• Hamilton Depression Rating Scale

  • Date *
     / /
  • Patient DOB*
     / /

  • Instructions: For each question below, please circle the number that best describes how you have felt over the past week.

  • Depressed Mood: How sad or hopeless have you felt?*
  • Feelings of Guilt: Have you felt guilty or blamed yourself a lot?*
  • Suicidal Thoughts: Have you thought about death, self-harm, or not wanting to live?*
  • Insomnia (Early): Do you have trouble falling asleep?*
  • Insomnia (Middle): Do you wake up during the night and find it hard to get back to sleep?*
  • Insomnia (Late): Do you wake up too early and can’t fall back asleep?*
  • Work and Activities: Have you been able to do your usual activities?*
  • Thinking or Moving Slowly: Have you felt that your thoughts or movements are slower?*
  • Agitation: Have you felt restless, fidgety, or unable to sit still?*
  • Anxiety (Psychic): Have you felt anxious, tense, or worried?*
  • Anxiety (Somatic): Have you had physical signs of anxiety, such as dry mouth, headaches, shortness of breath, palpitations, hyperventilation, or sweating?*
  • Somatic Symptoms (Gastrointestinal): Have you had nausea, cramps, diarrhea, or indigestion?*
  • Somatic Symptoms (General): Have you had unexplained pain or fatigue?*
  • Sexual Interest: Have you noticed a change in your interest in sex?*
  • Hypochondriasis: Are you overly worried about your health?*
  • Loss of Weight (Based on what I noticed):*
  • Loss of Weight (Based on being weighed recently):*
  • Insight: Do you understand these feelings may be part of a mental health issue?*
  • Should be Empty: