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    Patent Pending

    Montgomery-Asberg Depression Rating Scale (MADRS)

    Stratifies severity of depressive episodes in adults.

    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
    Dr. Stuart Montgomery

    About the Creator

    Stuart Montgomery, BSC, MD, FRC Psych, is a retired psychiatrist. He was an emeritus professor of psychiatry at London University School of Medicine and served as president of the European College of Neuropsychopharmacology and the British Association of Psychopharmacology. Dr. Montgomery's research interests include depression, anxiety disorders, schizophrenia, and bipolar disorder.

    To view Dr. Stuart Montgomery's publications, visit PubMed

    Are you Dr. Stuart Montgomery? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Dr. Marie Åsberg

    About the Creator

    Marie Åsberg, MD, PhD, is a psychiatrist and professor in the department of clinical sciences at the Danderyd Hospital in Sweden. Dr. Åsberg’s primary research is focused on depression and suicide prevention.

    To view Dr. Marie Åsberg's publications, visit PubMed

    Are you Dr. Marie Åsberg? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    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