The Montgomery–Åsberg Depression Rating Scale (MADRS, Montgomery & Åsberg, 1979) is a clinician-rated measure of depression severity with 10 items. The clinician scores each item from 0 to 6 based on a structured clinical interview rather than patient self-report; the total ranges from 0 to 60.
Unlike the Hamilton scale (HAM-D), MADRS focuses on the core affective-cognitive symptoms of depression and carries less somatic and anxiety loading, so it is less distorted by physical illness. It was originally designed to be sensitive to change — hence its wide use for grading treatment response and in antidepressant trials.
MADRS grades the severity of an already-established depressive condition; it is a severity scale, not a diagnostic test, and does not establish a diagnosis on its own. It is included in clinical guidelines for depression.
Each of the 10 items is scored from 0 to 6. The total ranges from 0 to 60. The assessment period is the past 7 days. The scale is completed by a clinician from an interview, not by the patient.
Severity cut-offs
MADRS — total-score severity bands (per Snaith et al., 1986)
Score range
Severity
Clinical meaning
0–6
No depression / remission
No depression / remission range
7–19
Mild depression
Mild depression
20–34
Moderate depression
Moderate depression
35–60
Severe depression
Severe depression
Use in clinical practice
MADRS is used to grade baseline severity and to monitor change over the course of treatment (repeat measurements every 1–2 weeks). Because it is sensitive to change, it is frequently used as a primary outcome in antidepressant trials.
Baseline severity
The total score places the patient in a severity band (no depression/remission, mild, moderate, severe), informing the intensity of the treatment plan.
Monitoring response
Repeat the assessment every 1–2 weeks. A ≥50% reduction from baseline defines treatment response; a total ≤6–7 is a remission reference (interpretation depends on the protocol).
IMPORTANT: item 10 concerns suicidal thoughts — any positive response warrants a direct suicide-risk assessment (the MADRS is not a risk tool). High scores call for prioritised clinical assessment and a safety check. Assessment should be carried out by a trained clinician; inter-rater agreement is higher with a structured interview.
Sources
Montgomery SA, Åsberg M. A new depression scale designed to be sensitive to change. British Journal of Psychiatry. 1979;134:382–389.
Snaith RP, Harrop FM, Newby DA, Teale C. Grade scores of the Montgomery–Åsberg Depression and the Clinical Anxiety Scales. British Journal of Psychiatry. 1986;148:599–601.
Riedel M, Möller HJ, Obermeier M, et al. Response and remission criteria in major depression — a validation of current practice. Journal of Psychiatric Research. 2010;44(15):1063–1068.
Azorin JM, Llorca PM, Despiegel N, Verpillat P. Comparative efficacy in severe depression: an example of MADRS threshold interpretation in an RCT. L'Encéphale. 2004;30(2):158–166.
Clinical guidelines for depressive disorder (current edition) — MADRS as an instrument for grading depression severity.
MADRS calculator
0 of 10 items scored10 items left
Apparent sadness — observed despondency, gloom, hopelessness (expression, posture, voice); rate by the depth that cannot be brightened up.
Reported sadness — the patient's account of low mood regardless of appearance; includes duration and reactivity of mood.
Suicidal thoughts — a feeling that life is not worth living, thoughts of death and suicide, and preparations for it. Any score above 0 warrants a direct suicide-risk assessment.
Total score (MADRS)0/ 60
Clinical use of MADRS
Questions about scoring, severity bands, and the scale's limits
Add the scores of all 10 items (each 0–6); the total ranges from 0 to 60. There are no multipliers or reverse items.
A common standard (Snaith et al., 1986): 0–6 no depression / remission, 7–19 mild, 20–34 moderate, 35–60 severe. These are severity bands, not a diagnostic threshold.
Both are clinician-rated depression severity scales. MADRS is shorter (10 items) and focuses on core affective-cognitive symptoms with less somatic and anxiety loading; HAM-D (17 items) covers more somatic and anxiety symptoms. MADRS is regarded as more sensitive to treatment-related change.
Remission is usually a total ≤6 (the "no depression" range); an empirically validated remission cut-off is around ≤7 (Riedel et al., 2010). Some study protocols use a looser ≤12. Treatment response is a ≥50% reduction from baseline.
No. The MADRS is completed by a clinician based on a structured clinical interview; it is not intended for patient self-completion. For self-report use PHQ-9 or BDI-II.
No. The MADRS indicates symptom severity as a guide; a diagnosis of a depressive disorder requires clinical assessment by a professional. High scores or thoughts of self-harm warrant urgent clinical assessment.
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MADRS — one of 44 instruments in your practice
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