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Experiencing mood shifts is common for everyone but for someone with persistent feelings of low mood or indifference, depression becomes a suspected diagnosis. Apathy, a condition where a person loses interest in daily activities, shares strong ties with depression but may or may not be present in everyone. Understanding the connection between apathy and depression can help people identify both problems and seek timely treatment for a better quality of life.
Overview of Apathy in Depression
It is not uncommon for people with underlying depression to experience apathy. However, bear in mind that both apathy and depression and distinctive conditions with different features. [1] Depression is a type of mood disorder that involves persistent feelings of emptiness, hopelessness, or sadness. Other symptoms may include appetite changes, sleep issues, guilty feelings, low energy, and suicidal thoughts. Apathy, on the other hand, causes people to lack interest or motivation in performing activities that they previously enjoyed.
Many people battling depression also experience apathy, but the latter is quite different from the former. Some people may experience reduced motivation and low energy as a part of depression, these symptoms are not universal and do not always indicate underlying apathy.
Remember that apathy alone may or may not require treatment but its cooccurrence with depression needs urgent attention. The co-occurrence can significantly affect the quality of life while worsening both issues individually and combined.
Apathy Causes
Apathy causes are not always apparent enough to be picked up. The phenomenon may occur as a result of underlying physical health conditions, while some may get it secondary to mental health conditions, like depression. Following are some health conditions with a possible relationship with apathy:
Brain injury
Schizophrenia
Brain injury
Depressive disorders
Stroke
Parkinson’s disease
Huntington’s disease
Studies suggest that apathy is associated with the ventral striatum and dorsal anterior cingulate cortex, two key areas in the brain that control emotions, behaviors, and goals. Any dysfunction in these areas can generate feelings of apathy. In some cases, apathy may occur due to a history of experiencing trauma. In this regard, some experts coin the term apathy syndrome which involves a pattern of emotional indifference acquired by people with a history of catastrophes or trauma. In such cases, apathy occurs as people try to detach themselves emotionally to stop feeling further stress.
Apathetic Depression Symptoms
An individual with apathy often has no desire to engage in activities that they previously enjoyed or found pleasurable. Consequently, they start losing motivation and interest in hobbies, work, and socialization. Other symptoms of apathetic depression include the following:
- Difficulty making decisions
- Lack of emotion
- Feeling indifferent
- Slowed thinking
- Poor concentration
If apathy is due to depression, a person may also experience the following additional symptoms:
- Sadness
- Fatigue
- Changes in appetite
- Low self-esteem
- Suicidal feelings or attempts
- Feelings of worthlessness or guilt
- Sleep issues
Diagnosing Apathetic Depression
Even though apathy is a well-recognized symptom of multiple health conditions, it is never an official clinical diagnosis. For someone experiencing persistent feelings of apathy affecting their daily life, the best step is to seek help from a mental health professional or doctor.
A doctor will typically begin by taking a medical history while enquiring about a person’s emotions, mood, and physical health. Additionally, they may also ask about any circumstances that may have contributed to their symptoms. Physical examination is often a part of the diagnosis process to rule out any other health conditions that may be contributing to the apathetic symptoms.
A doctor may also request for certain blood samples, such as the following:
- Complete blood count
- HIV test
- Blood and urine toxicology
- Arterial blood gas test
- Liver function tests
- Blood urea nitrogen and creatinine levels
- Vitamin B12 levels thyroid stimulating hormone levels
- Levels of electrolytes, such as phosphate, calcium, and magnesium
Depending on what comes up on these tests, a doctor may proceed further and request additional imaging and blood tests.
Treatment for Apathy in Depression
The treatment for apathy generally varies depending on the root cause. In cases where it is secondary to depression, a combination of therapy, medications, and lifestyle changes is the best way forward.
Lifestyle Changes
A person can easily make changes to their lifestyle and self-care strategies to manage the feelings of depression and apathy more easily. Some of these tips include the following:
- Thinking positively
- Avoiding substance use
- Eating a balanced diet
- Increasing the levels of physical activity
- Practicing mindfulness
- Quitting smoking
- Having a strong support system
- Getting enough sleep
- Trying new things
- Spending time in nature
- Finding new sources of joy and interest
- Communicating with loved ones
Therapy
Sometimes, apathy is associated with past or present trauma or challenges. In such cases, therapy can help people navigate their feelings more properly. [2] It also allows people to get to the root cause of their apathy, such as a setback or a loss. Cognitive behavioral therapy, or CBT, is one of the best therapies to treat depression while easing the feelings of co-existing apathy. CBT focuses on supporting a person to change their thinking and behavior, in addition to identifying negative behaviors and thoughts and replacing them with positive ones.
Medications
So far, there are no specific medications manufactured to treat apathy. However, many medications are currently available in the market to treat the underlying conditions triggering apathy. For instance, for people with apathy depression, options may include using tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), such as desipramine and amitriptyline.
Outlook for Apathetic Depression
Daily life can become significantly challenging when a person is uninterested, unmotivated, or unable to feel emotions. However, those living with apathy due to depression can manage their symptoms with professional help and self-care tips. However, remember that if apathy is secondary to depression or another mental health issue, addressing the root cause is imperative to treat the condition. Experiencing persistent or progressively intense feelings of apathy and depression indicates an urgent meeting with a doctor who can assess overall health and provide guidance on effective symptom management to improve quality of life.
FAQs
Is apathy a symptom of depression?
While apathy is not a definitive symptom of depression, its presence along with other depressive signs may warrant a detailed investigation to rule out an underlying mood disorder.
Can I have depression with apathy?
It is possible to experience depression without feeling apathetic. Apathy or loss of pleasure or interest is only one of the possible symptoms of depression and is not always required to be present to make a diagnosis. For some people, depression may manifest in other ways, such as irritability, addiction, or anger. In others, it may cause worthlessness, increased sensitivity to criticism or rejection, or constant worrying about life, symptoms not consistent with apathy.
What are the risk factors of apathy and depression?
Some risk factors for apathy and depression may overlap but this is not true for all instances. Many things may contribute to a person developing depression, such as a positive family history of depression, loss and grief, trauma, social isolation, or negative experiences that induce hopelessness. Other risk factors may also include poor nutrition, long-term stress, substance use, or long-term dependence on medication. Some of these risk factors for depression may also make a person feel apathetic as well, mostly because such people are tired of the burden that depression puts on them. Hence, they decide to block it out by practicing apathy.
What is the difference between apathy and depression?
While apathy is a disorder that causes a reduction in goal-directed, self-initiated activities, depression is characterized by elements of anhedonia and sadness.
References
1 Lanctôt KL, Ismail Z, Bawa KK, Cummings JL, Husain M, Mortby ME, Robert P. Distinguishing apathy from depression: A review differentiating the behavioral, neuroanatomic, and treatment‐related aspects of apathy from depression in neurocognitive disorders. International Journal of Geriatric Psychiatry. 2023 Feb;38(2):e5882.
2 Chand SP, Arif H, Kutlenios RM. Depression (nursing).
