Depression is a mental illness that very often has physical effects. There are several potential ways in which depression affects movement, and this post will explore low energy, psychomotor retardation, and leaden paralysis. These symptoms can occur in both bipolar and unipolar depression.
Low Energy
Fatigue is one of the most common symptoms of depression. Fatigue can involve low energy, decreased endurance, sluggishness, and weakness, and can spill over into mental effects including decreased motivation. However, fatigue is a very non-specific symptom that can occur in the context of many other health conditions, and most healthy people will experience mild fatigue from time to time following periods of high activity.
In people who get partially but not fully better from a depressive episode, fatigue is one of the most common residual symptoms.
Among antidepressants, bupropion is more likely to be helpful with fatigue. While most antidepressants affect serotonin and sometimes norepinephrine, bupropion affects norepinephrine and dopamine, and it tends to be more activating. Stimulant medications are also an option.
Psychomotor Retardation
Psychomotor retardation involves a slowing of movement and thoughts. It’s most common in depression with melancholic features and psychotic features.
The slowness is objectively observable by others. It’s most noticeable in movements closer to the core, and it would be more visible when someone is walking, for example, rather than making small hand movements. For me, walking is significantly impacted, while I don’t notice a major change in my typing.
Other effects of psychomotor retardation can include slowed speech, minimal eye contact, and flat affect (i.e. a lack of facial expressiveness of emotions). The post What Is… Psychomotor Retardation goes into more detail.
While the biological basis is uncertain, several possibilities have been identified. Dopamine activity in an area of the brain called the basal ganglia appears to play a role. There may also be abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis, which is involved in the release of the stress hormone cortisol.
Electroconvulsive therapy (ECT) seems to be one of the most effective treatments for this particular symptom of depression. Among the different antidepressant classes, tricyclics may be the most effective.
Leaden paralysis
Leaden paralysis tends to occur in depression with atypical features. The subtype is named that way not because it’s uncommon, but because it involves increased appetite, increased sleep, and mood reactivity to positive events, which is different from the pattern of decreased appetite, insomnia, and anhedonia that’s somewhat more common in depression. Atypical depression also tends to be associated with a pattern of sensitivity to interpersonal rejection.
About half of people with atypical depression experience leaden paralysis, which involves a feeling of heaviness and being weighed down in the limbs, with significant fatigue. Greater leaden paralysis is associated with worse depression symptoms overall and greater chronicity. Leaden paralysis is more common in females and adults over 30, as well as people who also have an anxiety disorder.
While the biological mechanism behind this is unclear, there’s some indication it may be related to disruptions in the HPA axis or changes in the balance between left and right brain functioning. MAOI (monoamine oxidase inhibitor) antidepressants tend to work particularly well, although they’re not the first line of treatment because of the potential side effects and the need for dietary restrictions.
What’s the difference?
Although there’s certainly overlap in the different ways that depression affects movement, the three are seen as discrete symptoms. It’s probably fairly safe to say that most people who experience depressive episodes as part of their illness have experienced fatigue as a symptom at one time or another. Leaden paralysis and psychomotor retardation are quite a bit less common.
I can’t speak to what leaden paralysis feels like, since I haven’t experienced it, but the key element is a feeling of lead weights in the arms and legs exerting a downward pull. This produces fatigue rather than being something that occurs as a result of fatigue.
Psychomotor retardation feels like walking through molasses. It doesn’t feel like I could go faster if only I had more energy. It’s like one of those speed-restricted vehicles—my brain has set a top speed my body can move at, and I simply can’t go any faster than that. I find the slow movement to be quite tiring, but as with the leaden paralysis, fatigue is an aftereffect rather than the cause. It affects my speech, too; my best friend has said that when he calls me, he can tell within seconds from my voice if I’m not feeling well.
The physicality of mental illness
While the difference between these three symptoms matters somewhat in terms of treatment, what I find most interesting is how physical the illness is, and in particular how much depression affects movement. These symptoms all fall under the umbrella of a major depressive episode in the DSM-5, but I wonder when/if science will be able to narrow it down a little more.
Do you experience any of these symptoms?
References
- Buyudura, J.S. et al. (2011). Psychomotor retardation in depression: Biological underpinnings, measures, and treatment. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(2), 395-409.
- Posternak, M. A., & Zimmerman, M. (2001). Symptoms of atypical depression. Psychiatry Research, 104(2), 175-181.
