What your HAM-D score really means (the clinician-administered depression rating)

You had a clinical interview and received a HAM-D (Hamilton Depression Rating Scale) score between 0 and 52. The HAM-D has been the gold standard for measuring depression severity in clinical trials and psychiatric practice for over 60 years. Unlike questionnaires you fill out yourself, the HAM-D is completed by a trained clinician based on interview and observation. Here's what your score means.

The quick answer

A score of 7 or below is typically defined as "remission"—meaning your symptoms are in the normal range. A score of 14 or higher indicates depression that typically benefits from treatment.

Why the HAM-D is different

The HAM-D isn't like most depression questionnaires. Here's what makes it unique:

Clinician-administered. A trained professional conducts an interview and rates your symptoms based on what you say and what they observe. They can pick up on things you might not notice or report—like slowed movements, changes in your voice, or agitation.

Observational component. Some items are rated partly on observation. If the clinician notices you're fidgeting, speaking slowly, or showing depressed affect, that counts even if you don't mention it.

The "gold standard." The HAM-D has been used in thousands of clinical trials testing antidepressants. When you hear that "a medication reduced depression by 50%," they usually measured it with the HAM-D.

What the 17 items cover

The HAM-D evaluates several symptom domains:

Mood (Items 1-3)
- Depressed mood (sadness, hopelessness)
- Feelings of guilt
- Suicidal thoughts or actions

Sleep (Items 4-6)
- Trouble falling asleep (early insomnia)
- Waking during the night (middle insomnia)
- Early morning waking (late insomnia)

Activity and interests (Item 7)
- Loss of interest in work, hobbies, or activities

Psychomotor changes (Items 8-9)
- Slowed thinking, speech, or movement (retardation)
- Restlessness or inability to sit still (agitation)

Anxiety (Items 10-11)
- Psychological anxiety (worry, tension)
- Physical anxiety (racing heart, stomach problems)

Physical symptoms (Items 12-14)
- Appetite and digestive problems
- Energy and body aches
- Sexual symptoms

Other (Items 15-17)
- Preoccupation with health
- Weight loss
- Insight into illness

What the scores mean for treatment

Score 0-7: Remission

If you're in treatment and your score dropped to this range, you've achieved remission. This is the goal of treatment—getting symptoms below the threshold where they significantly affect your life.

If this is your baseline score before treatment, you likely don't have clinical depression.

Score 8-13: Mild

You have some depressive symptoms, but they're at the milder end. This might mean:
- You're improving but not yet in remission
- Your depression is mild to begin with
- Symptoms are emerging but not fully developed

For mild depression, psychotherapy alone may be effective. Medication is often considered for moderate or severe cases.

Score 14-18: Moderate

This is the typical threshold for "clinically significant" depression that warrants active treatment. At this level:
- Depression is meaningfully affecting your life
- Treatment (therapy, medication, or both) is recommended
- Improvement is possible with appropriate care

Score 19-22: Severe

Substantial depression that significantly impairs daily functioning. At this level:
- Combined treatment (therapy + medication) is often recommended
- Close monitoring is important
- Improvement may require more intensive approaches

Score 23+: Very severe

This indicates maximum severity requiring immediate attention:
- Hospitalization may be appropriate
- Safety evaluation is essential
- Intensive treatment is needed

Treatment response: What change means

In clinical trials, "treatment response" is typically defined as a 50% reduction in HAM-D score.

Example:
- Starting score: 22 (severe)
- After 8 weeks of treatment: 11 (mild)
- This is a 50% reduction = treatment "response"

Remission means getting below 7—not just improving, but getting symptoms into the normal range.

The goal isn't just response; it's remission. Residual symptoms (scoring 8-10 even after improvement) increase relapse risk.

The suicide question (Item 3)

Item 3 specifically asks about suicidal thoughts. The clinician rates this from 0 to 4:

- 0: No suicidal thoughts
- 1: Feels life isn't worth living
- 2: Wishes they were dead
- 3: Has suicidal ideas or has made gestures
- 4: Has made a suicide attempt

Any score of 2 or higher on this item requires a safety assessment, regardless of your total score. If you're having thoughts of suicide, please tell your clinician or call 988 (Suicide & Crisis Lifeline).

How the HAM-D differs from the PHQ-9

You might wonder how the HAM-D compares to the PHQ-9 (a common self-report questionnaire):

Both measure depression, but the HAM-D includes clinician observation and is more detailed. The PHQ-9 is faster and practical for routine screening.

Limitations of the HAM-D

The HAM-D has been criticized for some imbalances:

Heavy emphasis on physical symptoms. Multiple items address sleep, appetite, energy, and physical symptoms. If you have medical conditions causing these symptoms, your score may be elevated even without psychological depression.

Less emphasis on cognitive symptoms. Hopelessness, negative thinking, and concentration problems—core features of depression—get less attention than somatic symptoms.

Requires trained administration. Untrained administration produces unreliable results. Proper use requires training and calibration.

Despite these limitations, the HAM-D remains widely used because of its extensive validation and historical importance in antidepressant research.

Common questions

My clinician told me my score, but it seems high. Does that mean my depression is severe?

Not necessarily "severe" in the alarming sense—it means your symptoms are in a range where treatment typically helps. Think of it as useful information for tracking progress, not a judgment.

I'm in treatment and my score went from 24 to 12. Is that good?

Yes. That's a 50% reduction, which is defined as "treatment response." You've improved significantly. The next goal is getting below 7 (remission).

My score is 8. Should I still be in treatment?

A score of 8 is in the "mild" range—not remission but not severe. Whether you continue treatment depends on:
- How you feel functionally
- How long symptoms have been stable
- Risk of relapse if treatment stops
- Your preferences

Discuss with your provider.

Can I take the HAM-D myself?

The HAM-D is designed for clinician administration. Self-administered versions exist but may be less reliable since you miss the observational component. For self-assessment, the PHQ-9 or BDI-II may be more appropriate.

The bottom line

Your HAM-D score reflects your depression severity as rated by a clinician through structured interview and observation. Scores of 0-7 represent remission; 8-13 is mild; 14-18 is moderate; 19+ is severe. The HAM-D is the gold standard for measuring treatment outcomes in clinical trials, and the goal of treatment is typically remission (score ≤7). If your score is elevated, this is useful information for guiding treatment—not a label, but a measurement that can help track your progress toward feeling better.

Related assessments

- MADRS — Alternative clinician-rated scale with higher change sensitivity
- PHQ-9 — Brief self-report depression questionnaire
- DASS-21 — Combined depression, anxiety, and stress measure
- CES-D-R — Self-report depression scale for research settings