Montgomery-Asberg Depression Rating Scale (MADRS)

Introduction
The Montgomery-Asberg Depression Rating Scale (MADRS) is a widely recognized clinical assessment tool designed to measure the severity of depressive episodes in patients with mood disorders. Developed by British psychiatrist Stuart Montgomery and Swedish psychiatrist Marie Asberg in 1979, the scale provides a detailed measure of depressive symptoms aimed at evaluating the effectiveness of antidepressant treatments. The MADRS is noted for its sensitivity to changes in depression severity, making it a valuable tool for monitoring patient progress during the course of treatment.

The scale consists of ten items, each targeting a different aspect of depression such as apparent sadness, reported sadness, inner tension, sleep disturbances, appetite, concentration, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts. Each item is scored on a scale from 0 to 6, with higher scores indicating more severe symptoms. This scoring system allows clinicians to quantify symptoms in a standardized manner, facilitating both the initial assessment of depression severity and the ongoing monitoring of therapeutic interventions.

In clinical practice, the MADRS is administered through an interview by a trained health professional. This ensures that the assessment is based on a comprehensive understanding of the patient's emotional and cognitive state, rather than solely on self-reported symptoms. The scale's focus on the psychological rather than somatic symptoms of depression distinguishes it from other scales which may not as effectively differentiate between depression and other co-occurring physical illnesses.

The Montgomery-Asberg Depression Rating Scale is recognized for its reliability and validity in both research and clinical settings. Its widespread use across diverse populations and its sensitivity to treatment-induced changes in symptoms underscore its adaptability and enduring relevance in the field of psychiatry. The MADRS continues to serve as a fundamental instrument for evaluating depression, supporting improved patient outcomes through precise and targeted treatment strategies.

Instructions
Please note: This test is typically administered by a third-party clinician, but it is provided here informational purposes. This test may not be as accurate when self-administered, as it relies on a somewhat objective assessment.

Specify one of the choices listed below by clicking the dot next to the appropriate statement. These questions concern how the patient has felt over the past week. Rate each item on a scale from 0 to 6, with 0 being “normal/not present” and 6 being “extreme.”

Numbers 1, 3, and 5 do not have their own textual rating of severity, rather, these numbers are representative of levels in between two choices.

  1. Apparent Sadness

    Representing 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.
  2. Reported Sadness

    Representing 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. Rate according to intensity, duration and the extent to which the mood is reported to be influenced by events.
  3. Inner Tension

    Representing feelings of ill-defined discomfort, edginess, inner turmoil, mental tension mounting to either panic, dread or anguish. Rate according to intensity, frequency, duration and the extent of reassurance called for.
  4. Reduced Sleep

    Representing the experience of reduced duration or depth of sleep compared to the subject’s own normal pattern when well.
  5. Reduced Appetite

    Representing the feeling of a loss of appetite compared with when well. Rate by loss of desire for food or the need to force oneself to eat.
  6. Concentration Difficulties

    Representing difficulties in collecting one’s thoughts mounting to incapacitating lack of concentration. Rate according to intensity, frequency, and degree of incapacity produced.
  7. Lassitude

    Representing a difficulty getting started or slowness initiating and performing everyday activities.
  8. Inability to Feel

    Representing the 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.
  9. Pessimistic Thoughts

    Representing thoughts of guilt, inferiority, self-reproach, sinfulness, remorse and ruin.
  10. Suicidal Thoughts

    Representing the feeling that life is not worth living, that a natural death would be welcome, suicidal thoughts, and preparations for suicide. Suicidal attempts should not in themselves influence the rating.
Sources
  1. SA Montgomery, M Asberg. A New Depression Scale Designed to be Sensitive to Change. British Journal of Psychiatry 134 (4): 382-389. 04-1979.
  2. JBW Williams, KA Kobak. Development and Reliability of a Structured Interview Guide for the Montgomery-Asberg Depression Rating Scale (SIGMA). The British Journal of Psychiatry 192 (1): 52-58. .