Big News: Depression Is a Movement Disorder

Last week’s column reported the breakthrough discovery of a new type of dopamine neuron that becomes active when the body moves.

This discovery expands the understanding of dopamine as a neuromodulator that regulates not only reward and motivation but movement. It strengthens the link between neurodegenerative diseases and mood disorders. And it opens a gateway into therapies for low-dopamine illnesses like Parkinson’s Disease, ADHD, and depression.

Today, I’d like to enlarge that gateway a little. I’ll focus the lens on depression, review another compelling study, and wonder out loud with you about its implications.

The “SAD” History of Movement Research in Depression

Exercise has long topped the list of interventions for depression. This is due partly to the boosting effects of exercise on a key molecule involved in neuroplasticity (the notion that the brain and nervous system can change, particularly with respect to learning and memory). The molecule in question: brain-derived neurotropic factor (BDNF), which is also implicated in depression.

And yet, the use of exercise to alleviate depression is in my opinion a very blunt tool. And it’s not the only one.

Most research on bodily processes in depression refers to psychomotor slowing, a global decrease in the speed of movement, speech, facial expression, and cognitive processing.

Psychomotor slowing occurs in people immersed in a current depressive episode, even after remission. It has been the focus of body-related depression studies for many decades, and there’s been little nuance since. (Another blunt tool, and one without strong clinical implications to boot—except perhaps for the exhortation that people with depression should move more, or move faster.)

Another issue is the lack of research translation of into clinical practice. For example, gross and fine motor activity, discrete body movements, speech, and movement reaction time can reliably differentiate people with depression from those without. Yet even though they make up a key component of depression, psychomotor symptoms receive little attention from the clinical field.

But this may be about to change.

Last week’s column mentioned the scarcity in depression of internally generated movements, those cued by internal mechanisms rather than external factors (as well as in Parkinson’s Disease). And there’s more.

Of special interest is a trio of studies which found that particular gait patterns (think proprioception) were associated with a bias toward depressive memories and dysphoric mood, and that slumped posture primes a bias toward the cognitive recall of negative words.

Despite the backlash she endured, I think researcher Amy Cuddy was on to something. But the body of work that looks at posture implicates the negative impact of poor posture more than the Ted Lasso-sanctioned positive impact of power posing.

Recently, a group of researchers examined global body movements in depression. They showed that the more severe a patient’s depression, the fewer body movements they made.

And yet, few studies have probed deeper into the nature of sensorimotor processing in depression, anxiety, and other mood disorders—that is, until recently.

Depression and the Sensorimotor Self

An innovative 2022 study delved into the specifics of movement issues in depression, with implications for what and how we might move.

To offer a little background, I’ve written a lot about sensory issues in depression, including low levels of interoception and proprioception (briefly mentioned above). This week’s article focuses on motor aspects of depression.

Sensory and motor functions aren’t separate; they overlap and are commonly referred to as sensorimotor experiences.

The researchers examined three major domains of movement: muscle tone and posture, gross motor skills, and perceptual-motor skills.

They used a battery of psychomotor tasks to assess several subdomains of movement including:

• passive muscle tone

• active muscle tone

• posture

• gross motor skills

• dynamic balance

• static balance

• manual dexterity

• spatial integration

• rhythm

The results were striking across a wide variety of motor tasks.

The researchers observed significant differences between people with depression and healthy controls on tasks assessing muscle tone, posture, and gross motor skills (seen, for example, in the ability to walk backwards down a straight line, jumping tasks, and manual dexterity).

People with major depression also scored low on dynamic balance (measured by other walking tests), additional types of jumping, coordination of arms and legs, and walking in rhythm. To be clear, these weren’t obvious, observable differences that anyone could visually see; they only came through via psychomotor tests.

The researchers found something else, too, which struck me as significant. People with depression had difficulty voluntarily achieving muscle relaxation. This goes hand in hand with what we know about depression involving nervous system hyperarousal, which I wrote about in my first book, published nearly 100 years ago. (Deliberate use of typo to highlight how long my current book is taking.)

Psychomotor delay or slowness, they concluded, may mask a high level of body tension unobservable to clinicians.

I’ve wondered about the question of which came first: the depression (resulting in movement issues), or the movement issues (resulting in depression). But chances are high that they co-occur.

That aside, issues with movement have repercussions that extend well beyond the body or the individual, and include the relationships we have with others and with the world at large.

