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Montgomery-Asberg Depression Rating Scale (MADRS)
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About Montgomery-Asberg Depression Rating Scale (MADRS)
Scale Name
Montgomery-Asberg Depression Rating Scale (MADRS)
Author Details
Stuart A. Montgomery and Marie Asberg
Translation Availability
English
Background/Description
The Montgomery-Asberg Depression Rating Scale (MADRS), developed by Stuart A. Montgomery and Marie Asberg in 1979, is a clinician-rated tool designed to assess the severity of depressive symptoms with a particular emphasis on sensitivity to treatment-related changes. Published in the British Journal of Psychiatry, the MADRS was created to improve upon existing scales like the Hamilton Depression Rating Scale by focusing on core psychological symptoms of depression, minimizing somatic bias, and enhancing responsiveness to therapeutic interventions. It has become a gold standard in clinical trials and psychiatric practice for evaluating antidepressant efficacy.
The MADRS consists of 10 items, each scored on a 7-point scale (0 = “absent” to 6 = “severe”), covering symptoms such as apparent sadness, inner tension, reduced sleep, and pessimistic thoughts, assessed over the past week. Total scores range from 0 to 60, with thresholds like 7-19 indicating mild, 20-34 moderate, and 35+ severe depression. Administered through a semi-structured interview, it takes about 15-20 minutes to complete, relying on clinician observation and patient input. Its extensive translations and focus on change detection make it a globally recognized tool for tracking depression in diverse populations.
Administration, Scoring and Interpretation
- Obtain the copy: Access the MADRS from its original publication in Montgomery and Asberg (1979) via British Journal of Psychiatry or authorized clinical resources, ensuring training for use.
- Explain the purpose: Inform the clinician (and indirectly the patient) that the scale measures depression severity to monitor treatment progress or research outcomes.
- Provide instructions: Instruct the clinician to rate each of the 10 items based on a semi-structured interview and observation, using the 7-point scale and provided descriptors.
- Approximate time: Allow approximately 15-20 minutes for the interview and scoring, depending on the patient’s presentation and clinician experience.
- Administer the scale: Conduct the assessment in a clinical setting, observing the patient’s behavior and responses during the interview, and record scores systematically.
Reliability and Validity
The Montgomery-Asberg Depression Rating Scale exhibits strong psychometric properties, as established in Montgomery and Asberg (1979) and subsequent research. Inter-rater reliability is high, with intraclass correlation coefficients (ICC) ranging from 0.89 to 0.95 among trained clinicians, ensuring consistent scoring. Test-retest reliability over short intervals yields coefficients around 0.80-0.85, reflecting stability in untreated patients.
Validity is robustly supported. Concurrent validity is shown through strong correlations (r = 0.70-0.85) with the Hamilton Depression Rating Scale and Beck Depression Inventory, while its focus on core symptoms enhances content validity. Discriminant validity distinguishes MADRS scores from mania or anxiety scales, and its exceptional sensitivity to change—evidenced in antidepressant trials—makes it a preferred tool for measuring treatment response. These properties confirm its reliability and validity for clinical and research applications.
Available Versions
10-Items
Reference
Montgomery, S. A., & Åsberg, M. A. R. I. E. (1979). A new depression scale designed to be sensitive to change. The British journal of psychiatry, 134(4), 382-389.
Important Link
Scale File:
Frequently Asked Questions
What does the MADRS measure?
It measures the severity of depressive symptoms, sensitive to treatment changes.
How many items are in the MADRS?
It includes 10 items scored from 0 to 6.
Who developed the MADRS?
It was developed by Stuart Montgomery and Marie Asberg in 1979.
How long does it take to complete the MADRS?
It takes about 15-20 minutes via clinical interview.
Why is the MADRS used in clinical trials?
Its sensitivity to change makes it ideal for tracking treatment effects.
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