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    Patent Pending

    Montgomery-Asberg Depression Rating Scale (MADRS)

    Stratifies severity of depressive episodes in adults.
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    INSTRUCTIONS

    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)").

    When to Use
    Pearls/Pitfalls
    Why Use

    Adult patients with suspected depression.

    • Unlike the Hamilton Rating Scale for Depression (HAM-D), does not assess sexual function, hypochondriasis, diurnal variation, or depersonalization, among others.

    • Not diagnostic for major depressive disorder; rather, can help stratify severity of depressive symptoms.

    • Highly sensitive (95% in cross-sectional studies in the general population), so may be helpful in ruling out depression (though not diagnostic of major depressive disorder).

    • Correlates well with other rating scales, such as the HAM-D.

    • High interrater reliability makes it useful in both clinical and research settings; can be used to stratify severity of depressive symptoms and for trending severity of a patient’s depressive episode.

    Rate each of the following based on clinical interview with the patient:
    No sadness
    0
    (Worsening symptoms)
    +1
    Looks dispirited but brightens up without difficulty
    +2
    (Worsening symptoms)
    +3
    Appears sad and unhappy most of the time
    +4
    (Worsening symptoms)
    +5
    Looks miserable all the time; extremely despondent
    +6
    Occasional sadness in keeping with circumstances
    0
    (Worsening symptoms)
    +1
    Sad or low but brightens up without difficulty
    +2
    (Worsening symptoms)
    +3
    Pervasive feelings of sadness or gloominess; mood still influenced by external circumstances
    +4
    (Worsening symptoms)
    +5
    Continuous or unvarying sadness, misery, or despondency
    +6
    Placid; only fleeting inner tension
    0
    (Worsening symptoms)
    +1
    Occasional feelings of edginess and ill-defined discomfort
    +2
    (Worsening symptoms)
    +3
    Continuous feelings of inner tension or intermittent panic which the patient can only master with some difficulty
    +4
    (Worsening symptoms)
    +5
    Unrelenting dread or anguish; overwhelming panic
    +6
    Sleeps as normal
    0
    (Worsening symptoms)
    +1
    Slight difficulty dropping off to sleep, or slightly reduced, light, or fitful sleep
    +2
    (Worsening symptoms)
    +3
    Sleep reduced or broken by at least two hours
    +4
    (Worsening symptoms)
    +5
    <2-3 hours of sleep
    +6
    Normal or increased appetite
    0
    (Worsening symptoms)
    +1
    Slightly reduced appetite
    +2
    (Worsening symptoms)
    +3
    No appetite; food is tasteless
    +4
    (Worsening symptoms)
    +5
    Needs persuasion to eat
    +6
    No difficulties in concentrating
    0
    (Worsening symptoms)
    +1
    Occasional difficulties in collecting one’s thoughts
    +2
    (Worsening symptoms)
    +3
    Difficulties in concentrating and sustaining thought which reduces ability to read or hold a conversation
    +4
    (Worsening symptoms)
    +5
    Unable to read or converse without great initiative
    +6
    Hardly any difficulty getting started in daily activities; no sluggishness
    0
    (Worsening symptoms)
    +1
    Difficulty in starting activities
    +2
    (Worsening symptoms)
    +3
    Difficulty starting simple routine activities, which are carried out with effort
    +4
    (Worsening symptoms)
    +5
    Complete lassitude; unable to do anything without help
    +6
    Normal interest in surroundings/other people
    0
    (Worsening symptoms)
    +1
    Reduced ability to enjoy usual interests
    +2
    (Worsening symptoms)
    +3
    Loss of interest in surroundings; loss of feelings for friends/acquaintances
    +4
    (Worsening symptoms)
    +5
    Emotionally paralyzed, unable to feel anger, grief, or pleasure; complete failure to feel for close relatives and friends
    +6
    No pessimistic thoughts
    0
    (Worsening symptoms)
    +1
    Fluctuating ideas of failure, self reproach, or self depreciation
    +2
    (Worsening symptoms)
    +3
    Persistent self accusations or definite but still rational ideas of guilt; increasingly pessimistic about the future
    +4
    (Worsening symptoms)
    +5
    Delusions of ruin, remorse, or irredeemable sin; absurd and unshakable self accusations
    +6
    Enjoys life
    0
    (Worsening symptoms)
    +1
    Weary of life; only fleeting suicidal thoughts
    +2
    (Worsening symptoms)
    +3
    Feels better off dead; suicidal thoughts common and considered as possible solution but no specific plans/intention
    +4
    (Worsening symptoms)
    +5
    Explicit plans for suicide; active preparations
    +6

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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.

    Content Contributors
    • Joshua Salvi, MD, PhD
    About the Creator
    Dr. Stuart Montgomery
    Are you Dr. Stuart Montgomery?
    Dr. Marie Åsberg
    Are you Dr. Marie Åsberg?
    Content Contributors
    • Joshua Salvi, MD, PhD