To put an exclamation point on this idea: The body in motion is embedded in the world. When something compromises movement, our relationship with self and world is naturally disturbed. This may explain in part the social withdrawal emblematic of depression.

The Implications

These results have striking implications for the role of the body in the treatment of depression.

First, they strengthen the case for restorative yoga (or, as I call them, dynamic rest practices) as an arrow in the quiver of depression treatments.

They complement a beautiful study by Johannes Michalak (a principal investigator in the trio of studies on gait and posture above) and fascia pioneer Robert Schleip on the effectiveness of myofascial approaches to treating depression.

And they illuminate an augmented role for body-based teachers and therapists to offer highly-specified one-on-one work targeted to each person’s movement anomalies. This can be done through yoga, yoga therapy, mind-body movement practices like tai chi, qi gong, Zumba, Parkour, and other therapeutic movement modalities.

The researchers advocate not for exercise, but for physical activity and psychomotor therapy adapted to the abilities and specific motor challenges of people with depression. (This ties in with the notion of novel movement for depression.)

Ultimately, I think this also has implications for neurodegenerative diseases and for the body as it ages.

And it has relevance for a primary therapeutic target in depression: the restoration of the bodily self in motion and its right relationship with the world.  

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Sources:

The molecule: brain-derived neurotropic factor, or BDNF—which is also implicated in depression: Miranda, M., Morici, J. F., Zanoni, M. B., & Bekinschtein, P. (2019). Brain-Derived Neurotrophic Factor: A Key Molecule for Memory in the Healthy and the Pathological Brain. Frontiers in cellular neuroscience, 13, 363. https://doi.org/10.3389/fncel.2019.00363

Psychomotor slowing occurs in people with a current depressive episode—even after remission: Wüthrich, F., Nabb, C. B., Mittal, V. A., Shankman, S. A., & Walther, S. (2022). Actigraphically measured psychomotor slowing in depression: systematic review and meta-analysis. Psychological medicine, 52(7), 1208–1221. https://doi.org/10.1017/S0033291722000903

The scarcity of internally generated movements in depression: Hoffstaedter, F., Sarlon, J., Grefkes, C., & Eickhoff, S. B. (2012). Internally vs. Externally triggered movements in patients with major depression. Behavioural Brain Research, 228(1), 125–132. https://doi.org/10.1016/j.bbr.2011.11.024

Particular gait patterns were associated with a bias toward depressive: Adolph, D., Tschacher, W., Niemeyer, H., & Michalak, J. (2021). Gait Patterns and Mood in Everyday Life: A Comparison Between Depressed Patients and Non-depressed Controls. Cognitive Therapy and Research, 45(6), 1128–1140. https://doi.org/10.1007/s10608-021-10215-7. See also: Michalak, J., Troje, N. F., Fischer, J., Vollmar, P., Heidenreich, T., & Schulte, D. (2009) Embodiment of sadness and depression—Gait patterns associated with dysphoric mood. Psychosomatic Medicine, 71(5), 580–587. https://doi.org/10.1097/PSY.0b013e3181a2515c

Slumped posture primes cognitive recall of negative words: Michalak, J., Mischnat, J., & Teismann, T. (2014). Sitting Posture Makes a Difference—Embodiment Effects on Depressive Memory Bias. Clinical Psychology & Psychotherapy, 21(6), 519–524. https://doi.org/10.1002/cpp.1890

Recently, a group of researchers examined global body movements in depression: Sandmeir, A., Schoenherr, D., Altmann, U., Nikendei, C., Schauenburg, H., & Dinger, U. (2021). Depression Severity Is Related to Less Gross Body Movement: A Motion Energy Analysis. Psychopathology, 54(2), 106–112. https://doi.org/10.1159/000512959

The researchers examined three major domains of movement: Paquet, A., Lacroix, A., Calvet, B., & Girard, M. (2022). Psychomotor semiology in depression: a standardized clinical psychomotor approach. BMC psychiatry, 22(1), 474. https://doi.org/10.1186/s12888-022-04086-9

They complement a beautiful study by Johannes Michalak: Michalak, J., Aranmolate, L., Bonn, A., Grandin, K., Schleip, R., Schmiedtke, J., Quassowsky, S., & Teismann, T. (2022). Myofascial Tissue and Depression. Cognitive therapy and research, 46(3), 560–572. https://doi.org/10.1007/s10608-021-10282-w