Apathy can be defined as an absence or suppression of emotion, feeling, concern or passion. Further, apathy is an indifference to things generally found to be exciting or moving.
A strong connection exists between apathy and mental disorders. Apathy is one of the hallmark symptoms of schizophrenia. Many people with schizophrenia express little interest in the events surrounding them. Apathy can also occur in depression and depressive disorders. For example, people who are depressed and have major depressive disorder or dysthymic disorder often feel numb to events occurring around them, and do not derive pleasure from experiences that they once found enjoyable.
The World Health Organization (WHO) defines health as an optimal state of being that maximizes one’s potential for physical, mental, emotional and spiritual growth. It does not confine health to physical parameters or measures. Passion, interest and action are needed for optimal mental and emotional health. Persons who are apathetic would seem to fall short of the WHO definition
of health.
All people may experience periods of apathy. Disappointment and dejection are elements of life, and apathy is a normal way for humans to cope with such stresses— to be able to “shrug off” disappointments enables people to move forward and try other activities and achieve new goals. When the stresses pass, the apparent apathy also disappears. A period of apathy can also be viewed as a normal and transient phase through which many adolescents pass.
It is important to note, however, that long-term apathy and detachment are not normal.
How to Treatment
Transient apathy can be overcome. Friends and professionals may be able to assist individuals to develop an interest in their surroundings. Attitude is important. Persons who desire to overcome apathy have much higher odds of succeeding than do persons lacking a positive attitude.
Other than support, no specific treatment is needed for apathy associated with adolescence, unless other, more troubling disorders are also present.
The treatment of more persistent apathy (in a depressive disorder, for example), or the apathy that is characteristic of schizophrenia, may respond to treatment for the primary disorder.
DEPRESSION. For depressive disorders, a number of antidepressants may be effective, including tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). The tricyclic antidepressants include amitriptyline (Elavil), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor). MAOIs include tranylcypromine (Parnate) and phenelzine (Nardil). The most commonly prescribed SSRIs are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram (Celexa).
SCHIZOPHRENIA. For schizophrenia, the primary goal is to treat the more prominent symptoms (positive symptoms) of the disorder, such as the thought disorder and hallucinations that patients experience. Atypical antipsychotics are newer medications introduced in the 1990s that have been found to be effective for the treatment of schizophrenia. These medications include clozapine (Clozaril), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), and olanzapine (Zyprexa). These newer drugs are more effective in treating the negative symptoms of schizophrenia (such as apathy) and have fewer side effects than the older antipsychotics. Most atypical antipsychotics, however, do have weight gain as a side effect; and patients taking clozapine must have their blood monitored periodically for signs of agranulocytosis, or a drop in the number of white blood cells.
Resources
BOOKS
Gelder, Michael, Richard Mayou, and Philip Cowen. Shorter Oxford Textbook of Psychiatry. 4th ed. New York, Oxford University Press, 2001.
Wilson, Josephine F. Biological Foundations of Human Behavior . New York, Harcourt, 2002.
PERIODICALS
Adams, K. B. “Depressive symptoms, depletion, or developmental change? Withdrawal, apathy, and lack of vigor in the Geriatric Depression Scale.” Gerontologist 41, no. 6 (2001): 768-777.
Carota A., F. Staub, and J. Bogousslavsky. “Emotions, behaviours and mood changes in stroke.” Current Opinions in Neurology 15, no. 1, (2002): 57-69.
Kalechstein, A. D., T. F. Newton, and A. H. Leavengood. “Apathy syndrome in cocaine dependence.” Psychiatry Resident 109, no. 1 (2002): 97-100.
Landes, A. M., S. D. Sperry, M. E. Strauss, and D. S. Geldmacher. “Apathy in Alzheimer’s disease.” Journal of the American Geriatric Society 49, no. 12 (2001): 1700-1707.
Ramirez, S. M., H. Glover, C. Ohlde, R. Mercer, P. Goodnick, C. Hamlin, and M. I. Perez-Rivera. “Relationship of numbing to alexithymia, apathy, and depression.” Psychological Reports 88, no. 1, (2001): 189-200.
Starkstein, S. E., G. Petracca, E. Chemerinski, and J. Kremer. “Syndromic validity of apathy in Alzheimer’s disease.” American Journal of Psychiatry 158, no. 6 (2001): 872-877.
ORGANIZATIONS
American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. FAX: (202) 682-6850.
American Psychological Association. 750 First Street NW, Washington, DC, 20002-4242. Phone: (800) 374-2721 or (202) 336-5500, Web site: <http://www.apa.org/>.
L. Fleming Fallon, Jr., M.D., Dr.P.H.
