — Nightly difficulty falling asleep+2

5. Insomnia — Middle Night (Waking During Night)

0 — No difficulty+01 — Restless and disturbed sleep; wakens during night+12 — Waking during night; any getting up from bed (except for toilet) = 2+2

6. Insomnia — Late Night (Early Morning Wakening)

0 — No difficulty+01 — Wakes earlier than average but goes back to sleep+12 — Unable to fall asleep again after waking+2

7. Work and Activities

0 — No difficulty+01 — Thoughts and feelings of incapacity, fatigue or weakness related to work; loss of interest+12 — Loss of interest in activities (directly by patient or indirectly in listlessness, indecision, vacillation)+23 — Decrease in actual time spent in activities or decrease in productivity+34 — Stopped working because of present illness (hospital admission only if patient NOT admitted)+4

8. Psychomotor Retardation (Slowness of Thought, Speech, Impaired Concentration, Decreased Motor Activity)

0 — Normal speech and thoughts+01 — Slight retardation at interview+12 — Obvious retardation at interview+23 — Interview difficult+34 — Complete stupor (patient immobile and unresponsive)+4

9. Agitation

0 — None+01 — Fidgetiness+12 — Playing with hands, hair, etc.+23 — Moving about; can't sit still+34 — Hand-wringing, nail-biting, hair-pulling, biting of lips+4

10. Anxiety — Psychic (Subjective Anxiety)

0 — No difficulty+01 — Subjective tension and irritability+12 — Worrying about minor matters; tension+23 — Apprehensive attitude apparent in face or speech+34 — Fears expressed without questioning+4

11. Anxiety — Somatic (Physiological Concomitants of Anxiety)

12. Somatic Symptoms — Gastrointestinal

0 — None+01 — Loss of appetite but eating without encouragement; heavy feeling in abdomen+12 — Difficulty eating without urging; requests or requires laxatives or medication for bowel or GI symptoms+2

13. Somatic Symptoms — General

0 — None+01 — Heaviness in limbs, back, or head; diffuse backache; loss of energy, fatigability+12 — Any clear-cut symptoms rated 2+2

14. Genital Symptoms (Loss of Libido, Menstrual Disturbance)

0 — Absent+01 — Mild+12 — Severe+2

15. Hypochondriasis

0 — Not present+01 — Self-absorption (bodily)+12 — Preoccupation with health+23 — Frequent complaints, requests for help, etc.+34 — Hypochondriacal delusions+4

16. Weight Loss (Rate A or B)

0 — No weight loss+01 — Probable weight loss associated with present illness+12 — Definite (patient-reported) weight loss+2

17. Loss of Insight

0 — Acknowledges being depressed and ill+01 — Acknowledges illness but attributes cause to bad food, climate, overwork, virus, need for rest, etc.+12 — Denies being ill at all+2

Hamilton Depression Rating Scale (HAM-D 17)

Hamilton Depression Rating Scale (HAM-D 17)