The Montgomery-Asberg Depression Rating Scale, or MADRS, is a 10-item clinician-rated scale for depression severity, published in 1979. It was designed to be more sensitive to change during treatment than the older Hamilton scale, and it focuses on the core psychological symptoms of depression rather than physical complaints. The items are apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts and suicidal thoughts. Each is scored 0 to 6, giving a total from 0 to 60.
Commonly used cutoffs are 0 to 6 for remission, 7 to 19 for mild depression, 20 to 34 for moderate, and 35 or higher for severe. The MADRS was the primary outcome measure in the clinical trials that led to Spravato's approval, and it is often used in TMS research as well, so you will see it referenced in insurance criteria and in published response and remission figures. A clinician scores it during a conversation that takes 15 to 20 minutes, drawing on your answers and their own observation. Because a few items depend on observed behavior, it is best done in person or by video rather than by phone. At Stedfast Psychiatry, a MADRS may be recorded at the start of an interventional treatment and at intervals afterward to document progress for your records and for your insurer.