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Montgomery-Asberg Depression Scale (MADRS)
Please visit this website for more information about the instrument: Montgomery-Asberg Depression Rating Scale and the Structured Interview Guide for the MADRS (SIGMA), published in 2008. The MADRS is in the public domain, but copyrighted by the British Journal of Psychiatry, where it was originally published.
Supplemental: Mitochondrial Disease (Mito) and Parkinson's Disease (PD)
Short Description of Instrument
The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10-item rater-administered assessment tool that is most often used in clinical trials of antidepressants to select patients with a diagnosis of depression for the study and to assess efficacy of the treatment. Ratings are based on the patient's condition in the past week.
Construct Measured: The tool was designed to be used in individuals with major depression to measure the overall severity of depression and change in symptom severity in placebo-controlled clinical trials. The 10-items cover the core symptoms of Major Depression (apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts), which were selected based on their being common symptoms in depression and sensitivity to change with treatment. Major Depressive symptoms of hypersomnia, increased appetite, and psychomotor retardation or agitation were not included.
Generic vs. Disease-specific: Generic
Means of administration: The MADRS is rater-administered with scores based on direct observation and clinical interview with the patient. Interviews are reported as taking 15 to 20 minutes to complete. With use of The Structured Interview Guide for the MADRAS (SIGMA), inter-rater reliability was high and equivalence was demonstrated across telephone, videoconference, and face-to-face interviews. A self-report version (MADRS-S), developed in 1994, includes 9 items based on symptoms over the last 3 days.
Intended respondent: Patient
Subscales: None
Comments/Special Instructions
The Montgomery-Asberg Depression Rating Scale (MADRAS) was introduced in 1979 as an alternative outcomes measure to the Hamilton Rating Scale for Depression (HRDS) in antidepressant clinical trials.
Scoring and Psychometric Properties
Scoring: Each item is rated on a 7-point (0 to 6) ordinal scale with anchors at 2-point intervals. The total score (sum of the 10 items) ranges from 0 to 60, with scores of 11 representing borderline ill, 19 for Mildly ill, and 29 moderately ill. The scale has demonstrated good face validity, criterion validity, and concurrent validity, and high inter-rater reliability and internal consistency.  Higher scores indicate a greater severity of depression. Generally, a cut score of 12 has been suggested to represent the presence of clinically significant depression symptoms, though some groups have suggested that a cut score of >8 produces more acceptable sensitivity and specificity (Kjaergaard et al., 2014; Williams JR, 2009).
Mitochondrial Disease-specific: Given the prevalence of mood concerns in mitochondrial disease, this is a useful tool in providing a brief method to screen for symptoms and to measure change over time in response to intervention.
Parkinson's Disease-specific: As compared to the Hamilton Depression Rating Scale, the MADRS has relatively few somatic symptoms. It is valid in older adults with PD and mild cognitive impairment. The scale is not typically used for screening purposes, though it can be suitable for this purpose when appropriate cut-off scores are used.
Strengths: The measure is relatively brief and can be completed by a physician or other provider familiar with the individual for those who may be too impaired to complete a self-report measure. As noted above, the instrument was designed originally to measure change in depression symptoms in response to intervention for research purposes. Over time it has also come to be used as a brief screening tool in clinical populations. There are some concerns, however, that the measure may lack sufficient construct validity, and, as such, is not sufficiently unidimensional to provide a reliable assessment of depression severity (Bech et al., 2014). Similarly, concordance between self and physician ratings is only moderate to good, and therefore caution must be taken to ensure they are not used interchangeably (Cunningham et al., 2011). This scale has been used in previous studies, but is no longer widely used and can be difficult to administer.
Weaknesses: Research suggests the 10-item scale may be comprised of 4 underlying factors: sadness, negative thoughts, detachment and neurovegetative symptoms (Quilty et al., 2013). The latter may be inflated in individuals with mitochondrial disease, and therefore results must be interpreted with caution whether they represent fatigue and other physical consequences of the disease or whether they represent symptoms of depression. Removal of physical symptoms reduces specificity and increases specificity in other populations with neurological and physical impairment, and it is may therefore be recommended that a higher cutoff score be utilized in populations such as Parkinson's disease in which physical symptoms of the disorder and depression may overlap (Reijnders et al., 2010).
Key Reference:
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979 Apr;134:382-9.
Additional References:
Bech P, Allerup P, Larsen ER, Csillag C, Licht RW. The Hamilton Depression Scale (HAM-D) and the Montgomery-Asberg Depression Scale (MADRS). A psychometric re-analysis of the European genome-based therapeutic drugs for depression study using Rasch analysis. Psychiatry Res. 2014 Jul 30;217(3):226-32.
Cunningham JL, Wernroth L, von Knorring L, Berglund L, Ekselius L. Agreement between physicians' and patients' ratings on the Montgomery-Asberg Depression Rating Scale. J Affect Disord. 2011 Dec;135(1-3):148-53.
Fantino B, Moore N. The self-reported Montgomery-Asberg Depression Rating Scale is a useful evaluative tool in Major Depressive Disorder. BMC Psychiatry. 2009 May 27;9:26.
Kjaergaard M, Arfwedson Wang CE, Waterloo K, Jorde R. A study of the psychometric properties of the Beck Depression Inventory-II, the Montgomery and Asberg Depression Rating Scale, and the Hospital Anxiety and Depression Scale in a sample from a healthy population. Scand J Psychol. 2014 Feb;55(1):83-9.
Quilty LC, Robinson JJ, Rolland JP, Fruyt FD, Rouillon F, Bagby RM. The structure of the Montgomery-Asberg depression rating scale over the course of treatment for depression. Int J Methods Psychiatr Res. 2013 Sep;22(3):175-84.
Svanborg P, Asberg M. A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS). J Affect Disord. 2001 May;64(2-3):203-16.
Williams JB, Kobak KA. Development and reliability of a structured interview guide for the Montgomery Asberg Depression Rating Scale (SIGMA). Br J Psychiatry. 2008 Jan;192(1):52-8.
Parkinson's Disease-Specific References:
Calleo J, Williams JR, Amspoker AB, Swearingen L, Hirsch ES, Anderson K, Goldstein SR, Grill S, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone GM, Weiss H, Rabins P, Marsh L. Application of depression rating scales in patients with Parkinson's disease with and without co-Occurring anxiety. J Parkinsons Dis. 2013;3(4):603-8.
Reijnders JS, Lousberg R, Leentjens AF. Assessment of depression in Parkinson's disease: the contribution of somatic symptoms to the clinimetric performance of the Hamilton and Montgomery-Asberg rating scales. J Psychosom Res. 2010 Jun;68(6):561-5.
Schrag A, Barone P, Brown RG, Leentjens AF, McDonald WM, Starkstein S, Weintraub D, Poewe W, Rascol O, Sampaio C, Stebbins GT, Goetz CG. Depression rating scales in Parkinson's disease: critique and recommendations. Mov Disord. 2007 Jun 15;22(8):1077-92.
Torbey E, Pachana NA, Dissanayaka NN. Depression rating scales in Parkinson's disease: A critical review updating recent literature. J Affect Disord. 2015 Sep 15;184:216-24.
Williams JR, Hirsch ES, Anderson K, Bush AL, Goldstein SR, Grill S, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone G, Weiss H, Rabins P, Marsh L. A comparison of nine scales to detect depression in Parkinson disease: which scale to use? Neurology. 2012 Mar 27;78(13):998-1006.
Document last updated August 2022