Psychomotor Retardation in Bipolar Disorder

Impaired thought and motor skills linked to depression

man signing bill
A symptom of psychomotor retardation is intellectual difficulty, such as unusual difficulty with calculating bills or tips. Tetra Images/Getty Images

Psychomotor retardation (also called psychomotor impairment) is the visible and often profound slowing of physical function, including movement and speech. It can be the result of a mental disorder, a disease, medication misuse, or some other cause.

While it is often linked to muscular degeneration or neurological disorders such as Parkinson's disease, psychomotor retardation is also associated with bipolar disorder — or, more specifically, bipolar depression.

Symptoms of Psychomotor Retardation

People with psychomotor retardation move, speak, and act more slowly than would normally be expected. The condition can manifest with a slowed response time and long, obvious pauses in conversation. It may take a person a long time to do otherwise simple tasks such as crossing a room, chewing one’s food, or tying a shoe.

A general overview of symptoms include:

  • difficulty with both fine and gross motor skills, including walking, writing, or cutting
  • difficulty in caring for one’s self, including bathing, dressing, or cooking
  • impaired hand-eye coordination, making it difficult to catch and throw a ball or to perform tasks like shaving or putting on makeup
  • difficulty in following or engaging in conversation
  • difficulty with mathematical or analytical skills, even simple tasks like calculating a tip or maneuvering the drive home
  • an inability to perform the daily, "mundane" tasks that the person used to do

    While psychomotor retardation can be relatively mild, particularly in familiar surroundings, it can become severe in those with a major depressive disorder. In such case, it can resemble catatonia (the inability to move accompanied by stupor).

    Causes of Psychomotor Retardation

    There are a number of possible causes for psychomotor retardation which can be broadly classified as being:

    • psychiatric (dementia, schizophrenia)
    • psychological (anxiety disorders, mood disorders)
    • pharmaceutical (namely misuse or overuse of psychiatric medicines)
    • neurological (Parkinson’s)

    However, the most common cause of psychomotor retardation is depression, particularly that related to bipolar disorder. Some literature, in fact, suggests a direct correlation between the severity of psychomotor retardation and the severity of bipolar depression.

    Treating Psychomotor Retardation

    Medication is typically the first course of treatment for persons with psychomotor retardation. It often starts with a review of the person’s current medications to assess whether of those drugs may be causing the condition. This can certainly be the case if an antidepressant or mood stabilizing drug is being misused or improperly prescribed.

    Benzodiazepines and antipsychotics, for example, may help reduce anxiety but can sometimes lead to a stunting of psychomotor skills. Adding a stimulant can help reverse this but may end up triggering a manic episode with psychomotor agitation (relentless, purposeless movement).

    In the end, finding the right combination of drugs to treat bipolar depression can be a challenge. As a result, many practitioners will turn to mood stabilizers as first-line treatment, including lithium, lamotrigine, carbamazepine, and valproic acid.

    In very severe cases, electroconvulsive therapy (ECT) may be an option. While it is one of the fastest ways to treat bipolar depression, particularly in persons with psychotic or suicidal symptoms, it generally indicated when all other treatment options have failed.

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

    Sources:

    Bennabi, D.; Vandel, P.; Papaxanthis, C.; et al. "Psychomotor Retardation in Depression: A Systematic Review of Diagnostic, Pathophysiologic, and Therapeutic Implications."BioMed Research International. 2013; 2013:158746.

    Buyukdura, J.; McClintock, S.; and Croarkin, P. "Psychomotor retardation in depression: Biological underpinnings, measurement, and treatment."Prog Neuropsycho Pharma Biol Psyc.2011; 35(2):395-409.

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