- Quitkin, F.M. (2002). Depression with Atypical Features: Diagnostic Validity, Prevalence, and Treatment. The Primary Care Companion to the Journal of Clinical Psychiatry, 4(3), 94-99.
- Singh, T., & Williams, K. (2006). Atypical depression. Psychiatry MMC, 3(4), 33-39.
- Targum, S.D, & Fava, M. (2011). Fatigue as a residual symptom of depression. Innovations in Clinical Neuroscience, 8(10), 40-43.
Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.
Wonderful article Ashley. Right on target. With me, fatigue weighed on me like lead, fogging everything I did. Thank you for sharing this! <3
Learned some new things here!!
The leaden paralysis is something I can relate to. My whole body is affected when depressed. It’s not just the physical/chronic pain I noramlly have, it as lf the rest of the body shuts down and hurts just as much as the depression.
Quite an interesting post, Ashley. Thank you for sharing.
It’s really quite bizarre how huge an effect depression can have on the body.
So true, indeed.
I have to laugh a little… I was feeling rather low, but pushing through it prior to what happened to my mom.
This entire week, I almost feel like I’m the one that this happened to. So sore all over, exhaustion, it feels like my body is rebelling against me.
I also know it doesn’t help by me not really being motivated enough to get out of the bed that much either. (That’s my own doing)… I need to get my at together, but depression is like being in a boxing ring and I was knocked out.
You have definitely got a lot to deal with right now.
It’s hard for me to tell what comes from what. My daily Topamax (50mg 2x) has slowed me down and also messes with my ability to regulate my body temp (sweating), which can leave me out of breath more quickly than “normal” (though this is normal for me now)… and thus exhausted from barely anything. But I can sometimes overcome this psychologically with a burst of energy to clean or organize for OCD purposes as long as I pace myself. Yet there are other times I just sit and stare at my phone for 6 hours and don’t move even though I want to. It’s weird! Definitely mood dependent…
Oh that’s interesting.
I’ve definitely battled a lot of these issues-it’s always hard to pull apart what symptom goes with what issue but what I’m certain of is everything mental is expressed through my body….every health issue I’ve ever had can be traced to a mental one and the only thing that’s worse than that is people (especially doctors) who invalidate or think physical issues aren’t “real” if they stem from emotions. Luckily I’ve got an incredible team who sees everything from a holistic perspective, collaborates together and treats me medically while I do emotional treatment alongside. Such an important topic! 🙂
That’s great that you’ve got a team that gets it, Physical issues are no less “real” because the origin is in the brain.
❤️❤️thank you!
The only one I have is the fatigue. Fortunately I do not experience either of the other two. I think those must make the depression so much worse…well they would for me. The fatigue is bad enough, but I know what it is and what I have to do to combat it. The other two would probably have me so worried that I’d end up hospitalized. Wow. My sympathies if you have more than one of the three though! 🙁
Although I guess like anything else once symptoms become part of the pattern it all starts to just blend together.
Two out of the three, fatigue yes! I am also very slow which is quite dangerous in traffic; I can’t react as quickly as in the past and far more worse; I lose every game of ping pong. I see the ball, I process and it’s too late. As for heavy legs, yes but I don’t know what that is. How is it supposed to feel? It sometimes hurt when I need to walk and put my leg in the air to take a step. It’s only in the upper leg though. Maybe it’s fatigue too or maybe I’m just out of order!
I can certainly see how ping pong would be a problem! And traffic is a problem for me too. Sometimes it surprises me that drivers are patient enough to let me cross the street without honking their horns at me to get moving.
Fatigue feels like a normal part of life, now. It seems like a slippery slope back into depression if you have residual fatigue. At least for me, being fatigued makes me less motivated, which means I’m less active/productive, so then I feel bad about myself, etc. etc.
I definitely have psychomotor retardation, especially the sensation of slowness, which feels to me like doing anything at all takes 5X the energy it normally would. I also once met with a psychiatrist during a PHP who talked to me for a bit and then said “wow, your affect is really flat.” So, that was a new thing to hear. Started to understand why people weren’t laughing at my jokes as much, lol.
Yeah hard to put on a humorous face when your face doesn’t want to move any more tham the legs do…
Great piece. Learned much. Didn’t know anything about Leaden Paralysis. Thank you.