MADRS: Montgomery-Åsberg Depression Rating Scale

The MADRS is a 10-item clinician-administered scale measuring depression severity across cognitive, vegetative, and affective symptoms. Scores 0–60. The validated primary outcome measure in antidepressant clinical trials, valued for its sensitivity to change.

What the MADRS measures

The Montgomery-Åsberg Depression Rating Scale (MADRS) was developed by Stuart Montgomery and Marie Åsberg in 1979 specifically to detect and measure changes in depression severity during antidepressant treatment. Unlike the HAM-D, which was designed to characterize depression, the MADRS was built to be maximally sensitive to the effects of treatment, making it the preferred outcome measure in most pharmaceutical trials.

The MADRS contains 10 items, each rated on a 7-point scale (0–6), where 0 and 6 are the anchor points and 2, 4 represent intermediate grades. The items assess both observable and subjective aspects of depression, with a deliberate emphasis on psychological symptoms over somatic symptoms – reducing the confounding effects of physical illness that can artificially elevate HAM-D scores.

The MADRS is a clinician-administered scale. It is not designed for self-report and requires a trained assessor. Total scores range from 0 to 60; ≤10 is the widely adopted remission criterion in antidepressant trials. Check the copyright holder's terms before clinical or commercial use of the MADRS.

How to administer the MADRS

A trained clinician conducts a semi-structured interview with the patient and rates each of the 10 items on a 7-point scale from 0 to 6, where 0 represents absence of the symptom and 6 represents the most severe level. Each item has defined anchor points at 0, 2, 4, and 6, with odd scores used for intermediate presentations. Administration typically takes 15 to 30 minutes. The MADRS is not designed for self-report.

The 10 MADRS Items

Each item scored 0–6. Items reflect the core domains of clinical depression assessment.

MADRS scoring and interpretation

Item ratings are summed for a total from 0 to 60. Enter a MADRS total score (0–60) in the interpreter above to see the corresponding severity band and clinical meaning.

Severity bands in common use (Snaith et al., 1986): 0–6 normal or symptom absent, 7–19 mild, 20–34 moderate, and 35–60 severe depression. ≤10 is the remission criterion adopted by most antidepressant trials.

Clinician-rated scale. Requires trained assessor for valid scoring.

Psychometric properties

Montgomery and Åsberg (1979) built the MADRS from the 10 items, out of 17 common symptoms of primary depressive illness, that showed the largest changes with treatment in 64 patients across studies of four antidepressants. Inter-rater reliability was high, scores correlated significantly with the Hamilton Rating Scale (HRS), and the MADRS differentiated responders from non-responders to antidepressant treatment better than the HRS, indicating greater sensitivity to change.

Limitations

• Requires a trained rater. Scores depend on interview skill and rater training; it is not a self-screen.
• Not a diagnosis. A MADRS total rates severity; it does not establish a depressive disorder.
• Less emphasis on somatic symptoms. This reduces confounding by physical illness, but the scale captures somatic features of depression less fully than the HAM-D.

MADRS vs HAM-D vs PHQ-9

Choosing the right depression scale depends on clinical setting, rater, and purpose.

Measuring Depression in HiBoop

HiBoop does not offer the MADRS; this page is reference material. For depression, HiBoop offers the PHQ-9 and PHQ-8, scored on submission and tracked over time.