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 it often includes changes in speech and eye contact.
These symptoms have been described as far back as ancient Greek times.
What does psychomotor retardation look like?
The slowing of movement in psychomotor retardation is objectively noticeable by others. Symptoms of PMR include:
- 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 mobility in trunk and proximal limbs (upper legs and arms)
While non-clinicians probably wouldn’t be able to recognize what it is they’re seeing, the changes don’t require clinical training to be noticed in the first place.
In this video, I’m not moving far enough to get much of a sense of how walking is affected, but my speech impairment is quite obvious.
It isn’t known exactly what causes this PMR, 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 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 post The Biology of Psychomotor Retardation.
Psychomotor retardation is more common in the melancholic subtype of depression, and also when there are psychotic features. There tends to be 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 does 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 feels like it has 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 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. 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.
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, which seems like it may relate to the cortisol stress response. 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?
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.