Psychomotor Disturbance as a Predictor of Treatment Response in Mood Disorders: A Systematic Review

Psychomotor disturbance (PMD) is a symptom of mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD), yet its potential utility as a predictor of therapeutic efficacy remains underinvestigated. Herein, we aim to evaluate whether scale-based assessments of PMD are associated with clinical efficacy across pharmacological and non-pharmacological interventions for mood disorders. Following PRISMA guidelines, a systematic search was conducted from inception to July 2025 on Ovid and PubMed databases to retrieve randomized controlled trials, open-label trials, and observational studies reporting treatment efficacy and scale-based assessments of PMD. Studies were screened, methodological quality was assessed, and data extraction was conducted by three independent reviewers. A total of 29 studies were included, evaluating antidepressants (monoaminergic & glutamate modulators), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), OnabotulinumtoxinA (OnA), and psychotherapy. PMD - particularly psychomotor retardation (PmR) - was consistently associated with improved treatment response for ECT. PMD predicted worse or no difference in clinical efficacy to SSRIs. Findings for other interventions such as TCAs or rTMS were mixed or limited. Studies were largely confined to MDD populations, with limited research on bipolar and psychotic depression. Small sample sizes and variability in PMD assessment methods also constrained generalizability. Despite these limitations, PMD appears to be a promising, low-cost clinical marker for predicting treatment outcomes in mood disorders. Future prospective studies are needed to validate PMD’s predictive capacity across diverse populations and interventions. Integrating PMD into multimodal predictive models holds hope for advancing personalized treatment approaches and navigating the complex heterogeneity of mood disorders.