What is... psychology series

What Is… Psychomotor Retardation

Symptoms of psychomotor retardation in depression

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.

Biology

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.

Melancholic depression

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?

How depression affects movement: decreased energy, psychomotor retardation, and leaden paralysis

You can find the rest of the What Is series here, and read more about psychomotor retardation in the post How Depression Affects Movement.


Sources

book cover: Managing the Depression Puzzle by Ashley L. Peterson

Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle. It’s available on Amazon and other online retailers, as well as the MH@H Store.

This post contains affiliate links that let you support MH@H at no extra cost to you.

13 thoughts on “What Is… Psychomotor Retardation”

  1. I have this (without cognitive function being affected) but I never knew what it WAS. I thought I was just getting ‘old’. Wow. Depression has a myriad of symptoms, many of which are never shared with the patient apparently. Now I’ll worry less at least, on a bad day when I can’t move very well or at all without a lot of pain and feeling like I’m tripping over my own feet. I’ll know it’s my brain chemistry doing that. Thanks Ashleyleia!

  2. I was so angry at those mean hospital people, and I hope you’re feeling better today!! I can definitely see how it would cause psychomotor retardation.

    Yeah, I sometimes get into a fog. I just kind of lose awareness of everything around me and zone out, sometimes sitting still and staring at nothing for a while. If I’m in a better mood, I might pace and talk to myself. Huh… maybe catatonia is different from psychomotor retardation…? I’m not sure.

    I always have the feeling (particularly when it happens and I’m in a good mood) that it’s a way for my subconscious mind to work through something, by dulling what I’m doing consciously. When I’m in a bad mood, it’s the same thing, only not so pleasant.

    Have you gotten some space from those horrible ER experiences? I’ve been worried!!

  3. With the two episodes of depression which were more severe than the others, which includes the one I had following withdrawal from long-term antidepressants, this was definitely something I noticed. Kind of a wading-through-treacle feeling both mentally and physically. I also noticed very specific cognitive deficits like difficulty sequencing tasks, which took a surprisingly long time to recover and didn’t exactly parallel the improvement in mood.

  4. I am not sure if I have grasped all that is within this article. I may have to read this over several times.
    I do agree though about “stigma”. I find it mostly among people when I mention “bi-polar”. It seems that they have in their mind what a person who is bi-polar should act like, talk like. This can be attributed to our overblown media which has no understanding of the basics when it comes to mental health.

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