> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # HAM-D — scoring and severity cutoffs > How to score the 17-item Hamilton Depression Rating Scale, what each severity band means, and what you need in front of you to administer it. The HAM-D is the most widely cited clinician-administered depression rating scale. It's been the standard outcome measure in depression treatment trials for more than sixty years — through the lithium era, SSRIs, ketamine, TMS, and every iteration in between. You fill it about the client, after a structured interview. The client never sees the form. ## What it measures Seventeen items covering: * Depressed mood, guilt, suicide * Insomnia (early, middle, late) * Work and activities, retardation, agitation * Anxiety (psychic and somatic) * Somatic symptoms (general and gastrointestinal) * Genital symptoms * Hypochondriasis, weight loss, insight The scale uses mixed item weighting: items 1, 2, 3, 7, 8, 9, 10, 11, and 15 score 0-4. Items 4, 5, 6, 12, 13, 14, 16, and 17 score 0-2. Total range is 0-52. ## When to use it * Longitudinal monitoring of depression severity in psychiatric or consultation-liaison contexts * Treatment-response outcome measurement (the standard for response is ≥50% reduction in total score; remission is total ≤7 sustained across three weeks per Frank et al. 1991) * Pre/post measurement in ECT, TMS, ketamine, and trial protocols * STAR\*D-style stepped-care workflows For routine therapy outcome tracking, the PHQ-9 self-report is usually the lighter choice. Use the HAM-D when you need rater anchors — research contexts, complex presentations, or settings where self-report reliability is in question. ## How you fill it Solo fill. Open **HAM-D** from the templates picker and tap **New response**. The renderer walks you through each item with the Williams 1988 SIGH-D anchor language distilled into the answer options. You score from the structured interview probes — typically 15-30 minutes for a trained rater. The form never goes to the client. There is no "Send to client" option for this measure. ## Scoring and severity cutoffs Total = sum of all 17 items, with the mixed-weight scoring above. ### Severity bands (Frank et al. 1991) | Total | Band | | ----- | ---------------------- | | 0-7 | Remission | | 8-13 | Mild depression | | 14-18 | Moderate depression | | 19-22 | Severe depression | | ≥23 | Very severe depression | ### Clinical change thresholds * **Response:** ≥50% reduction in total score from baseline * **Remission:** total ≤7, sustained across three weeks ## Item 3 — suicide Item 3 (suicide) is flagged sensitive. A score of 3 ("Suicidal ideas or gesture") or 4 ("Attempts at suicide") fires the high-risk cutoff — regardless of the total. A patient with mild overall depression but an active plan still requires safety planning and a level-of-care decision in the room. Rivet surfaces the flag in the response view. It does not auto-escalate, does not contact crisis services, and does not substitute for your clinical judgment. The decision — safety plan, means restriction, hospitalization — is yours. For documented safety planning, pair the HAM-D with the C-SSRS or a Stanley-Brown safety plan in the same session. ## Rater training The HAM-D requires rater training for reliable scoring. The standard reference is the Williams 1988 Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D), which provides probe questions and severity anchors. It's free at the University of Wisconsin psychiatry library. Inter-rater reliability on trained raters typically reaches ICC 0.85+ (Bagby 2004). ## What we render vs. the source Verbatim Hamilton 1960 items, with Williams 1988 SIGH-D severity anchors distilled into the choice display text. The total computes as a simple sum; factor-analysis subscales are not surfaced. One known difference: item 16 (weight loss) is a single combined item in Rivet. The original Hamilton 1960 allowed either "A: by history" or "B: actual weight change measured" with item 16 = max of the two. Rivet collapses to a single rating. The 21-item Hamilton 1967 extension (diurnal variation, depersonalization, paranoid symptoms, obsessional symptoms) isn't included — the 17-item version is the dominant clinical-practice configuration. ## HAM-D vs PHQ-9 and the BDI-II The HAM-D is rated by you in an interview; the [PHQ-9](/clinical-templates/screening/phq-9) is filled in by the client in two minutes. Both measure depression severity and they are not interchangeable numbers. Reach for the HAM-D when the measurement has to carry weight — tracking response to a medication change, a course of treatment where response is defined formally (a 50% drop) and remission has a threshold (7 or below), or any context where the standard from six decades of depression trials is the expected instrument. Reach for the PHQ-9 for routine tracking, for anything sent ahead of a session, and when a referrer needs a number they recognise. The real cost of the HAM-D is your time and your training. Reliable scoring depends on familiarity with the rating anchors; the structured interview guide exists for that, and it is free. Against the BDI-II: the Beck inventory is the self-report scale most often set beside the HAM-D. It's licensed by Pearson and paid for per administration, so Rivet doesn't include it — the library was built from instruments with no per-use fee. The PHQ-9 is the self-report depression measure to pair with the HAM-D here. ## Is it free to use? **Yes — it is public domain.** Hamilton published it in 1960 and it has been the standard clinician-administered depression rating scale in clinical trials ever since. Williams' SIGH-D structured interview guide is public domain too. ## Citations * Hamilton, M. (1960). "A rating scale for depression." *Journal of Neurology, Neurosurgery, and Psychiatry,* 23(1): 56-62. Public domain. * Williams, J. B. W. (1988). "A structured interview guide for the Hamilton Depression Rating Scale." *Archives of General Psychiatry,* 45(8): 742-747. * Frank, E., Prien, R. F., Jarrett, R. B., Keller, M. B., Kupfer, D. J., Lavori, P. W., Rush, A. J., & Weissman, M. M. (1991). "Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence." *Archives of General Psychiatry,* 48(9): 851-855. ## Related articles The Hamilton Anxiety Rating Scale. Frequently paired with HAM-D in mixed depression/anxiety presentations. Columbia Suicide Severity Rating Scale. The dedicated suicide severity instrument; use it when item 3 fires.