In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is psychomotor retardation.
Psychomotor retardation is one of the less common but more outwardly observable symptoms of depression, and it’s listed as one of the possible diagnostic criteria for a major depressive episode (in major depressive disorder, bipolar disorder, or schizoaffective disorder). It involves a slowing of both thinking and physical movement, and often includes slowed speech with delayed responses and quiet volume. Gaze tends to be fixed and eye contact is avoided. Affect is often flat, meaning there is little to no facial expression of emotions.
These symptoms have been described as far back as ancient Greek times.
What psychomotor retardation looks like
Psychomotor retardation can cause a slowing of thought, but it’s the slowed movement that can be observed by others. This includes:
- slowed movements that are objectively observable by others
- walking is slow, with abnormal gait
- lack of facial expressiveness (“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 mobility in trunk and proximal limbs (upper legs and arms)
While non-clinicians probably won’t be able to recognize what they’re looking at, the changes don’t require clinical training to be noticeable.
There are a few scales that measure psychomotor retardation, including the Salpêtrière Retardation Rating Scale and the Motor Agitation and Retardation Scale.
It’s not known exactly what causes this symptom, but it’s been suggested that changes in neural circuits in the prefrontal cortex may affect the basal ganglia, an area of the brain involved in regulating movement. The neurotransmitter dopamine may play a role. The hypothalamic-pituitary-adrenal axis, which connects the brain and the adrenal glands, has also been implicated. There may also be reduced regional cerebral blood flow.
There’s more on this topic in The Biology of Psychomotor Retardation.
Psychomotor retardation is more common in the melancholic subtype of depression, and also in depression with psychotic features. These tend to have a stronger biological component 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, particularly the cognitive aspects. Electroconvulsive therapy (ECT) seems to be particularly helpful for this aspect of depression.
What dos it feel like?
Psychomotor retardation feels 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, as movement has to push through physical resistance. I’ve always been aware of it when it’s happening, although that awareness doesn’t help me do anything. It feels like my body just won’t go any faster. When it’s mild, it’s mostly walking that’s affected, but when it’s bad, it has a big impact on my speech. Words are hard and slow to get out. Making eye contact requires more mental energy than I have available.
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 psychomotor retardation in response to major environmental stressors. It generally starts when I wake up the day following the stressor, and tends to last a few weeks. It’s always been something I’ve been quite aware of but have no control over. I’ve come to conceptualize it as my brain’s way of trying to protect me from the world, because my thinking gets slowed down and my emotions are shoved off into a corner somewhere.
Is psychomotor retardation a symptom you’ve experienced with your illness? Have you noticed any patterns with it?
- 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.
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