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.
Presentation of psychomotor retardation
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.
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. 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.
My own experience
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 clusterfuck 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?
- 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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