What is… psychomotor retardation

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: psychomotor retardation

Psychomotor retardation is one of the less common but more outwardly observable symptoms of depression, and is 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.

There is a standardized test to measure psychomotor retardation called the Salpêtrière Retardation Rating Scale.  It contains 14 items that measure walking, speed of movements in the limbs/trunk and head/neck, flow of speech, speech volume, shortness of verbal responses, limited spontaneous speech, easily fatigued, rumination, loss of interest, time perceived as painfully slow, and problems with memory and concentration.

The Motor Agitation and Retardation Scale is another test used to evaluate the extent of psychomotor retardation.  It considers abnormal gait, immobility of trunk and proximal limbs, postural collapse, slowing of movement, flat affect, downcast gaze, and speech that is soft and monotone, with delayed onset.

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.

Psychomotor retardation is more common in the melancholic subtype of depression, and  also in depression with psychotic features.  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.

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.

This was triggered again for me this past weekend after the stigmatized cluster-f*ck I experienced when I went into ER (twice) for physical reasons but they decided I was just a psych patient.  When I woke up the next morning, even walking to the bathroom was a challenge.  For me at least it’s not the same feeling as lack of energy; it’s more like my body is trying to resist the movement.  The rating scale described above mentions slowing of time; I don’t always experience that, but this time around it was pretty painful for a few days.  I didn’t feel like doing anything, even watching tv, and of course that made the time go by even slower.  Putting words together to speak out loud can be challenging.

Is psychomotor retardation a symptom you’ve experienced with your illness?  Have you noticed any patterns with it?

You can find the rest of my What Is series here.

Sources:

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11 thoughts on “What is… psychomotor retardation

  1. Melanie B Cee says:

    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. Meg says:

    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. DV says:

    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.

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