Apathy: causes, how it differs from depression and what to do

“I don’t feel like doing anything.” This is how people often describe apathy. Not sadness, not pain, just emptiness and not caring. Things pile up, your favourite pastimes give you nothing, you have no energy to answer messages, and on top of it all you tell yourself off for being lazy. Apathy is common, and it is not a character trait. It is usually a signal that something in your life or your body needs attention.

What apathy is

Apathy means a loss of interest, drive and initiative compared with how you used to be. It is important to know that apathy is not a diagnosis but a symptom, and it turns up in many different conditions. In 2018 an international group of experts described it as a noticeable drop in goal-directed activity that affects several areas of life:

• Behaviour and thinking: it is hard to get started, there are no plans, everything gets put off.
• Emotions: feelings are dulled, and neither good nor bad things stir much response.
• Social contact: you don’t want to see or talk to people, even those closest to you.

Sometimes apathy lasts a couple of days after a hard week, and that is a normal response to tiredness. It deserves a closer look when it goes on for weeks and gets in the way of life.

Causes of apathy

Apathy has many causes, and often several are at work at once.

• Exhaustion and chronic stress. Long periods of overload, caring for a sick relative, too little sleep. The body saves its energy, and wanting things is the first to go.
• Burnout. If the indifference is mostly about work and you feel lighter on holiday, it may be burnout.
• Depression. Losing interest and motivation is one of its main signs.
• Grief and big changes: a loss, a move, a divorce. After a loss, apathy can be part of grieving.
• Physical causes. An underactive thyroid (hypothyroidism) can cause extreme tiredness, difficulty concentrating and low mood. Iron deficiency anaemia shows up as tiredness and lack of energy. Tiredness also comes with diabetes, sleep apnoea and hormonal changes, and after some viral infections such as COVID-19. Apathy is also common in neurological conditions: after a stroke, in Parkinson’s disease and in dementia.
• Medicines. Some medicines can cause sluggishness and emotional blunting. Apathy has been described, for example, with some antidepressants, although it is not yet well studied. If you suspect a link with a medicine, don’t stop taking it on your own: talk to the doctor who prescribed it.

Apathy or depression?

Apathy and depression often go together, and even specialists can find them hard to tell apart. But there is a difference. In depression, painful feelings take centre stage: low mood, sadness, guilt, thoughts like “I’m worthless”, hopelessness. In apathy there may be no sadness or pain at all, just indifference and no urge to do anything.

A useful guide: if low mood or loss of interest lasts most of the day, nearly every day, for two weeks or more, it is worth checking for depression. On this site you can take the PHQ-9 (a depression questionnaire) and the short WHO-5, which shows your level of wellbeing over the last two weeks.

Apathy or laziness?

People often call something laziness when it isn’t. With ordinary laziness you don’t want to do one particular, boring thing, but enjoyable things still appeal: you put off the report and happily meet your friends. With apathy, the desire fades for almost everything, including what used to bring you joy, and it is a noticeable change from how you used to be. Telling yourself off in this state doesn’t help: shame drains what energy you have left and brings no motivation back.

Apathy: what to do

With apathy, people usually wait for the desire to come back. More often it works the other way round: first a small action, and then interest slowly returns. This is the idea behind behavioural activation, one of the methods of cognitive behavioural therapy (CBT), which NICE, the UK’s National Institute for Health and Care Excellence, includes in its recommendations for treating depression.

• Start really small. Not “tidy the whole flat” but “wash one mug”. Not “take up exercise” but “go outside for 10 minutes”.
• Plan instead of waiting for the mood. Write down one useful and one pleasant thing for tomorrow and do them, even if you don’t feel like it.
• Afterwards, notice how you felt. An action often brings at least a little relief, and that is worth noticing.
• Bring back the basics: going to bed at the same time, regular meals, daylight, movement.
• Lighten the load wherever you can. Apathy often means your reserves have run low.
• Stay in touch. A short message to a friend or a walk together already counts as a step.
• Be kind to yourself. Speak to yourself the way you would speak to a tired person you love.

When to see a doctor or a psychologist

See your GP or family doctor if the apathy has lasted several weeks and you don’t know why, or if it comes with severe tiredness, weight changes, always feeling cold, breathlessness or other new symptoms. The doctor will usually start with an examination and blood tests, for example for thyroid hormones and haemoglobin.

A psychologist can help if physical causes have been ruled out, or if you sense that behind the indifference there is weariness with life, grief, burnout or depression. In therapy we look for what has drained your energy and, step by step, bring back what gives you strength. If medication is needed along the way, that decision is made by a doctor.

If thoughts of death or of harming yourself come with the apathy, get help the same day: tell someone close, write to me, and if you are in immediate danger, call 911.

To start, you can take the PHQ-9 and WHO-5 tests on this site: it only takes a few minutes. The tests don’t give a diagnosis, but they help you see the picture and start the conversation. If you would like to work out together what has drained your energy, book a free 15-minute intro call. Sessions are online or in person in Yerevan, held in Armenian or Russian.