Hostname: page-component-7d684dbfc8-kpkbf Total loading time: 0 Render date: 2023-10-01T18:41:42.377Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false

A New Depression Scale Designed to be Sensitive to Change

Published online by Cambridge University Press:  29 January 2018

Stuart A. Montgomery*
Academic Department of Psychiatry, Guy's Hospital Medical School, London, S.E.I
Marie Åsberg
Karolinska Institute, Stockholm, Sweden


The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample.

Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change.

The inter-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.

Copyright © Royal College of Psychiatrists, 1979 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Anderson, N. H. (1961) Scales and statistics: parametric and non-parametric. Psychological Bulletin, 58, 305–16.CrossRefGoogle Scholar
Angst, J. (1972) Concluding discussion. In Depressive Illness (ed. P. Kielholz). Bern: Huber.Google ScholarPubMed
Åsberg, M., Kragh-Sorensen, P., Mindham, R. H. S. & Tuck, J. R. (1973) International reliability and communicability of a rating scale for depression. Psychological Medicine, 3, 458–65.CrossRefGoogle Scholar
Åsberg, M., Ringberger, V. A., Sjöqvist, F., Thorn, P., Träskman, L. & Tuck, J. R. (1977) Monoamine metabolites in the cerebrospinal fluid and serotonin uptake inhibition during treatment with clomipramine. Clinical Pharmacology and Therapeutics, 21, 201–7.CrossRefGoogle Scholar
Åsberg, M., Montgomery, S., Perris, C., Schalling, D. & Sedvall, G. (1978) A comprehensive Psycho-pathological Rating Scale. Acta Psychiatrica Scandinavica, Supplement 272.Google Scholar
Boneau, C. A. (1961) A note on measurement scales and statistical tests. American Psychologist, 16, 160261.CrossRefGoogle Scholar
Carroll, B. J., Fielding, J. M. & Blashki, T. G. (1973) Depression rating scales. A critical review. Archives of General Psychiatry, 28, 361–6.CrossRefGoogle Scholar
Coppen, A., Gupta, R., Montgomery, S., Ghose, K., Bailey, J., Burns, B. & de Ridder, J. J. (1976) Mianserin hydrochloride: a novel antidepressant. British Journal of Psychiatry, 129, 342–5.CrossRefGoogle ScholarPubMed
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G. & Munoz, R. (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 5763.CrossRefGoogle ScholarPubMed
Ferl, P. J., Quantock, D. C. & van der Burg, W. J. (1973) The human pharmacology of GB94—a new psychotropic agent. European Journal of Clinical Pharmacology, 5, 166–73.Google Scholar
Guilford, J. P. (1954) Psychometric methods. 2nd Ed., p 278. New York: McGraw-Hill.Google Scholar
Gurney, C., Roth, M., Garside, R. F., Kerr, T. A. & Schapira, K. (1972) Studies in the classification of affective disorders. The relationship between anxiety states and depressive illnesses—II. British Journal of Psychiatry, 121, 162–6.CrossRefGoogle Scholar
Hamberger, B. & Tuck, J. R. (1973) Effect of tricyclic antidepressants on the uptake of noradrenaline and 5-hydroxytryptamine by rat brain slices incubated in buffer or human plasma. European Journal of Clinical Pharmacology, 5, 229–35.CrossRefGoogle Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.CrossRefGoogle Scholar
Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278–96.CrossRefGoogle ScholarPubMed
Hamilton, M. (1976) Comparative value of rating scales. British Journal of Clinical Pharmacology, 3, 5860.CrossRefGoogle ScholarPubMed
Mass, J. W. (1975) Biogenic amines and depression. Biochemical and pharmacological separation of two types of depression. Archives of General Psychiatry, 32, 1357–61.Google Scholar
Maitre, L., Staehelin, M. & Bein, H. J. (1971) Blockade of noradrenaline uptake by 34276 B a, A new antidepressant drug. Biochemical Pharmacology, 20, 2169–86.CrossRefGoogle Scholar
Montgomery, S., Åsberg, M., Träskman, L. & Montgomery, D. (1978a) Cross-cultural studies on the use of the CPRS in English and Swedish depressed patients. Acta Psychiatrica Scandinavica, Supplement 272, 33–9.Google Scholar
Montgomery, S., Åsberg, M., Jörnestedt, L., Thoren, P., Träskman, L., McAuley, R., Montgomery, D. & Shaw, P. (1978b) Reliability of the CPRS between the disciplines of psychiatry, general practice, nursing and psychology. Acta Psychiatrica Scandinavica. Supplement 272, 2932.Google Scholar
Morris, J. B. & Beck, A. T. (1974) The efficacy of antidepressant drugs—a review of research (1958 to 1972) Archives of General Psychiatry, 30, 667–74.CrossRefGoogle Scholar
Pichot, P. (1972) The problem of quantifying the symptomatology of depression. In Depressive Illness (ed. P. Kielholz). Bern: Huber.Google Scholar
Silverstone, T. & Turner, P. (1974) Drug Treatment in Psychiatry, p 117. London: Routledge & Regan Paul.Google Scholar
Tuck, J. R. & Punell, G. (1973) Uptake of 3H-5-hydroxytryptamine and 3H-noradrenaline by slices of rat brain incubated in plasma from patients treated with clomipramine, imipramine or amitriptyline. Journal of Pharmacy and Pharmacology, 25, 573–4.CrossRefGoogle Scholar
Submit a response


No eLetters have been published for this article.