MADRS: Montgomery-Åsberg Depression Rating Scale

Overview

The MADRS is a 10-item clinician rating of depression. A trained rater scores each item from 0 to 6 after a clinical interview. The ten ratings add to a total from 0 to 60, and a higher total means more severe symptoms.

Each item describes what a rating of 0, 2, 4, or 6 looks like. The rater can also choose 1, 3, or 5 when the person falls between two descriptions. Survey Doctor's form shows all seven choices separately and uses the item wording published with the scale in 1979.

Introduction

Montgomery and Åsberg developed the scale to follow change in depression symptoms. A trained rater combines interview information and observation, then selects a defined even-numbered anchor or a true intermediate rating.

Who should use the MADRS?

The MADRS is for trained clinicians and research raters. It is not a self-report questionnaire. Survey Doctor does not offer it for public self-service, and direct submissions to the public take-assessment route are rejected.

An authorized protocol should specify the form, interview method, assessment interval, and rater training. Record those details with each rating.

Score interpretation

The source MADRS has ten ratings from 0 to 6. Adding them gives a total from 0 to 60.

A higher total means more severe depression symptoms. Survey Doctor shows the total without a severity label. The 1979 paper did not publish severity bands, and later groupings come from particular samples. Snaith and colleagues (1986) proposed grade ranges from psychiatrists' judgments of treatment need in one hospital. Müller and colleagues (2003) found that a total of 31 best separated moderate from severe depression in their sample.

The total does not establish diagnosis, remission, treatment response, or level of care on its own.

Item 10 and safety

Item 10 concerns thoughts about death and suicide. In native item-level records, any value above 0 is marked for direct safety review. The total cannot show whether that item was endorsed.

A total-only record is especially limited. Some historical imported MADRS scores came from an incompatible 0/2/4/6 form without item answers. Survey Doctor keeps those records outside native scoring and interpretation, and their missing safety-item response cannot be reconstructed.

If item 10 is above 0, complete a direct suicide-risk assessment under the organization's safety protocol. Do not wait for the total.

If you need help now. In the US, Call 988 or text 988. Call 911 if you are in immediate danger. Outside the US, contact your local emergency number or find support in your country.

What the questions measure

The ten domains cover observed and reported mood, tension, sleep, appetite, concentration, energy, ability to feel, pessimism, and suicidal thoughts. A trained rater considers the interview and observation together.

Clinical applications

The MADRS was designed to be sensitive to change, so it suits repeated ratings during treatment and in clinical trials. Keep the item ratings, interval, rater method, and date together with each total.

The QIDS-SR16 and PHQ-9 are questionnaires people answer themselves. They serve different purposes and their scores cannot be converted to MADRS totals.

When to seek help

The total does not define an emergency or treatment plan. Respond to symptoms, functioning, and current safety. Follow the organization's suicide-risk assessment protocol for any item 10 value above 0.

Evidence and validation

Montgomery and Åsberg developed the scale to measure change in depression symptoms. Later studies examined cutoff conventions in specific settings. Those findings depend on a valid form and trained, consistent administration.

For a patient-facing explanation, read what your MADRS score means.