psychiatry

Hamilton Anxiety Rating Scale (HAM-A)

14-item clinician-administered scale measuring anxiety severity. Each item rated 0–4. Total score 0–56. Widely used in clinical trials and clinical practice for anxiety disorders.

Used in: Depression & Anxiety

Anxious mood (worries, anticipation of the worst, fearful anticipation)*

Tension (feelings of tension, fatigability, inability to relax, trembling)*

Fears (of dark, strangers, being left alone, animals, crowds, traffic)*

Insomnia (difficulty falling asleep, broken sleep, unsatisfying sleep, dreams, nightmares)*

Intellectual (cognitive) — difficulty concentrating, poor memory*

Depressed mood (loss of interest, anhedonia, early waking, diurnal variation)*

Somatic (muscular) — pains, twitching, stiffness, teeth grinding*

Somatic (sensory) — tinnitus, blurred vision, hot flushes, weakness*

Cardiovascular symptoms — tachycardia, palpitations, chest pain*

Respiratory symptoms — chest tightness, choking, sighing, dyspnoea*

Gastrointestinal symptoms — dysphagia, nausea, vomiting, diarrhoea, weight loss*

Genitourinary symptoms — urinary frequency, dysmenorrhoea, loss of libido, impotence*

Autonomic symptoms — dry mouth, flushing, pallor, tendency to sweat*

Behaviour at interview — fidgeting, restlessness, tremor, furrowed brow, tense face*

Score interpretation

Minimal Anxiety 0–7

HAM-A ≤7 — minimal or no anxiety

→ Monitor; supportive therapy; psychoeducation; lifestyle measures (exercise, sleep hygiene)

Mild Anxiety 8–14

HAM-A 8–14 — mild anxiety

→ Psychotherapy (CBT); low-intensity psychological intervention; monitor response to treatment

Moderate Anxiety 15–23

HAM-A 15–23 — moderate anxiety

→ CBT; consider SSRI/SNRI (sertraline, escitalopram, duloxetine, venlafaxine); reassess at 4–6 weeks; consider psychiatry referral if no response

Severe Anxiety 24–56

HAM-A ≥24 — severe anxiety

→ Pharmacotherapy essential; consider SSRI + buspirone or pregabalin; psychiatry referral; CBT; monitor for comorbid depression; assess functional impairment

Interpretation bands for the HAM-A. Apply clinical judgement and local guidance.

References

Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50–55.

Curated clinical cross-links plus same-class fallbacks.

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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