Review Article

Psychomotor Retardation in Depression: A Systematic Review of Diagnostic, Pathophysiologic, and Therapeutic Implications

Table 3

Studies exploring the predictive capacity of psychomotor retardation treatment response.

AuthorsDesignSample (criteria)InterventionTreatments associatedCriteriaResults

Del Zompo et al. 1990 [88]Comparative, randomized trialMDD = 60
(DSM-III)
+HDRS > 16
(i) Minaprine: 6 weeks, 30 patients
(ii) Amitriptyline: 6 weeks, 30 patients
LorazepamItem “retardation” HDRSMinaprine: reduction of score on the item “retardation”
Rampello et al. 1991 [89]Double blind, randomized, against placebo trialUP = 40
(DSM III-R)
+clinical retardation
(i) Amineptine: 4 weeks, 10 patients
(ii) Minaprine: 4 weeks, 10 patients
(iii) Placebo: 4 weeks, 10 patients
(iv) Clomipramine: 4 weeks, 10 patients
NoneHDRS
SRRS
Minaprine and amineptine: reduction of score on SRRS
Burns 1995 [90]Double blind, comparative trialMDD = 183
(DSM III-R)
(i) Lofepramine: 6 weeks, 93 patients
(ii) Fluoxetine: 6 weeks, 90 patients
BenzodiazepineItem “retardation” HDRSPMR predict lower response to lofepramine
Entsuah et al. 1995 [91]Meta-analysisMDD = 1222
(DSM III-R)
(i) Venlafaxine: 6 weeks
(ii) Imipramine: 6 weeks
(iii) Placebo
NSItem “retardation” HDRSRetarded depression: higher response rate with venlafaxine
Sabbe et al. 1996 [92]Comparative trialMDD = 22
(DSM III-R)
+HDRS > 18
Controls = 22
(i) Fluoxetine: 6 weeks
(ii) Drawing tasks
Anxiolytic
Neuroleptic
HDRS at day 0 and week 6
SRRS
RT and MT
Partial improvement
Flament et al. 1999 [93]Comparative, multicenter, randomized, double blind trialMDD = 286
(DSM III-R)
(i) Wash out: 1 week
(ii) Sertraline: 6 weeks
(iii) Fluoxetine: 6 weeks
Hypnotic
Temazepam
Item “retardation” HDRSSertraline > fluoxetine in melancholic depression with PMR
Bondareff et al. 2000 [94]Comparative, randomized, double blind trialMDD = 144
(DSM III-R)
+age > 60
+MMSE > 24
(i) Wash out: 1 week
(ii) Sertraline: 12 weeks
(iii) Nortriptyline: 12 weeks
NoneHDRS
Neuropsychological assessments
Baseline information processing Resp = non-Resp
Baseline executive functioning Resp > non-Resp
Navarro et al. 2001 [95]Simple blind, randomized trialMDD = 58
(DSM IV)
+age > 60
+MMSE > 25
(i) Wash out: 2 weeks
(ii) Nortriptyline: 12 weeks
(iii) Citalopram: 12 weeks
HaloperidolItem “retardation” HDRSSevere retardation: response rate nortriptyline (82%) > citalopram (11%)
Mild retardation: equal response rates (95 and 100%)
Ferguson et al. 2003 [96]Comparative, multicenter, randomized, double blind trialMDD = 350
(DSM III-R)
+HDRS > 20
(i) Wash out: 4 to 28 days
(ii) Reboxetine: 4–8 weeks, 350 patients
(iii) Placebo: 353 patients
NoneItem “retardation” HDRSReboxetine: early psychomotor improvement
Volkers et al. 2002 [97]Comparative, randomized, double blind trialMDD = 52
(DSM IV)
(i) Wash out: 7 days
(ii) Imipramine: 4 weeks, 25 patients
(iii) Fluvoxamine: 4 weeks, 27 patients
NoneActimetry
SRRS
Imipramine: increase in daytime motor activity
Fluvoxamine: no modifications in motor activity
Caligiuri et al. 2003 [98]Double blind, randomized trialMDD = 28
(DSM IV)
(i) Phenelzine: 8 weeks, 12 patients
(ii) Sertraline: 8 weeks, 9 patients
(iii) Bupropion: 8 weeks, 7 patients
NoneWrist rotation
Item “retardation” HDRS
Baseline motor impairment: Resp < non-Resp
Sechter et al. 2004 [99]Double blind, randomized, multicenter
trial
MDD = 302
(DSM IV)
+MADRS > 20
(i) Milnacipran: 6 weeks 148 patients
(ii) Paroxetine: 6 weeks, 151 patients
NoneItem “retardation” HDRSBaseline PMR predict good response to milnacipran
Taylor et al. 2006 [100]Open studyMDD = 47
(DSM IV)
(i) Wash out: 1 week
(ii) Fluoxetine: 12 weeks
NSCOWAT FAS
Stroop test
Baseline Resp COWAT FAS performance: non-Resp
Mallinckrodt et al. 2007 [101]Meta-analysisMDD = 2463
(DSM IV)
(i) Duloxetine: 8 weeks
(ii) Escitalopram: 8 weeks
(iii) Paroxetine: 8 weeks
NSItem “retardation” HDRSGreater reduction of PMR in duloxetine group
Herrera-Guzmán et al. 2008 [102]Open studyMDD = 26
(DSM IV)
+age > 60
Bupropion: 8 weeksNoneHDRS
CANTAB
Psychomotor speed predicts response to bupropion
