Why the Hamilton Depression Rating Scale Endures

To the Editor: It is widely accepted that the Hamilton depression scale is less than ideal as a measure of outpatient depression severity. However, while we await the development and validation of other scales, the Hamilton depression scale will almost certainly continue to be used in regulatory and academic clinical trials for at least a few more years. As Dr. Bagby et al. noted, the Depression Rating Scale Standardization Team developed the GRID-HAMD to fill this gap. The Depression Rating Scale Standardization Team was formed in 1999 by individuals in academia, clinical practice, the pharmaceutical industry, and government to develop a standard approach to administering and scoring the Hamilton depression scale that would remain acceptable to the Food and Drug Administration and be used by pharmaceutical, academic, and clinical researchers (1). The authors described the GRID-HAMD as “virtually unchanged from the original” (p. 2174), but this is not the case. The Depression Rating Scale Standardization Team standardized the administration and scoring of the Hamilton depression scale to improve item reliability by clarifying and operationalizing ambiguous anchor descriptions and providing interview probes and conventions within the instrument (2). Thus, the original intent of the items and the scaling remain the same. Given the many versions of the scale in use, the Depression Rating Scale Standardization Team concluded that standardization would improve the current scale and lay the groundwork for development of a new scale. This effort is now underway by the Depression Inventory Development Project, and item development and field testing are being conducted. (The Depression Rating Scale Standardization Team and the Depression Inventory Development Project are funded by the International Society for CNS Drug Development. The GRID-HAMD can be downloaded, free of charge, at http://ISCDD.org.)

We recognize that not only does it take years to develop a new scale but also that its acceptance requires a thoughtful consideration of diverse theoretical viewpoints, acknowledgment of past efforts, and innovation. The Hamilton depression scale glass of Dr. Bagby et al. is clearly half-empty. We believe the glass should be viewed as half-full and that future efforts should take advantage of all that has been learned from the many years of use of this scale.