I've recently been studying the issue of psychomotor retardation (PMR) as a symptom of depression. It seems that DSM criteria for depression include at least two other items which seem to duplicate important features of this. Both 'fatigue or loss of energy' and 'diminished ability to think or concentrate, or more indecisiveness' are both well documented elements of PMR, in which case the conflation of these items might artificially inflate the rating of depression by these criteria, and exaggerate the role that PMR symptomatology has to play.
Is this duplication and overlap of the features of depression taken into account by psychiatrists making a diagnosis of depression, or is the importance of PMR deemed high enough to warrant its common features, such as difficulty in concentrating and fatigue being - in effect - 'counted twice'?
Article Psychomotor Retardation in Depression: A Systematic Review o...
I look upon depression as a state of intense demotivation, to the point that the body actively counteracts further initiatives and efforts. This is often due to a series of experiences that could be characterized as disparity between emotional commitment, drive, on the one hand, and result and social response on the other. Such demotivation gives rise to a kind of psychomotor retardation that feels and looks completely different from the slowing down due to mere loss of motivation and interest, or to normal but intense fatigue, as the case may be. (The fatigue in depression is not really the type of fatigue, due to prolonged or intense effort.)
This holds for both regular depression and clinical depression. However, in clinical depression, the symptom picture becomes more complicated because restorative mechanisms that normally preserve some balance seem to have stopped functioning , so the person involved gets into an avalanche-like downward spiral.
Conclusion: the symptom of psychomotor retardation should be preserved in the diagnosis depression.
From a clinical perspective sometimes it would be difficult to assess separately fatigue or lack of motivation in a patient with psychomotor inhibition, because this inhibition seems to be a syndrome that includes other 'negative symptoms'. However, in the other hand it is very frequent to find depressed patients with fatigue, lack of energy, lack of interest, etc. in the absence of symptom "psychomotor inhibition"
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