Montgomery-Asberg Depression Rating Scale MADRS
Montgomery-Asberg Depression Rating Scale MADRS overview
Creator and Context
The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10 item clinician rated measure of depression severity, designed specifically to be sensitive to change.
It was published by Stuart Montgomery and Marie Asberg in the British Journal of Psychiatry in 1979. The items were selected from a larger pool precisely because they moved most with treatment, which is why the MADRS became the standard outcome measure in antidepressant trials. Copyright sits with the Royal College of Psychiatrists.
Presenting Conditions
The ten items are apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts and suicidal thoughts.
Item 10, suicidal thoughts, is routinely used as a standalone risk flag.
Administration
Clinician administered as a structured interview, typically covering the past 7 days. Each item is rated from 0 to 6 against defined anchors.
Desired Audience
Adults with depressive illness. A self report version, the MADRS-S, exists but is a different instrument with different properties and should not be conflated with the clinician rated scale.
The MADRS deliberately carries fewer somatic items than the Hamilton scale, which is why it discriminates treatment responders from non responders more cleanly. If the question is whether an antidepressant is working, this is the instrument built to answer it.
Considerations
Clinician rated. Reliability depends on rater training, and a structured interview guide is recommended.
It is a severity and change measure, not a diagnostic tool.
It is deliberately light on somatic symptoms, which is a strength for treatment sensitivity and a limitation if you need a full symptom picture.
The self report MADRS-S is not interchangeable with the clinician rated version.
How to score the Montgomery-Asberg Depression Rating Scale MADRS
Conducting the assessment
The clinician rates 10 items from 0 to 6 based on the interview.
Interpretation
Items are summed to give a total from 0 to 60.
The commonly used severity bands, derived from Snaith et al. (1986):
0 to 6 normal or absent
7 to 19 mild
20 to 34 moderate
35 to 60 severe
Remission is most defensibly defined as a score below 10 (Hawley et al., 2002). A reduction of 50 percent or more from baseline is the conventional definition of treatment response.
Clinical Considerations
Read item 10 separately every time. A falling total score with a rising suicidality item is a clinical emergency, not an improvement.
Track change from baseline rather than reading bands in isolation.
Use a structured interview guide to keep ratings consistent between clinicians.
Montgomery-Asberg Depression Rating Scale MADRS use cases
Measuring depression severity in adults
Tracking response to antidepressant treatment
Defining remission at the end of a treatment episode
Clinical trials, where it is the reference outcome measure
Category
Depression
Research Summary
Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382 to 389.
Snaith, R. P., Harrop, F. M., Newby, D. A., & Teale, C. (1986). Grade scores of the Montgomery-Asberg Depression and the Clinical Anxiety Scales. British Journal of Psychiatry, 148, 599 to 601.
Hawley, C. J., Gale, T. M., & Sivakumaran, T. (2002). Defining remission by cut off score on the MADRS: Selecting the optimal value. Journal of Affective Disorders, 72(2), 177 to 184.
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Note on Assessment licensing
Some assessments are copyright protected and require a licence or the copyright holder's permission for clinical, commercial or digital use. Where that applies, obtaining and maintaining that permission is the responsibility of the practice or organisation using the assessment. Tacklit provides the digital administration, scoring and reporting. We do not grant, transfer or supply rights to the underlying instrument.
