Apathy is defined by a lack of goals, drive, interest or motivation. It can best be summed up as the lack of concern for something or someone, like a type of blankness. It’s like losing all feelings — those that feel good and even those that don’t feel good. It’s not unusual to feel apathy, especially if we’re going through hardship. Death, divorce, unemployment, and other big, traumatic life changes can make it challenging to feel motivated or driven. However, apathy, which differs from depression, can be incredibly problematic when it takes over. It can also be seen as a key indicator of chronic illnesses like Alzheimer’s and Parkinson’s disease, amongst others.
Signs, Symptoms, and Causes
Ashley Ertel, a peer consultant with Talkspace says some signs and symptoms of apathy can include no longer feeling joy, pleasure, anger, or sadness towards people or things that used to elicit an emotional response from you.
“You no longer feel excited or concerned for things,” she explains. “Long story short, apathy attacks your motivation and pleasure responses.”
How does apathy manifest? It may be a component of depression or other mental health concerns like anhedonia, or it may just be an indicator that you are in need of a change of pace. Apathy can be triggered by being overwhelmed, which causes you to shut down, or being underwhelmed, which can cause you to experience feelings of being lost with no direction.
Apathy and the eldery
A review from 2009 looked at apathy and its impact on the elderly and concluded that this common feeling is easy to overlook, especially since it’s often mistaken for, or related to, depression. Apathy is often associated with a number of brain disorders that involve the frontal lobes and their associated subcortical structures. It is often related to a number of adverse outcomes, including apparent cognitive impairment, decreased daily function, poor insight into one’s own functional and cognitive impairment, and poor outcome from rehabilitation treatment. It also has the potential to significantly add to a caregiver’s burden.
However, treatment of apathy depends on understanding it from a biomedical, psychological, and socio-environmental perspective.
Apathy and disease
Apathy can be used as a clue that pinpoints bigger problems in a patient’s health. Alzheimer’s disease, dementia, Parkinson’s, and Huntington’s disease are some of the illnesses that can trigger apathy as a result of their occurrence. Here is what some of the research says about apathy and illness.
A review from 2005 titled “Apathy: Why Care?” looked at data that examined apathy across a number of disorders. It found that apathy wasn’t only common but also linked with significant problems, like reduced functioning, decreased response to treatment, poor illness outcome, caregiver distress, and chronicity.
A 2018 study used apathy as a model for investigating behavioral and psychological symptoms in dementia. It looked at interactions between the person with dementia, their caregiver, and possible environmental triggers for the behaviour, in the context of underlying neurodegeneration. It found that the disordered physiological processes associated with apathy is not a single mechanism, but rather it is multifaceted. Furthermore, the study found that “it may be possible to identify selective impairments in goal-directed behavior which may contribute to different clinical phenotypes or subtypes of apathy.”
A 2006 longitudinal study of apathy in Alzheimer’s disease found that it was significantly associated with older age, and a higher frequency of minor and major depression. Apathy was the starting point and was a significant predictor of depression and was associated with a faster cognitive and functional decline in patients.
Another study from 2020, found that apathy could predict the onset of some forms of dementia long before other symptoms arise, offering a window of opportunity to start treating the disease. The research, conducted by a team of scientists led by Professor James Rowe at the University of Cambridge, looked at frontotemporal dementia, a type of dementia that affects younger people. It’s often diagnosed between the age 45 and 65, and its effects change behaviour, personality, and language. A common trait in this type of dementia is apathy. Brain scans showed there was shrinkage in special parts of the brain in people with frontotemporal dementia. Those with more severe shrinkage also displayed more severe apathy.
“Apathy is one of the most common symptoms in patients with frontotemporal dementia. It is linked to functional decline, decreased quality of life, loss of independence and poorer survival,” said Maura Malpetti, a cognitive scientist at the Department of Clinical Neurosciences, University of Cambridge. “The more we discover about the earliest effects of frontotemporal dementia, when people still feel well in themselves, the better we can treat symptoms and delay or even prevent the dementia.”
Parkinson’s disease is another progressive disease where apathy can be observed amongst its symptoms. A 2002 study looked at the level of apathy in 45 patients with the disease. It found that those with the disease were more likely to experience apathy as a direct result of physiological changes rather than a psychological reaction or adaptation to disability. It also found that there could be a possible role of cognitive mechanisms in the expression of apathy.
Another study from 2009 looked at the clinical presentation of depression and apathy in patients with Huntington’s disease, an illness that causes degeneration of nerve cells in the brain. It found that apathy in Huntington’s disease was associated with neurodegeneration and connected to cognitive dysfunction and functional decline. It featured prominently in patients with early- and middle-stage Huntington’s disease. Based on its major effect on daily functioning and quality of life, the research found apathy could be an important target for therapeutic interventions in the future.
Diagnosis and Treatment
There are several ways that apathy can affect your life and those around you.
“Apathy, when presenting as the loss of enjoyment, can really take a toll on relationships and your self-esteem,” says Ertel. “It is easy to wonder ‘what’s wrong with me?’ and ‘will I ever get back to who I was?’”
Apathy can cause you to lose motivation to engage in the health habits you had committed to. But on the other hand, apathy can also be useful if it helps you to move past drama into a space of no longer allowing chaos to control your emotions.
How is apathy diagnosed
There is no official clinical diagnosis of apathy, rather it is often a symptom or sign associated with a mental health condition. You can easily self-identify the symptoms of apathy, however. When trying to drill down to the root cause of how you’re feeling, and why, it might be helpful to discuss your experience and feelings with a professional to rule out any underlying depression or diseases like Parkinson’s or Huntington’s.
How is apathy treated?
It depends on what’s being treated on a larger scale. A study from 2010 that looked at dysthymia and apathy found that there is no consensus about treatment for apathy. Any medical or therapeutic treatment for apathy generally relates to a larger condition for which it is presenting. For example, dopamine agonists seem to work in patients with Parkinson’s disease, while atypical antipsychotics, used in schizophrenia, have been reported to help treat apathy in Alzheimer’s disease and other dementias. It concluded that the treatment of apathy should be considered according to the biology and pathology of the patient.
For apathy that is caused by being overwhelmed to the point of shutting down, Ertel recommends a few simple methods for coping:
- Make a prioritized list of your required tasks
- Practice setting boundaries and saying “no” to unnecessary tasks/requests,
- Make self-care non-negotiable
For apathy that is caused by being underwhelmed to the point where you are feeling lost and out of sorts, try the following:
- Identify some new short and long-term goals
- Make a list of hobbies you might enjoy, try each one at a time to see if any spark your interest or joy
- Invest in yourself by reading and making a point to learn at least one new thing per week
Speaking to a professional can also be a useful strategy to work through feelings of apathy. With Talkspace online therapy, you can speak to a licensed therapist today from the comfort of your home. It’s an inexpensive and convenient way to start feeling better today.