Hand-Motor Dysfunction in Depression: Characteristics and Pharmacological Effects

Abstract

Motor retardation is a relevant aspect of depression. Kinematic analysis of movements can be applied to explore which type of motor dysfunction is associated with depression and to examine motor side effects of antidepressants. Using this tool, we aimed to investigate fine motor performance in patients suffering from depression and to compare a selective noradrenaline re-uptake inhibitor (NARI) (reboxetine) and a selective serotonin reuptake inhibitor (SSRI) (citalopram) regarding motor side effects after 4 weeks of treatment.

In the first study (I), we examined 37 depressed patients and 37 healthy subjects using a digitizing graphic tablet and kinematic analysis of handwriting and rapid drawing movements. Both groups were comparable regarding age, gender distribution, handedness (preponderance of right-handers) and educational level. In the second study (II), we examined different types of hand movements in 16 depressed patients receiving citalopram (flexible dosage) and 12 depressed patients treated with reboxetine (varying dosage) using the afore-mentioned methods. Both groups were comparable regarding age, gender, handedness and the baseline Hamilton Depression Rating Scale total score.

I: Depressed patients performed drawing with significantly less regular velocity than controls (p < 0.001), but normal velocity. Handwriting of depressed patients was abnormally slow (p = 0.04). II: Reboxetine led to a significant improvement of repetitive drawing movements in depression. In contrast, citalopram had no pronounced effects on hand movements in depressed patients.

I: Irregular patterns of velocity peaks in depressed patients point to basal ganglia dysfunction and/or deficient activity of the sensorimotor cortex and the supplementary motor area as possible substrates of hand-motor disturbances in depression. II: Computer-aided analysis of hand movements is a sensitive tool for the registration of differential pharmaceutical effects on hand-motor function in depression.

Keywords

Antidepressants Citalopram Depression Digitizing Graphic Tablet Hand-Motor Function Kinematical Analysis Reboxetine

Get full access to this article

View all access options for this article.

References

Widlöcher

Ghozlan

. The measurement of retardation in depression. In: Hindmarch

Stonier

, (eds). Human Psychopharmacology: Measures and Methods. New York: Wiley; 1989:1–22.

Sabbe

Hulstijn

Van Hoof

Zitman

. Depressive retardation: Assessment by means of writing and drawing tasks. Curr Opin Psychiatry 1999; 12 (suppl 1): 107.

van Hoof

Hulstijn

van Mier

Pagen

. Figure drawing and psychomotor retardation: Preliminary report. J Affect Disord 1993; 29(4): 263–266.

Sabbe

Hulstijn

Van Hoof

Zitman

. Fine motor retardation and depression. J Psychiatr Res 1996; 30(4): 295–306.

Pier

Hulstijn

Sabbe

. Psychomotor retardation in elderly depressed patients. J Affect Disord 2004; 81(1): 73–77.

Pier

Hulstijn

Sabbe

. No psychomotor slowing in fine motor tasks in dysthymia. J Affect Disord 2004; 83(2–3): 109–120.

Pier

Hulstijn

Sabbe

. Differential patterns of psychomotor functioning in unmedicated melancholic and non-melancholic depressed patients. J Psychiatr Res 2004; 38(4): 425–435.

Sabbe

van Hoof

Hulstijn

Zitman

. Changes in fine motor retardation in depressed patients treated with fluoxetine. J Affect Disord 1996; 40(3): 149–157.

Sabbe

van Hoof

Hulstijn

Zitman

. Depressive retardation and treatment with fluoxetine: Assessment of the motor component. J Affect Disord 1997; 43(1): 53–61.

10.

Tucha

Aschenbrenner

Eichhammer

Putzhammer

Sartor

Klein

. The impact of tricyclic antidepressants and selective serotonin re-uptake inhibitors on handwriting movements of patients with depression. Psychopharmacology (Berl) 2002; 159(2): 211–215.

11.

Mergl

Juckel

Rihl

Henkel

Karner

Tigges

. Kinematical analysis of handwriting movements in depressed patients. Acta Psych Scand 2004; 109: 383–391.

12.

Hegerl

Mergl

Henkel

Pogarell

Müller-Siecheneder

Frodl

. Differential effects of reboxetine and citalopram on hand motor function in patients suffering from major depression. Psychopharmacology 2005; 178: 58–66.

