Seventeen items, or twenty-one?
Sources describe the 1960 scale differently. One says the original had 21 items and Hamilton later dropped four for poor construct validity. Another says the 1960 version had 17 scored items plus four extra questions that weren't added to the total. A history of the scale calls it the "21-item HRSD" but counts 17 variables in the scale.3,1,2
The accounts agree on the practical point: 17 items make up the severity total, and the extra items describe the type of depression.5
From "a tremendous wave of apathy" to the gold standard
"I went around with my scale and it created a tremendous wave of apathy."Max Hamilton, interviewed in 19822
When the total improves but the patient doesn't
Critics point out that a drug can look effective on the total even when suicidal thoughts increase, because sleep has improved.1 Load that scenario for a fictional patient, or change any rating yourself, and watch the total.
A simplified illustration using the areas the scale probes. Most items are rated 0–4, and items that are hard to grade for severity are rated 0–2.6,3 It isn't the official item list or wording, and it isn't a clinical tool.
How a rating is made
Revised by Hamilton, then by everyone
Hamilton himself revised the scale four times. Other researchers later built versions ranging from 7 to 29 items.6,1,5
That was the title of a 2004 review by Bagby and colleagues in the American Journal of Psychiatry.8 The scale still serves as the benchmark that other depression scales are checked against.3 But because different symptoms add up to one total, side effects that raise gut or sexual symptom ratings can make a drug look less effective against depression than it really is.1
References
- [1]Wikipedia contributors. Hamilton Rating Scale for Depression (accessed 30 Sept 2026).en.wikipedia.org
- [2]Worboys, M. (2013). The Hamilton Rating Scale for Depression: the making of a "gold standard" and the unmaking of a chronic illness, 1960–1980. Chronic Illness, 9(3), 202–219. PubMed Central.pmc.ncbi.nlm.nih.gov/PMC3837544
- [3]Kobak, K. A. Hamilton Depression Rating Scale. In The Corsini Encyclopedia of Psychology. Wiley (2010).onlinelibrary.wiley.com
- [4]Hamilton Rating Scale for Depression: an overview. ScienceDirect Topics (Neuroscience).sciencedirect.com
- [5]HDRS/HAM-D: Hamilton Depression Rating Scale. Testable (2026).testable.org
- [6]The Chinese Familial Alzheimer's Network: study protocol NCT03657732, §7.2.5 Hamilton depression scale. ClinicalTrials.gov (PDF).cdn.clinicaltrials.gov
- [7]SAGE-547 in moderate postpartum depression: study protocol NCT02942017, Appendix 2 (HAM-D 17-item). ClinicalTrials.gov (PDF).cdn.clinicaltrials.gov
- [8]Hamilton Rating Scale for Depression (HAM-D), with reference list incl. Bagby et al. (2004), Am J Psychiatry 161(12), 2163–2177. University of Pennsylvania (PDF).med.upenn.edu (PDF)
Related historical tests
Published a year later, and filled in by the patient rather than rated by a clinician. Comparing the two shows the two main ways of measuring depression that emerged in the early 1960s.
A factor-analytic personality questionnaire. Like Hamilton, Cattell turned judgements about a person into scores that could be compared statistically.
Patients told stories about ambiguous pictures, and clinicians interpreted them. Hamilton concluded that impressionistic global judgements alone were of little value for judging a treatment.
The standard adult ability test in clinics from the same decade. Both were given one-to-one by a trained professional, but the WAIS measures ability, not mood.
Another scale completed by someone other than the person being assessed, in that case from reports of everyday functioning. It is a different route to the same problem of self-report.
Wechsler developed it for patients at Bellevue Hospital, as Hamilton developed his scale for patients in treatment. Both came out of clinical work rather than school or military screening.