What Is Apathy?

Apathy is a lack of motivation or goal-directed behavior and indifference to your surroundings. People who experience apathy may have a low desire to complete tasks or engage with their environment.

Most people experience apathy at times, but it usually goes away. For other people, these feelings become chronic (long-term). Apathy can be a symptom of mental health conditions like severe depression or schizophrenia, a mental illness with symptoms like hallucinations and paranoia. It's also a behavioral symptom of Alzheimer’s disease, Parkinson’s disease, and other neurological (brain-related) disorders such as traumatic brain injury.

Apathy can resemble depression, but it's a different diagnosis. Treatment typically depends on the underlying cause.

Signs and Symptoms of Apathy

Apathy isn't considered a medical condition itself. Instead, it's considered a symptom of some mood disorders and conditions related to thinking and reasoning.

In the past, people experiencing apathy had to present with signs that affected at least two out of three domains—behavior/cognition, emotion, and social interaction—over a period of four weeks. These domains have been updated to include anhedonia (decreased interest in things you used to enjoy), decreased initiative, and decreased motivation.

Other symptoms associated with apathy include:

• Impaired concentration
• Reduced libido (sexual drive)
• Fatigue

Apathy is a common symptom of Alzheimer’s disease and Parkinson’s disease. People with depression may also experience apathy or similar symptoms.

Apathy vs. Depression

Apathy can be a common symptom of depression, but you do not need to be depressed to experience apathy. Like depression, you might experience it later in life. Apathy can be difficult to diagnose in older adults because apathy and depression have similar presentations among this population.

Apathy and depression share some symptoms, but there are a few key differences.

Research also highlights differences in social relationships. Many people with depression view social relationships as valuable even if there is no drive or motivation to pursue them. Someone with apathy no longer finds worth in social relationships.

What Triggers Apathy?

Apathy is observed in about 60% of medical conditions that affect the brain's cortex. The cortex is the outer layer of your brain. It controls muscle function, speech, thoughts, emotions, and learning.

Apathy can be an early symptom of mild cognitive impairment. It most often occurs in people living with Parkinson’s disease or Alzheimer’s disease, as well as in people with a history of traumatic brain injury or schizophrenia. While the exact mechanisms of apathy are not fully understood, dopamine dysregulation is believed to be a contributing factor.

Dopamine is a neurotransmitter in the body that helps to regulate mood, movement, and motivation. It also helps regulate your reward system, including motivation to experience pleasure. Most cases of apathy are reported following a dopamine imbalance in the body. This is common in Parkinson’s disease.

Traumatic brain injury and schizophrenia also involve alterations in dopamine neurotransmission. Trauma to the brain or disruptions in blood supply can damage dopamine-producing cells or affect the connectivity of brain regions involved in dopamine regulation.

Research suggests that apathy can also occur following a stroke. It can lead to a worse prognosis and is associated with functional disability and emotional distress. 

How Is Apathy Diagnosed?

A healthcare provider will likely want to perform a full health assessment before diagnosing apathy. The assessment will include questions about your motivation and your interest in doing things that are or once were important to you.

The provider will try to rule out other psychiatric diagnoses like depression. They might use a tool called the Apathy Evaluation Scale. This assessment tool is designed to measure apathy and can detect cognitive changes over a four-week period. 

Signs of apathy must persist (continue) for at least four weeks and must affect at least two of three dimensions:

• Diminished initiative: Decreased spontaneity and activity levels compared to your usual norms
• Diminished interest: Reduced interest in your surroundings, activities, and time spent with family and friends, as well as less persistence in maintaining tasks
• Diminished motivation: Might include a decline in spontaneous emotional expression, reduced affection toward others, and fewer expressions of emotions in response to various events

How Is Apathy Treated?

Apathy can be difficult to treat because it's a symptom of several different neurological disorders. There is no standard treatment, and there are no FDA-approved medications.

Rather than treating apathy itself, a healthcare provider will likely try to identify and treat the underlying cause. Treatment may include medications, physical therapy, cognitive rehabilitation, or other interventions to help manage the specific condition.

Other possible treatment methods include:

• Cognitive-behavioral therapy (CBT): A form of psychotherapy (talk therapy) that focuses on identifying negative or disruptive thought patterns and replacing them with more helpful thoughts and behaviors
• Goal setting and problem-solving: To help increase goal-directed behaviors, which often reduce significantly with apathy
• Repetitive transcranial magnetic stimulation (rTMS): With rTMS, an electromagnetic coil delivers pulses to your scalp that stimulate brain cells. It might be used to treat apathy after a stroke.
  

Apathy can be difficult to treat. For example, it typically doesn't respond well to antidepressants—and some antidepressants might actually worsen symptoms. Recognizing underlying causes can help your healthcare provider determine possible treatment approaches.

How To Cope With Apathy

Apathy can affect your overall quality of life. It can reduce your commitment to responsibilities, relationships, and personal health. You might have difficulty connecting to people who matter to you or enjoying hobbies that used to bring you joy. You might wonder what's wrong with you.

Certain strategies can help you cope, including the following:

• Focus on small goals: Creating and completing attainable goals will help you gradually work toward bigger goals. Try to celebrate each accomplishment. This can help boost motivation and self-confidence.
• Create a routine: Building a structured routine can provide stability and purpose. It can help you stay organized and provide a framework for engaging in activities even if you lack motivation.
• Seek and accept support: Participate in support groups, or lean on friends and family. People who experience similar challenges can provide validation and practical advice. Sharing thoughts and feelings with loved ones can help alleviate feelings of isolation and provide emotional support.

Challenging yourself to try new things can help you connect with something that feels more fulfilling. You might need to try several things before finding one that resonates. Try to be patient with yourself and avoid negative self-talk, which can be demotivating. Self-compassion and compassion from others are incredibly valuable.

Reach out to a healthcare provider if you have persistent symptoms of apathy. It may be a sign of an underlying health condition.

A Quick Review

Apathy is characterized by a lack of motivation or goal-directed behavior, indifference to your surroundings, and a low desire to complete tasks or engage with your environment. While it may mimic symptoms of depression, there are some key differences.

Apathy often occurs in conditions like Alzheimer's disease, Parkinson's disease, schizophrenia, and traumatic brain injury. Treatment typically focuses on treating the underlying condition. There are no specific clinical guidelines for treating apathy itself, and it can be difficult to treat. However, coping strategies can be effective.

Reach out to a healthcare provider if you experience persistent signs of apathy. They can help you determine the underlying cause(s) and possible treatment approaches. Reaching out to others for support and developing self-care practices can also help you reconnect with people and things that matter to you.