What your MADRS score really means (the most sensitive depression measure)

You had a clinical interview and received a MADRS (Montgomery-Åsberg Depression Rating Scale) score between 0 and 60. The MADRS was specifically designed to be highly sensitive to treatment changes—making it the preferred measure in antidepressant clinical trials. Unlike the older HAM-D, the MADRS focuses on psychological symptoms and can detect subtle improvements that other scales miss. Here's what your score means.

The quick answer

A score of 10 or below is typically defined as "remission"—the goal of treatment. A score of 20 or higher indicates depression that warrants active treatment.

Why the MADRS was created

In 1979, researchers Stuart Montgomery and Marie Åsberg developed the MADRS because existing depression scales weren't sensitive enough to detect treatment improvements. The older HAM-D, for example, includes many physical symptoms (sleep, appetite, energy) that don't always change quickly with treatment and can be affected by medical conditions.

The MADRS focuses on the psychological core of depression:
- How sad you feel
- How much interest you have in life
- How well you can concentrate
- How hopeful or hopeless you feel

This focus makes it better at picking up early signs that treatment is working.

What the 10 items cover

Each item is rated 0-6 by a trained clinician based on interview and observation:

Observable symptoms (rated partly on observation)
- Apparent sadness (Item 1): How you look—facial expression, posture, voice
- Inner tension (Item 3): Visible anxiety, restlessness, agitation

Reported psychological symptoms
- Reported sadness (Item 2): How low or depressed you feel
- Inability to feel (Item 8): Loss of interest, pleasure, emotional connection
- Pessimistic thoughts (Item 9): Guilt, self-criticism, hopelessness

Cognitive symptoms
- Concentration difficulties (Item 6): Trouble focusing, memory problems

Physical symptoms (fewer than other scales)
- Reduced sleep (Item 4): Insomnia
- Reduced appetite (Item 5): Loss of appetite
- Lassitude (Item 7): Difficulty getting started on things

Safety
- Suicidal thoughts (Item 10): Feelings about life, death wishes, suicidal ideas

What the scores mean for treatment

Score 0-6: Remission

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

Research suggests that the lower within this range, the better. Patients scoring 0-4 have better functional outcomes than those scoring 5-9. So if you're at 8, there may still be room for improvement.

Score 7-19: Mild

You have some depressive symptoms, but they're at the milder end. This might mean:
- Your depression is mild to begin with
- You're improving but not yet in remission
- Residual symptoms remain after treatment

For mild scores after treatment, the question is whether to continue current treatment, adjust it, or monitor.

Score 20-34: Moderate

This is the typical range for clinical depression that warrants active treatment:
- Medication, therapy, or both is recommended
- This is the entry threshold for most clinical trials
- Treatment response can often be detected within 2-4 weeks

Score 35-60: Severe

This indicates substantial depression:
- Intensive treatment is needed
- Combined approaches (medication + therapy) are often recommended
- Hospitalization may be considered if safety is a concern

Treatment response: What change means

In clinical trials, "response" is typically defined as a 50% reduction in MADRS score.

Example:
- Starting score: 34 (moderate)
- After 6 weeks of treatment: 17 (mild)
- This is a 50% reduction = treatment "response"

Remission means getting below 10—not just improving, but achieving near-normal functioning.

The distinction matters because partial response (improving but not reaching remission) is associated with higher relapse risk than full remission.

Why the MADRS is more sensitive than the HAM-D

Both are clinician-administered depression scales, but they have important differences:

The MADRS's graduated 0-6 scale per item (with intermediate ratings allowed) captures subtle changes that the HAM-D's broader categories might miss. This makes the MADRS better for:
- Detecting early treatment response
- Tracking improvement over time
- Distinguishing between similar treatments

The suicide question (Item 10)

Item 10 specifically asks about suicidal thoughts. The clinician rates this from 0-6:

- 0: Enjoys life or takes it as it comes
- 2: Weary of life, fleeting suicidal thoughts
- 4: Probably better off dead, suicidal thoughts common
- 6: Explicit suicide plans, active preparation

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).

What remission really means

There's ongoing research about what MADRS score truly represents "remission":

Research shows that patients who achieve scores of 4 or below function better than those scoring 5-9. This suggests that while ≤10 is "remission," lower is genuinely better.

Common questions

My clinician says I've "responded" to treatment, but I don't feel better. What gives?

"Response" means 50% improvement, not full recovery. If you went from 40 to 20, that's a response—but a score of 20 is still moderate depression. The next goal is getting to remission (below 10).

I'm in remission (score of 8) but still don't feel like myself. Is that normal?

A score of 8 is technically remission, but there's a range. Some research suggests that scores of 5-9 still have noticeable residual symptoms. It may be worth discussing with your provider whether treatment adjustments could help you feel even better.

Why does my clinician use the MADRS instead of the PHQ-9?

The MADRS is more sensitive to treatment changes and provides richer information, but takes longer (15-20 minutes vs. 2 minutes for PHQ-9). In research settings and when tracking treatment closely, the MADRS's sensitivity is worth the extra time. For routine screening, the PHQ-9 is more practical.

Can I take the MADRS myself?

The MADRS is designed for clinician administration. Self-report versions exist (MADRS-S) but are less common than self-report alternatives like the PHQ-9 or BDI-II. The observational component (Items 1 and 3 especially) benefits from trained clinical assessment.

The bottom line

Your MADRS score reflects your depression severity as rated by a clinician with a scale specifically designed to detect treatment changes. Scores of 0-6 represent remission; 7-19 is mild; 20-34 is moderate; 35+ is severe. The MADRS's sensitivity makes it ideal for tracking treatment progress—if your score drops by 50%, that's a treatment "response," and getting below 10 is "remission." If you're in treatment and tracking your MADRS, it's one of the most reliable ways to see whether you're getting better.

Related assessments

- HAM-D — Hamilton Depression Rating Scale (more somatic emphasis)
- 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