Psychomotor Retardation in Bipolar Disorder

Sluggishness and slow mental processing may signal a depressive episode

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Experiencing psychomotor retardation feels as if a dial has been turned to put you on slow speed. The resulting effects include sluggish or diminished body movements, usually accompanied by a similar slowing of your thought processes. The physical manifestations vary in scope and severity but are usually obvious to both loved ones and healthcare professionals. 

Psychomotor retardation occurs commonly during depressive episodes of bipolar disorder as well as major depressive disorder.

In these circumstances, the effects are usually temporary and recede as the depression lifts.

The development of psychomotor retardation does not always signal a depressive episode. Other situations and conditions—such as drug side effects and certain medical diseases—can also trigger reduced or slow physical and mental activity. 

Signs and Symptoms of Psychomotor Retardation

People with psychomotor retardation move, speak, react, and usually think more slowly than normal. This can manifest in a variety of ways, largely depending on the severity of the impairment. An affected person's speech is noticeably slow and may be punctuated by long pauses or losing the train of thought.

Delayed responsiveness and difficulty following another person's conversation are also common. Complex mental process—such as calculating a tip or mapping out directions—take longer to accomplish. Common examples of physical manifestations of psychomotor retardation include: 

  • Sluggishness when walking or changing positions, such as getting up from a chair
  • Slumped posture
  • Speaking in a soft, monotonous voice
  • Staring into space and reduced eye contact
  • Diminished facility with fine motor tasks, such as writing, using scissors, and tying shoelaces 
  • Impaired ability to perform task requiring eye-hand coordination, such as catching a ball, shaving, and applying makeup
  • Slow reaction time, such as when reaching for a falling object

A person with severe psychomotor retardation may appear catatonic or nearly catatonic. In this state, the person does not respond to others or the environment and is typically virtually motionless. Catatonia represents a medical emergency, as it can become life threatening.

Causes of Slowed Physical and Mental Activity

Several disorders and conditions can cause slowed mental and physical activity. In the strictest sense of the term, psychomotor retardation refers specifically to these impairments when caused by an underlying psychiatric disorder. This occurs most frequently in people experiencing a depressive episode due to major depression or bipolar disorder.

Although a significant proportion of people with major depression experience psychomotor retardation, it is a more frequent feature of a depressive episode of bipolar disorder, especially type 1. The degree of physical and mental blunting often correlates to the severity of the depressive episode.   

Other psychiatric disorders sometimes associated with psychomotor retardation include:

  • Schizophrenia spectrum disorders
  • Other depressive disorders 
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Substance abuse    

Nervous systems diseases and other conditions that might cause blunted or slow physical and mental activity include:

  • Dementia
  • Medication side effects, especially psychiatric medicines 
  • Hypothyroidism
  • Parkinson's disease and related conditions
  • Certain genetic conditions, such as Huntington's disease

Treating Psychomotor Retardation

Reviewing current medications is one of the first steps in addressing psychomotor retardation. This is important to determine whether medication side effects might be triggering the physical and mental slowness. Certain anti-anxiety and antipsychotic medications commonly prescribed for bipolar disorder are possible culprits.

If other causes have been ruled out, medication is typically the first line of treatment for people experiencing psychomotor retardation associated with a depressive episode. The choice of medication or a combination of medicines is made on an individual basis. Current and past medications and an individual's response to them are important considerations in drug treatment decisions.

Common medication options for people with bipolar disorder experiencing a depressive episode include Abilify (aripiprazone), Depakote (valproic acid), Lamictal (lamotrigine), Latuda (lurasidone), lithium, Seroquel (quetiapine), and Zyprexa (olanzapine), among others.     

With severe depression—especially if accompanied by catatonia, loss of touch with reality, or a high risk of suicide—electroconvulsive therapy (ECT) may be an option. While it is one of the fastest ways to treat bipolar depression, ECT is generally undertaken only if other treatment options fail.

Once the right combination of medications is found, cognitive therapy and other nonmedical therapies may be used to support long-term mood stabilization.

Sources:

Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E. Psychomotor Retardation in Depression: A Systematic Review of Diagnostic, Pathophysiologic, and Therapeutic Implications.  Biomed Res Int. 2013;2013:158746. doi: 10.1155/2013/158746

Buyukdura JS, McClintock SM, Croarkin PE. Psychomotor Retardation in Depression: Biological Underpinnings, Measurement, and TreatmentProg Neuropsychopharmacol Biol Psychiatry. 2011 Mar 30;35(2):395–409.

Frankland A, Cerrillo E, Hadzi-Pavlovic D, et al. Comparing the Phenomenology of Depressive Episodes in Bipolar I and Ii Disorder and Major Depressive Disorder Within Bipolar Disorder PedigreesJ Clin Psychiatry. 2015 Jan;76(1):32–38.

Mitchell PB, Frankland A, Hadzi-Pavlovic D, et al. Comparison of Depressive Episodes in Bipolar Disorder and in Major Depressive Disorder Within Bipolar Disorder PedigreesBr J Psychiatry. 2011 Oct;199(4):303–309.

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