An estimated 30% to 50% of people with Parkinson’s are reported to experience depression, and up to half of those are never even diagnosed. Part of the reason is that a sinking mood is not one single thing. Depression and apathy look similar from the outside but are genuinely different symptoms, and they often turn up mixed together.
How depression and apathy differ
Depression shows up as sadness, guilt, a lack of energy and a feeling that nothing will get better. ApathyA loss of motivation and drive while not feeling sad or depressed. Unlike depression, the person is usually not particularly troubled by being in that state.Learn more, by contrast, is losing the drive or the interest to start anything while not feeling sad. The biggest difference from depression is that people with apathy often are not especially bothered by having no motivation.
The symptom families misread most often
From the outside, apathy is easy to read as “lazy,” “not interested,” or “choosing not to try,” which makes it one of the hardest symptoms for families and care partners to live with. But apathy is not a question of willpower — it is a neurological symptom that comes from the drop in dopamine and other brain chemicals. The brain’s motivation circuit, the part you need in order to get started on something, has itself been weakened. It is not that the person does not feel like doing it.
Anxiety often comes along too
Separately from depression and apathy, up to 40% of people with Parkinson’s are reported to experience anxiety. It is common for anxiety to spike during “off” periods, when medication wears off — and that is not simply a psychological reaction, but possibly part of the physical symptoms that arrive with the drop in medication effect. Like depression, anxiety has a large effect on quality of life while tending to go undiagnosed, so if your anxiety worsens in step with your off periods, it helps to describe that pattern specifically to your care team.
What helps
There is no medication or treatment yet proven to work specifically for apathy, but the following can help.
- Build structure into the day so activities happen at set times
- Set up occasions to be around other people, even when you have to push yourself
- Have your current Parkinson’s medications reviewed to check they are right for you
- If sleep problems or depression are also present, treat those first
Depression can often be managed with antidepressants or talk therapy, so if you feel sadness, guilt and low energy together, that is worth raising with your care team first.
What you can do now
It also helps to explain to your family that your loss of motivation is not laziness. If you describe your emotional state to your care team in concrete terms, they can help in different ways depending on whether it is depression or apathy.
This article is not a substitute for medical diagnosis or treatment. If changes in your mood persist, please talk with your care team.
