Calculators / Depression and mood
MADRS
Montgomery-Asberg Depression Rating Scale. Clinician-rated depression severity and change.
Members Library
The MADRS calculator is in the Library.
Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.
Use it for
- Rating the severity of depression in a person who already has the diagnosis.
- Following response and remission during treatment, with the same rater each time.
- Research and trial work, where it is a standard outcome.
Do not use it for
- Screening or diagnosing depression. It was built to measure severity and change.
- Atypical depression. It rates reduced sleep and reduced appetite only, so hypersomnia and weight gain are not captured.
- A self-report substitute. The MADRS-S is a separate self-rated version.
The MADRS is published in the British Journal of Psychiatry, and the Royal College of Psychiatrists holds the copyright. The published anchors are therefore not reproduced on this page. Interview the person with the published scale or the SIGMA interview guide, covering the past week, and enter the ten ratings here.
Each item is rated from 0 to 6. The published anchors sit at 0, 2, 4 and 6. Use 1, 3 and 5 for a rating between two anchors. 0 is normal or absent, and a higher number is more severe.
MADRS
Answer the questions to see the result.
This calculator adds up the score in your browser. Nothing you enter is stored or sent.
More about the MADRS
About the MADRSWhat it is and what it is for
Montgomery and Asberg published the MADRS in 1979. It has ten items, each rated by a clinician from 0 to 6, so the total runs from 0 to 60. The items were chosen from a longer symptom list because they changed most with treatment, which is why the scale is good at showing change.
It leans less on sleep and bodily symptoms than the HAM-D, and it rates mood, inner tension, concentration, lassitude, inability to feel, pessimism and suicidal thoughts. It is the primary outcome in many modern antidepressant and rapid-acting treatment trials.
How to use itGiving it and scoring it
Interview the person, ideally with a structured guide such as the SIGMA, and rate the ten items for the past week from the published anchors. Add all ten for a total from 0 to 60. This page does the addition.
Use the same rater and the same interview at each follow-up, so the change means something.
Interpreting the scoreScore ranges and what they suggest
| MADRS total | What it suggests | Usual response |
|---|---|---|
| 0 to 6 | Normal or symptom-freeFew or no depressive symptoms. | If in treatment, continue it and plan maintenance. |
| 7 to 19 | MildMild depression, or residual symptoms. | If treated, optimize before calling it a remission. If untreated, consider psychotherapy or watchful waiting. |
| 20 to 34 | ModerateClear symptoms with impairment. | Active treatment, with a plan to re-rate at the next visits. |
| 35 to 60 | SevereMarked symptoms and impairment. | Active treatment, close follow-up and a safety review. Consider psychotic features and the level of care. |
These are the severity bands most often quoted (Snaith 1986). The authors did not publish cutoffs. Other analyses put the line between moderate and severe lower, so say which bands you use. Remission has no single cutoff: trials have used 6 to 12, and 10 or below is the most common.
Pearls and pitfallsTips and common mistakes
- Record the baseline total at the start of treatment. Response and remission both depend on it.
- Read the suicidal thoughts item (10) on its own, whatever the total.
- The scale is good at showing early change. Little improvement in the first 2 to 4 weeks of an adequate trial makes a later response less likely, and is the time to review the plan.
- Because the sleep and appetite items rate reduction only, add a note when the picture is atypical.
- For a quick self-report measure of the same domain, use the PHQ-9.
EvidenceAccuracy and reliability
- Montgomery and Asberg (1979) built the scale from a longer symptom rating by keeping the items that changed most with treatment. It has been widely used as a trial outcome since.
- Interrater reliability is good with a structured interview. The SIGMA (Williams and Kobak 2008) was written to standardize the questions.
- Remission has no agreed cutoff. Zimmerman and colleagues (2004) noted trials had used cutoffs from 6 to 12.
- The severity bands usually quoted come from Snaith and colleagues (1986) and are conventions.
Source, license and referencesWhere it comes from
The MADRS was published by Stuart Montgomery and Marie Asberg in the British Journal of Psychiatry in 1979, and the Royal College of Psychiatrists holds the copyright. This page does not reproduce the published anchors. It only adds up the ten 0 to 6 ratings you give from the published scale or an interview guide, and the item descriptions here are written in our own words. For the full scale, use the original paper or request permission through the journal.
- Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382-389.
- Williams JBW, Kobak KA. Development and reliability of a structured interview guide for the Montgomery Asberg Depression Rating Scale (SIGMA). Br J Psychiatry. 2008;192(1):52-58.
- Snaith RP, Harrop FM, Newby DA, Teale C. Grade scores of the Montgomery-Asberg Depression and the Clinical Anxiety Scales. Br J Psychiatry. 1986;148:599-601.
- Zimmerman M, Posternak MA, Chelminski I. Defining remission on the Montgomery-Asberg Depression Rating Scale. J Clin Psychiatry. 2004;65(2):163-168.