13.

Lane

. SSRI-induced extrapyramidal side-effects and akathisia: Implications for treatment. J Psychopharmacol 1998; 12(2): 192–214.

14.

Hindmarch

. The effects of antidepressants on psychomotor function with particular reference to reboxetine. Eur Neuropsychopharmacol 1997; 7(suppl 1): S17–S21; discussion S71-S73.

15.

Dilling

Mombour

Schmidt

. Internationale Klassifikation psychischer Störungen ICD-10 Kapitel V. 2nd ed. Bern, Göttingen, Toronto, Seattle: Huber; 1993.

16.

Marquardt

Mai

. CS - Computerunterstützte Analyse der Bewegungsabläufe beim Schreiben. Bedienungshandbuch. München: MedCom; 1992.

17.

Marquardt

Mai

. A computational procedure for movement analysis in handwriting. J Neurosci Methods 1994; 52(1): 39–45.

18.

Hamilton

. A rating scale for depression. JNNP 1960; 23: 56–62.

19.

Jahn

. Diskrete motorische Störungen bei Schizophrenie. Weinheim: Beltz; 1999.

20.

Phillips

Bradshaw

Lansek

Chiu

. Motor functions of the basal ganglia. Psychol Res 1993; 55(2): 175–181.

21.

Cummings

. Depression and Parkinson's disease: A review. Am J Psychiatry 1992; 149(4): 443–454.

22.

Schröder

Essig

Baudendistel

Jahn

Gerdsen

Stockert

. Motor dysfunction and sensorimotor cortex activation changes in schizophrenia: A study with functional magnetic resonance imaging. Neuroimage 1999; 9(1): 81–87.

23.

APA. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association; 1994.

24.

Hamilton

Guy

. Hamilton Depression Scale. CIPS-Skalen. Berlin: Beltz; 1976.

25.

Henkel

Mergl

Juckel

Rujescu

Mavrogiorgou

Giegling

. Assessment of handedness using a digitizing tablet: A new method. Neuropsychologia 2001; 39(11): 1158–1166.

26.

Mergl

Tigges

Schröter

Möller

H-J

Hegerl

. Digitized analysis of handwriting and drawing movements in healthy subjects: Methods, results and perspectives. J Neurosci Methods 1999; 90(2): 157–169.

27.

Meulenbroek

Galen

. The acquisition of skilled handwriting: Discontinuous trends in kinematic variables. In: Colley

Beech

, (eds). Cognition and Action in Skilled Behaviour. Amsterdam: Elsevier; 1988: 273–281.

28.

Ferguson

Mendels

Schwart

. Effects of reboxetine on Hamilton Depression Rating Scale factors from randomized, placebo-controlled trials in major depression. Int Clin Psychopharmacol 2002; 17(2): 45–51.

29.

Tucker

Williamson

. Asymmetric neural control systems in human self-regulation. Psychol Rev 1984; 91(2): 185–215.

30.

Volz

H-R

Steil

Kriese

Kimmel

Sauer

Schüler

. Effekte von Reboxetin und Paroxetin im Vergleich zu Placebo auf kognitive Prozesse bei Gesunden. Nervenarzt 2000; 71(suppl 1): S139.

31.

Kerr

Powell

Hindmarch

. The effects of reboxetine and amitriptyline, with and without alcohol on cognitive function and psychomotor performance. Br J Clin Pharmacol 1996; 42(2): 239–241.

32.

Siepmann

Muck-Weymann

Joraschky

Kirch

. The effects of reboxetine on autonomic and cognitive functions in healthy volunteers. Psychopharmacology (Berl) 2001; 157(2): 202–207.

33.

Lemke

. Effect of reboxetine on depression in Parkinson's disease patients. J Clin Psychiatry 2002; 63(4): 300–304.

34.

Lader

Melhuish

Frcka

Overo

Fredricson K

Christensen

. The effects of citalopram in single and repeated doses and with alcohol on physiological and psychological measures in healthy subjects. Eur J Clin Pharmacol 1986; 31(2): 183–190.

35.

Milne

Goa

. Citalopram. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depressive illness. Drugs 1991; 41(3): 450–477.

36.

Muldoon

. The safety and tolerability of citalopram. Int Clin Psychopharmacol 1996; 11 (suppl 1): 35–40.