| ~APPARENT SADNESS | |
| Definition -- Despondency, gloom and despair, that is more than just ordinary transient low spirits; which may be reflected in speech, facial expression, and posture. | point 0, No sadness point 1 point 2, Looks dispirited but does brighten up without difficulty point 3 point 4, Appears sad and unhappy most of the time point 5 point 6, Looks miserable all the time; extremely despondent |
| ~REPORTED SADNESS | |
| Definition -- Reports of depressed mood, regardless of whether it is reflected in appearance. This includes low spirits, despondency or the feeling of being beyond help and without hope. Rated according to intensity, duration and the extent to which the mood is reported to be influenced by events. | point 0, Occasional sadness in keeping with the circumstances point 1 point 2, Sad or low but brightens up without difficulty point 3 point 4, Pervasive feelings of sadness or gloominess. The mood is still influenced by external circumstances point 5 point 6, Continuous or unvarying sadness, misery or despondency |
| ~INNER TENSION | |
| Definition -- Feelings of ill-defined discomfort, edginess, inner turmoil, or mental tension mounting to either panic, dread or anguish. Rated according to intensity, frequency, duration and the extent of reassurance called for. | point 0, Placid with only fleeting inner tension point 1 point 2, Occasional feelings of edginess and ill-defined discomfort point 3 point 4, Continuous feelings of inner tension or intermittent panic which the patient can only master with some difficulty point 5 point 6, Unrelenting dread or anguish; overwhelming panic |
| ~REDUCED SLEEP | |
| Definition -- Reduced duration or depth of sleep compared to the subject's own normal pattern when well. | point 0, Sleeps as usual point 1 point 2, Slight difficulty dropping off to sleep or slightly reduced, light or fitful sleep point 3 point 4, Sleep reduced or broken by at least two hours point 5 point 6, Less than two or three hours sleep |
| ~REDUCED APPETITE | |
| Definition -- Feeling of a loss of appetite compared with when well. Rated by loss of desire for food or the need to force oneself to eat. | point 0, Normal or increased appetite point 1 point 2, Slightly reduced appetite point 3 point 4, No appetite and / or food is tasteless point 5 point 6, Needs persuasion to eat at all |
| ~CONCENTRATION DIFFICULTIES | |
| Definition -- Difficulties in collecting one's thoughts mounting to incapacitating lack of concentration. Rated according to intensity, frequency, and degree of incapacity produced. | point 0, No difficulties in concentrating point 1 point 2, Occasional difficulties in collecting one's thoughts point 3 point 4, Difficulties in concentrating and sustaining thought which reduces ability to read or hold a conversation point 5 point 6, Unable to read or converse without great difficulty |
| ~LASSITUDE | |
| Definition -- Difficulty getting started or slowness initiating and performing everyday activities. | point 0, Hardly any difficulties in getting started; no sluggishness point 1 point 2, Difficulties in starting activities point 3 point 4, Difficulties in starting simple routine activities, which are carried out with effort point 5 point 6, Complete lassitude; unable to do anything without help |
| ~INABILITY TO FEEL | |
| Definition -- Subjective experience of reduced interest in one's surroundings or activities that normally give pleasure. One's ability to react with adequate emotion to circumstances or people is reduced. | point 0, Normal interest in surroundings and other people point 1 point 2, Reduced ability to enjoy usual interests point 3 point 4, Loss of interest in the surroundings; loss of feelings for friends and acquaintances point 5 point 6, Emotionally paralyzed, unable to feel anger, grief or pleasure and a complete or even painful failure to feel for close relatives and friends |
| ~PESSIMISTIC THOUGHTS | |
| Definition -- Thoughts of guilt, inferiority, self-reproach, sinfulness, remorse and ruin. | point 0, No pessimistic thoughts point 1 point 2, Fluctuating ideas of failure, self-reproach or self-depreciation point 3 point 4, Persistent self-accusations or definite but still rational ideas of guilt or sin; increasingly pessimistic about the future point 5 point 6, Delusions of ruin, remorse and unredeemable sin. Self-accusations which are absurd and unshakable |
| ~SUICIDAL THOUGHTS | |
| Definition -- Feeling that life is not worth living and/or a natural death would be welcome; suicidal thoughts and making preparations for suicide. Suicidal attempts should not in themselves influence the rating. | point 0, Enjoys life or takes it as it comes point 1 point 2, Weary of life; only fleeting suicidal thoughts point 3 point 4, Probably better off dead, frequent suicidal thoughts, with suicide considered as a possible solution, but without specific plans or intention point 5 point 6, Explicit plans for suicide when there is an opportunity; active preparations for suicide |
The Montgomery-Åsberg Depression Rating Scale (MADRS), is clinician administered and consists of 10 questions, each scoring from 0-6 points. The clinician must decide whether the rating lies at the defined scale steps (0,2,4,6 pts) or between them (1,3,5 pts) and score each item numerically based upon how the patient has been feeling / functioning over the prior week.
This scale is designed to be used in adults with a diagnosis of depression and detect changes in depression severity over time.
The Questionnaire:
1. APPARENT SADNESS
Definition: Despondency, gloom and despair, that is more than just ordinary transient low spirits; which may be reflected in speech, facial expression, and posture.
2. REPORTED SADNESS
Definition: Reports of depressed mood, regardless of whether it is reflected in appearance. This includes low spirits, despondency or the feeling of being beyond help and without hope. Rated according to intensity, duration and the extent to which the mood is reported to be influenced by events.
3. INNER TENSION
Definition: Feelings of ill-defined discomfort, edginess, inner turmoil, or mental tension mounting to either panic, dread or anguish. Rated according to intensity, frequency, duration and the extent of reassurance called for.
4. REDUCED SLEEP
5. REDUCED APPETITE
Definition: Feeling of a loss of appetite compared with when well. Rated by loss of desire for food or the need to force oneself to eat.
6. CONCENTRATION DIFFICULTIES
Definition: Difficulties in collecting one's thoughts mounting to incapacitating lack of concentration. Rated according to intensity, frequency, and degree of incapacity produced.
7. LASSITUDE
Definition: Difficulty getting started or slowness initiating and performing everyday activities.
8. INABILITY TO FEEL
Definition: Subjective experience of reduced interest in one's surroundings or activities that normally give pleasure. One's ability to react with adequate emotion to circumstances or people is reduced.
9. PESSIMISTIC THOUGHTS
Definition: Thoughts of guilt, inferiority, self-reproach, sinfulness, remorse and ruin.
10. SUICIDAL THOUGHTS
Definition: Feeling that life is not worth living and/or a natural death would be welcome; suicidal thoughts and making preparations for suicide. Suicidal attempts should not in themselves influence the rating.
Interpretation (score 0-60 pts):
0-6 pts = Absence of depression
7-19 pts = Mild depression
20-34 pts = Moderate depression
>34 pts = Severe depression
References
Montgomery S, Åsberg M. A new depression scale designed to be sensitive to change. Br. J. Psychiat. 1979;134:382-9.
Snaith RP, et al. Grade scores of the Montgomery-Åsberg Depression and the Clinical Anxiety Scales. Br J Psychiatry. 1986;148:599-601.