In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is psychomotor retardation.
Psychomotor retardation (PMR) is one of the less common but more outwardly observable symptoms of depression. It’s one of the DSM-5’s symptom criteria in a major depressive episode, which can occur in the context of major depressive disorder, bipolar disorder, or schizoaffective disorder. It involves a slowing of both thinking and physical movement, and the slowed movement is observable by others.
PMR has been described as far back as ancient Greek times.
What does psychomotor retardation look like?
PMR can affect multiple aspects of movement, including:
- slowed movements that are noticeable by others
- walking is slow, with abnormal gait
- lack of facial expressiveness of emotion (“flat affect”)
- decreased eye contact, fixed gaze
- speech changes: decreased volume, slow and monotonous speech with increased pauses, delayed verbal responses and spontaneous speech
- slumped posture
- reduced movement in the trunk and proximal limbs, i.e. upper legs and arms
Non-clinicians may notice PMR in others, but not understand what they’re seeing. My experience has been that general practitioners don’t tend to be familiar with what PMR (or at least severe PMR) looks like, and I have to tell them what they’re seeing.
In this video, I’m not moving far enough to get much of a sense of how ridiculously slow my walking is, but my speech impairment is quite obvious, as is the flat affect. When I’m well, I smile frequently and have done a fair bit of public speaking.
It isn’t known exactly how PMR happens biologically, but it’s been suggested that changes in neural circuits in the prefrontal cortex may affect the basal ganglia, an area of the brain thats’s involved in regulating movement. The neurotransmitter dopamine appears to play a major role. The hypothalamic-pituitary-adrenal axis, which connects the brain and the adrenal glands, has also been implicated.
There’s more on this topic in the post The Biology of Psychomotor Retardation.
Psychomotor retardation occurs most often in the melancholic subtype of depression, and also when there are psychotic features. There appears to be a stronger biological element and less of a link to situational factors.
One study found that a higher number of previous depressive episodes was associated with more severe psychomotor symptoms. Electroconvulsive therapy (ECT) seems to be particularly helpful for PMR.
What does PMR feel like?
Psychomotor retardation feels a lot like moving through molasses, both mentally and physically. It’s not a matter of lack of energy; if anything, I find that moving so slowly produces fatigue rather than the other way around, since moving feels like I need to push through physical resistance.
I’ve always been aware of PMR when it’s happening, although that awareness doesn’t help me do anything about it. It feels like my body just can’t go any faster. When it’s mild, it’s mostly walking that’s affected, but when it’s bad, it has a significant impact on my speech. Words are hard and slow to get out.
Making eye contact requires more mental energy than I have available. If I’m concentrating on getting words out, I find myself looking up at the ceiling, which you can see me doing in the video. The video also shows that I blink rapidly as I’m fishing for words. I actually hadn’t realized that prior to watching the video, but as far as I can tell, it seems to be as I’m looking for the motor scripts for words rather than looking for the words themselves.
Slowed psychomotor activity has appeared off and on throughout the course of my illness. It was particularly bad during my second hospitalization, which lasted two months. As time has passed, though, there’s been a pattern of abrupt onset (or worsening) of PMR in response to major environmental stressors, which seems like it may relate to the HPA-axis/cortisol stress response. It generally starts when I wake up the day following the stressor, and tends to last a few weeks. In the past, the PMR would resolve between stress-induced spikes, but that’s no longer the case.
Is psychomotor retardation a symptom you’ve experienced with your illness? Have you noticed any patterns with it?
You can find the rest of the what is… series in the Psychology Corner.
- Buyukdura, J. S., McClintock, S. M., & Croarkin, P. E. (2011). Psychomotor retardation in depression: biological underpinnings, measurement, and treatment. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 35(2), 395–409.
- Dantchev N, & Widlöcher DJ. (1998). The measurement of retardation in depression. The Journal of Clinical Psychiatry, 59 Suppl 14:19-25.
- Gorwood, P., Richard-Devantoy, S., Baylé, F., & Cléry-Melun, M. L. (2014). Psychomotor retardation is a scar of past depressive episodes, revealed by simple cognitive tests European Neuropsychopharmacology, 24(10), 1630-1640.
- Sobin, C., Mayer, L., & Endicott, J. (1998). The motor agitation and retardation scale: a scale for the assessment of motor abnormalities in depressed patients. The Journal of Neuropsychiatry and Clinical Neurosciences, 10(1), 85-92.