Singh et al. 2013 [103]Double blind, randomized, multicenter
trial
MDD = 113
(DSM IV)
(i) Venlafaxine: 8 weeks
(ii) Escitalopram: 8 weeks
NoneItem “retardation” HDRS
CORE
Greater reduction of PMR in venlafaxine group
PMR does not predict response to carbamazepine
Jouvent et al. 1998 [104]Double blind, randomized, multicenter
trial
MDD = 124
(DSM IV)
+MADRS > 25
+SRRS > 20
(i) Moclobemide: 4 weeks, 60 patients
(ii) Clomipramine: 4 weeks, 59 patients
NoneSRRS at days 7, 10, and 14Moclobemide: reduction of SRRS score at day 7
Joffe et al. 1987 [105]Open studyDepressed = 19
(RDC)
CarbamazepineNoneActimetryPMR does not predict response to carbamazepine
Álvarez et al. 1997 [106]Open studyMDD = 105
(DSM III-R)
LithiumImipramine or equivalentItem “retardation” NDIPMR does not predict response
Hantouche et al. 2005 [107]Retrospective studyMDD = 59
(DSM IV)
(i) Lithium
(ii) Valpromide
(iii) Carbamazepine
NSItem “retardation” HDRSLower response rate to mood stabilizer in motor-retarded patients
Strian et al. 1979 [108]Longitudinal studyMDD = 36
(ICD)
ECTNSItem “retardation” and “agitation” HDRSEarly improvement in “agitated” group
Mood fluctuations in “retarded” group
Hickie et al. 1990 [109]Open studyMDD = 36ECT: unilateralAntidepressant
Antipsychotic
CORECORE predict response to ECT
Buchan et al. 1992 [110]Comparative studyMDD = 165
(NS)
(i) Real ECT: 2 sessions per week, 4 weeks
(ii) Sham ECT: 2 sessions per week, 4 weeks
AnxiolyticPSEImprovement in patients with PMR
Sobin et al. 1996 [111]Randomized, double blind studyMDD = 148
(RDC)
(i) Real ECT: 3 sessions per week
(ii) Sham ECT: 3 sessions per week
LorazepamHDRS day 0 and every weekResponse rate: “retarded” = “non retarded”
Hickie et al. 1996 [112]Open studyMDD = 81
(NS)
ECT: 10 sessionsAntidepressant
Antipsychotic
Benzodiazepine
Mood stabilizer
CORECORE predicts response to ECT
Höppner et al. 2003 [113]Randomized, against placebo trialMDD = 30
(DSM IV)
+MADRS > 18
Controls: 30
(i) TMS: high frequency over the right DLPFC, 10 sessions
(ii) TMS: low frequency over the left DLPFC, 10 sessions
(iii) Sham TMS
AntidepressantMARSEarly improvement of psychomotor performance in the “high frequency” group
Höppner et al. 2010 [114]Comparative, randomized, double blind trialMDD = 30
(DSM IV)
+MADRS > 18
Controls: 30
(i) TMS: low frequency over the left DLPFC, 10 sessions
(ii) Sham TMS
Venlafaxine
Mirtazapine
Lorazepam
MARSNo effect of TMS on PMR
Baeken et al. 2010 [115]Open studyUP = 20
(DSM IV)
+resistance criteria
TMS: over the left DLPFC, 10 sessionsBenzodiazepine
Neuroleptic
SRRSImprovement of psychomotor performance
Ullrich et al. 2012 [116]Double blind, placebo controlled randomizedMDD = 43
(DSM IV)
TMS: over the left DLPFC, 15 sessions, ultrahigh frequencyLithium
Venlafaxine
Mirtazapine
Antipsychotic
Benzodiazepine
Item “retardation” HDRSImprovement of psychomotor performance
Loo et al. 2010 [117]Double blind, placebo controlled randomizedMDD = 40
(DSM IV)
tDCS: 10 sessions of anodal tDCS over the left DLPFC, at 1 mANoneCORE
MADRS
No significant difference in depression scores after real compared with sham tDCS
No improvement in CORE score
Loo et al. 2012 [118]Double blind, placebo controlled randomizedMDD = 64
(DSM IV)
tDCS: 15 sessions of anodal tDCS over the left DLPFC, at 2 mANoneCORE
MADRS
Significant difference in depression scores after real compared with sham tDCS
No improvement in CORE score

CANTAB: computerised psychometric testing battery; DLPFC: dorsolateral prefrontal cortex; DSM: Diagnostic and Statistical manual of mental disorders; ECT: electroconvulsivetherapy; HDRS: Hamilton Depression Rating Scale; MADRS: Montgomery Asberg Depression Rating Scale; MARS: Motor Agitation and Retardation Scale; MDD: major depressive disorder; MMSE: Mini Mental State Examination; NDI: Newcastle Index of Depression; NS: not specified; PMR: psychomotor retardation; PSE: Present State Examination; Resp: Responder; RDC: Research Diagnosis Criteria; SRRI: selective serotonin reuptake inhibitor; SRRS: Salpetrière Retardation Rating Scale; UP: unipolar