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The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10-item clinician-rated instrument widely regarded as one of the most sensitive measures of change in depression severity during treatment. Developed by Stuart Montgomery and Marie Asberg in 1979, the MADRS was specifically designed to be sensitive to antidepressant treatment effects, an area where the Hamilton Depression Scale was perceived to have limitations.
The MADRS was derived from a comprehensive 65-item rating scale, selecting the 10 items that showed the greatest change with antidepressant treatment and the highest correlation with overall response. This empirical derivation makes the MADRS inherently more change-sensitive than scales designed purely around diagnostic criteria. Each item is rated on a 0-6 scale with verbal descriptions at even-numbered anchor points, yielding a total range of 0-60.
The 10 MADRS items assess: apparent sadness (observed), reported sadness (subjective), inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel (anhedonia), pessimistic thoughts, and suicidal thoughts. Unlike the HAM-D, the MADRS focuses primarily on core depressive symptoms rather than somatic complaints, making it particularly suitable for evaluating non-sedating antidepressants.
The MADRS has become the preferred primary outcome measure in many European clinical trials and is increasingly used globally. Meta-analyses suggest slightly greater sensitivity to change than the HAM-D-17, particularly for cognitive and emotional symptoms. The MADRS also has better interrater reliability because items have clearer anchor points on the 0-6 scale.
Severity categories: 0-6 (no depression/remission), 7-16 (mild), 17-24 (moderate), 25-34 (severe), and >=35 (very severe). Remission is defined as <=10 (some studies use <=8 or <=12). Response is >=50% reduction from baseline. Item 10 (suicidal thoughts) is specifically monitored for safety assessment throughout treatment.
Scoring:
Total Score = Sum of all 10 items (range 0-60)
Each item scored 0-6 with anchor points at even numbers.
Severity Categories:
Suicidal Ideation Flag: Triggered when item 10 score is >=2.
Severity 0 (0-6, Remission): In remission or normal range. Continue maintenance if applicable. Severity 1 (7-16, Mild): May respond to psychotherapy alone. Severity 2 (17-24, Moderate): Initiate or adjust antidepressant and/or psychotherapy. Severity 3 (25-34, Severe): Combination treatment strongly recommended. Severity 4 (>=35, Very Severe): Aggressive treatment required. Consider ECT for treatment-resistant cases. Any Suicidal Ideation Flag requires direct clinical assessment.
Inputs
Results
MADRS score of 18 = moderate depression. No suicidal ideation. Antidepressant and/or psychotherapy recommended.
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Results
MADRS score of 41 = very severe depression. Suicidal thoughts flagged. Immediate safety assessment and intensive treatment required.
The Montgomery-Asberg Depression Rating Scale is a 10-item clinician-rated depression instrument designed to be sensitive to treatment change. Each item scored 0-6, range 0-60. Focuses on core psychological symptoms and is widely used in antidepressant clinical trials.
The MADRS has 10 items (vs 17), focuses more on core psychological symptoms, uses a uniform 0-6 scale, and is generally more sensitive to treatment change. It does not include items on agitation, GI symptoms, or hypochondriasis.
Most commonly <=10, though some studies use <=8 or <=12. Response is >=50% reduction from baseline.
A self-rated version (MADRS-S) exists and has been validated. However, the original was designed as clinician-rated. Both versions show good correlation.
Typically 10-15 minutes for a trained clinician — faster than the HAM-D (15-20 minutes).
Because the HAM-D was perceived as overly focused on somatic symptoms and insensitive to change with some antidepressants. The MADRS selected the 10 items most sensitive to treatment change from a 65-item pool.
It includes one anxiety item (inner tension) but is primarily a depression measure. Use GAD-7 or Hamilton Anxiety Scale alongside for co-occurring anxiety.
The Structured Interview Guide for MADRS provides standardized questions and probes for each item, improving interrater reliability. Recommended for research use.
Item 10 (Suicidal Thoughts) rated 0-6. Any score >=2 should trigger detailed suicidal risk assessment at every visit.
Yes, the MADRS is in the public domain and free to use without fees. The original publication is open access.
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