What is apathy and how does it differ from laziness?
Laziness is a choice: a person can act, but chooses not to do it, and with sufficient motivation he gets down to business. With apathy, the motivation mechanism itself disappears: there is neither desire nor pleasure from the result, and external stimuli do not help. A person often realizes that he must do something, feels guilty, but cannot begin. Apathy also needs to be distinguished from fatigue: when tired, desires persist, there is simply not enough strength, and after rest the energy returns. With apathy, rest does not bring relief, and interest is not restored.
- Lack of incentive rather than choice
- Decreased ability to experience pleasure
- Emotional indifference to good and bad
- Rest does not restore interest
- Persistence of criticism and guilt
- Gradual narrowing of the circle of activities and communication
Possible reasons
Most often, long-term apathy is caused by depression, in which loss of interest and the ability to rejoice is one of the main symptoms. The second common cause is emotional burnout after working at the limit for a long time. It is important to exclude physical causes: decreased thyroid function, anemia and iron deficiency, lack of vitamin B12 and vitamin D, chronic infections, consequences of previous diseases. Apathy can be a side effect of certain drugs and a consequence of alcohol abuse. In older adults, persistent apathy may be an early sign of dementia or Parkinson's disease.
- Depression
- Burnout and chronic stress
- Hypothyroidism
- Anemia and iron deficiency
- Vitamin B12 and vitamin D deficiency
- Chronic lack of sleep and sleep disorders
- Side effects of medications, alcohol abuse
- Neurological diseases and dementia
Associated symptoms
When assessing the condition, the doctor pays attention to what accompanies indifference. The combination with depressed mood, feelings of guilt, sleep and appetite disturbances speaks in favor of depression. If apathy is combined with chilliness, swelling, dry skin, weight gain and constipation, check the thyroid gland. Paleness, shortness of breath on exertion, and brittle hair indicate possible anemia. Memory deterioration, difficulties with finding words and orientation in an elderly person require a separate examination by a neurologist and psychiatrist.
- Depression, guilt, sleep disturbances
- Chilliness, swelling, dry skin, constipation
- Pallor, shortness of breath, hair loss
- Daytime sleepiness and snoring with pauses in breathing
- Memory loss and difficulty speaking
- Decreased libido and cycle disorders
What examinations are needed
They start with an examination by a therapist and basic tests that help rule out the most common physical causes. This step is usually inexpensive and quick, but eliminates a lot of searching. At the same time, mood, sleep, appetite and the presence of thoughts about not wanting to live are assessed: this is done by the doctor in conversation, using questionnaires if necessary. If the tests are normal and apathy persists for more than two weeks, the next step is a consultation with a psychiatrist or psychotherapist. In older adults, memory assessment and neurological examination are additionally performed.
- Examination by a therapist
- General blood test
- Ferritin
- TSH
- Vitamin B12
- Assessing depression and suicide risk
- Consultation with a psychiatrist for prolonged apathy
- Neurological examination in the elderly
What to do and how to treat it
If the cause is physical, treatment is aimed at it: they replenish the deficiency of iron or vitamin B12, correct the function of the thyroid gland, and at the same time interest in life returns. For depression, psychotherapy and, if indicated, antidepressants prescribed by a doctor are used. While the cause is being determined, simple but effective steps help: restoring sleep patterns, minimal daily activity, daylight, limiting alcohol and reducing time on the phone. It is important to set very small goals and not demand the same productivity from yourself: with apathy, action usually precedes desire, and not vice versa.
- Treatment of the identified physical cause
- Psychotherapy for depression and burnout
- Antidepressants as prescribed by a doctor
- Regular sleep and wake-up routine
- A short daily walk and daylight
- Small achievable tasks instead of big plans
- Limiting alcohol and reducing time on social networks
- Talking with loved ones and avoiding self-recrimination