MDCalc

Montgomery-Asberg Depression Rating Scale (MADRS)

Stratifies severity of depressive episodes in adults.

Use in adults only (≥18 years). Rate based on clinical interview with the patient. Use clinical judgment to determine whether the rating lies on the defined scale steps (0, 2, 4, 6 points) or between them (1, 3, 5 points, denoted as "(Worsening symptoms)").

Rate each of the following based on clinical interview with the patient:

Apparent sadness
Despondency, gloom, and despair (more than just ordinary transient low spirits), reflected in speech, facial expression, and posture; rate by depth and inability to brighten up
Reported sadness
Reports of depressed mood, regardless of whether it is reflected in appearance or not; includes low spirits, despondency, or the feeling of being beyond help and without hope
Inner tension
Feelings of ill-defined discomfort, edginess, inner turmoil, mental tension mounting to either panic, dread, or anguish; rate by intensity, frequency, duration, and extent of reassurance called for
Reduced sleep
Experience of reduced duration or depth of sleep compared to the patient's own normal pattern when well
Reduced appetite
Feeling of loss of appetite; rate by loss of desire for food or the need to force oneself to eat
Concentration difficulty
Difficulties in collecting one’s thoughts mounting to incapacitating lack of concentration; rate by intensity, frequency, and degree of incapacity produced
Lassitude
Difficulty getting started or slowness initiating and performing everyday activities
Inability to feel
Subjective experience of reduced interest in the surroundings or activities that normally give pleasure; the ability to react with adequate emotion to circumstances or people is reduced
Pessimistic thoughts
Thoughts of guilt, inferiority, self reproach, sinfulness, remorse, and ruin
Suicidal thoughts
Feeling that life is not worth living, that a natural death would be welcome, suicidal thoughts, and the preparations for suicide; suicidal attempts should not in themselves influence the rating

Result:

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Management

Always consider the patient’s entire clinical picture when assessing a depressive episode, as this tool is not diagnostic for depression. It can supplement clinical assessment and assist in trending a patient’s symptoms to determine therapeutic response.

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