Psychomotor impairment is a common but poorly understood symptom of clinical depression that can make everyday tasks feel impossible.
Your child (or partner or best friend or whoever) sits down at your kitchen table and starts telling you about their day. You sink into the chair across from them and try to track what they’re saying. Strangely, you can’t make your eyes focus on theirs, so you settle for looking vaguely at the middle of their face.
You feel as if you’re submerged in water—your child’s words and movements reach you slowly, on a slight delay. Your responses feel unnatural, and you force them out a second later than seems normal. Ok…she said something funny…I should attempt to smile at her…
You fight hard to stay present and engaged but acting “normal” feels exhausting and impossible. You consider telling your child, “I love you. But right now, I need to go sit on the couch and stare at the wall. That cool?”
What’s going on?!
Illustration by Joseph Moore
Some of us experience periods of psychomotor retardation without realizing it. We know something is off, but we don’t know why. We feel slowed down, as if we’re wading through thick syrup. It takes longer to shower and get dressed. We’re less coordinated and nick ourselves shaving or jab an eye with a mascara wand. Ouch! Talking feels forced and our speech comes out quiet and flat.
Possibly even worse (depending on your perspective), we can’t hide it. Psychomotor retardation is one of the few symptoms of depression that other people can actually see. Our loved ones may notice changes in the way we walk and talk, or even how often we touch our faces.
What is psychomotor retardation?
Psychomotor retardation is a symptom of Major Depressive Disorder (MDD) in which a person’s mental and physical abilities slow down. The person thinks, moves, reacts and speaks sluggishly. The intensity may wax and wane over the course of a day (often seeming worse in the morning) and over the course of the depressive episode.
Signs may include:
- Walking slowly, changing positions slowly
- Avoiding eye contact
- Slumped posture
- Slow, soft speech
- Staring into space
- Trouble with fine-motor tasks like typing, buttoning clothes, tying shoelaces
- Slower reaction speed
- Difficulty with tasks that require hand-eye coordination
- Increased self-touching, especially the face
What causes psychomotor retardation?
Research on the specific causes of psychomotor retardation is still developing. Our current understanding points to these factors.
Biological causes
Neuroimaging research shows associations between psychomotor retardation and decreased blood flow in certain parts of the brain, such as the dorsolateral prefrontal cortex, left prefrontal cortex, angular gyrus, and the anterior cingulate [1]. These regions are involved in a variety of cognitive processes, such as learning, working memory, task switching, selective attention, decision making, motivation and language.
Neurochemical research suggests a relationship between psychomotor retardation and faulty dopamine transmission in patients with major depressive disorder [2]. Dopamine is a neurotransmitter that’s involved in functions like learning, movement, motivation and more. Dopamine communicates messages between nerve cells in your brain and between your brain and the rest of your body.
Other research has shown a link between psychomotor retardation and overactivity of the hypothalamic–pituitary–adrenal (HPA) axis [3]. The HPA axis produces cortisol, which is the hormone your body releases to handle stress.
Other medical conditions
You may experience more pronounced psychomotor retardation if you have other medical conditions such as diabetes or premenstrual dysphoric disorder (PMDD).
Bipolar depression may increase your risk of developing psychomotor retardation [4].
How is psychomotor retardation treated?
When psychomotor retardation occurs alongside other symptoms of depression, standard practice is to treat the underlying depression.
Medication
SSRIs (serotonin reuptake inhibitors) are often the first line of treatment. Other antidepressant medications, including atypical antidepressants, tricyclics, and monoamine oxidase inhibitors, are considered subsequent options [5].
Electroconvulsive Therapy (ECT)
If you have severe depression that does not respond to antidepressants, ECT may be an option. Research suggests that some depressed patients with psychomotor retardation respond well to ECT. However, given the potential side effects of ECT, it’s usually prescribed only when other treatment options fail [6].
Repetitive Transcranial Magnetic Stimulation (rTMS)
rTMS is FDA-cleared to treat major depressive disorder and is unique in that it’s neither medication-based nor physically invasive. During a treatment session, short pulses of magnetic energy are directed at specific structures of the brain thought to control mood. These pulses stimulate nerve cells and may affect how the brain works and improve depression symptoms [7].
Research investigating whether rTMS treatment improves psychomotor retardation is still developing. However, current findings suggest that rTMS does help reduce the severity of psychomotor retardation in some patients [8].
Next Steps
If you or someone you love struggles with depression or other mental health issues, call your doctor or contact Athena Care, for mental health care in Tennessee.
One of our Care Coordinators will help you get the care you need.
Rachel Swan, MS
Editor
Rachel has a Masters of Science in Clinical Psychology from Vanderbilt University, where she spent 16 years as a Research Analyst in the Psychology and Human Development Department.