Montgomery-Asberg Depression Rating Scale (MADRS)

Addition of the selected points: Variable Points Apparent sadness (despondency, gloom, and despair (more than just ordinary transient low spirits), reflected in speech, facial expression, and posture; rate by depth and inability to brighten up) 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 Reported sadness (reports of depressed mood, regardless of whether it is reflected in appearance or not; includes low spirits, despondency, or the feeling of being beyond help and without hope) 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 Inner tension (feelings of ill-defined discomfort, edginess, inner turmoil, mental tension mounting to either panic, dread, or anguish; rate by intensity, frequency, duration, and extent of reassurance called for) 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 Reduced sleep (experience of reduced duration or depth of sleep compared to the patient’s own normal pattern when well) 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 Reduced appetite (feeling of loss of appetite; rate by loss of desire for food or the need to force oneself to eat) 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 Concentration difficulty (difficulties in collecting one’s thoughts mounting to incapacitating lack of concentration; rate by intensity, frequency, and degree of incapacity produced) 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 Lassitude (difficulty getting started or slowness initiating and performing everyday activities) 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 Inability to feel (subjective experience of reduced interest in the surroundings or activities that normally give pleasure; the ability to react with adequate emotion to circumstances or people is reduced) 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 Pessimistic thoughts (thoughts of guilt, inferiority, self reproach, sinfulness, remorse, and ruin) 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 Suicidal thoughts (feeling that life is not worth living, that a natural death would be welcome, suicidal thoughts, and the preparations for suicide; suicidal attempts should not in themselves influence the rating) 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 6