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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by HelenInCalif on September 20, 2006, at 3:08:44
I'm really having a problem with motivation and apathy. I can look at deadlines and things that need doing, but feel no motivation. Otherwise I'm eating well, exercising, spending time with friends and family... although I'm lax on initiating these.
While I've been reading here and elsewhere, any summaries or opinions on Apathy as a distinct problem would be helpful and welcome. I'm thinking to call my psychiatrist at Kaiser: there'll probably be 2-4 weeks before the next available appointment, and I should try to know what to say ahead of time.
It's apathy without depression. Or at least not in any way like I know, and I've had depression before (treated with SSRIs). Nor is there anxiety- I had that in 2004-2005 and treated it with Klonapin. In fact, what worries me (intellectually, not emotionally) is that I'm *not* feeling particularly anxious about late deadlines and this apathy I have towards them.
The apathy isn't from meds- I haven't had SSRIs or klonopin for over a year (after a very stressful 2004)- the only med I'm taking now is ritalin. And I'm taking the same 10mg 3x day that I've been taking for 10 years.
All my emotions but one seem normal- funny shows are funny, sad news makes me cry, stupidity makes me angry, scary things make me fearful... but when contemplating a long-due deadline I'm simply not motivated, not in any ordinary sense.
The closest analogy I can think of is that it's like I've lost my hunger, but food still tastes great and I still like to cook. But if you didn't feel hungry then eating would be an intellectual exercise, not something you're driven to do.
When reading on medline and here it seems as if one can differentiate apathy from depression. Based on my past experiences with depression, what I'm having now isn't depression, but it's definitely wrong.
Posted by med_empowered on September 20, 2006, at 11:05:11
In reply to Apathy and no motivation, but otherwise fine, posted by HelenInCalif on September 20, 2006, at 3:08:44
you could try talking to a counsellor/therapist about this...or just examining your life to see if something's going awry.
Maybe something with dopamine action could help...dexedrine or something, or one of the new dopamine agonists. Or maybe this will pass.
Posted by Phillipa on September 20, 2006, at 11:11:28
In reply to Re: Apathy and no motivation, but otherwise fine, posted by med_empowered on September 20, 2006, at 11:05:11
Could it be normal emotions to life? Love Phillipa
Posted by Racer on September 20, 2006, at 12:20:11
In reply to Apathy and no motivation, but otherwise fine, posted by HelenInCalif on September 20, 2006, at 3:08:44
A few days off Ritalin, to let your DA system rest a bit? I've read -- although I don't know how accurate it is -- that that can help a lot in avoiding that sort of burn out.
Regardless of whether or not that's the problem, I'd call for that appointment. I hope your pdoc at Kaiser is good, and that you can figure it out. What you're describing is NOT a "normal emotion to life," as someone else put it. You're describing just what you think you're describing: a distinct symptom of *something* -- I'm just not sure what.
For what it's worth, though, sometimes that sort of apathy is a precursor to full blown depression for me. Can you remember if your episodes of depression might have started with apathy in the past? Might be worth exploring.
Hope that helps, and that your pdoc can help you figure out a good solution. Good luck.
Posted by blueberry on September 20, 2006, at 15:53:40
In reply to Apathy and no motivation, but otherwise fine, posted by HelenInCalif on September 20, 2006, at 3:08:44
Generally I think dopaminergic and/or noradrenergic drugs are used to treat apathy. Mainly dopaminergic ones, such as ritalin, adderall, wellbutrin, and various dopamine agonists. You might simply have become immune to the motivational aspects of ritalin after so long.
I have heard that when tolerance to ritalin develops you can switch to adderall and regain the good effects. Taking holidays from ritalin might help too, though after 10 years that might be hard.
Without getting into side effects of dopamine agonists, wellbutrin, or TCAs such as desipramine, the simplest thing to do might be to switch to adderall for a short trial.
Posted by BryanII on September 20, 2006, at 17:28:30
In reply to Apathy and no motivation, but otherwise fine, posted by HelenInCalif on September 20, 2006, at 3:08:44
I have wondered if this happens to other people. I’ve had some similar experiences with apathy and haven't figured it out.
I think you are on to the right strategy. Get your questions and your description of your experience straight before meeting with your psychiatrist. Bring notes if needed. You may have to push the point and also be lucky in who you are seeing; the default professional bias seems to be that apathy is just a feature of depression.
Though I've had apathy during depression, I've also experienced paralyzing apathy without depression as well as depression without apathy. The "apathy-only" is sometimes transitional to depression, but sometimes it is its own problem.
Your comment about not initiating things struck a nerve. It seems like there's "I don't give a rip" apathy but also "I can't get started" apathy. Caring about something and initiating action about it seem to be separate processes and might be biologically distinct. Maybe animal behaviorists or neurobiologists have studied this?
I have periods where I just can't initiate (work, social contacts, etc) even though I feel OK emotionally. Normally I'm very self-motivated and independent, but at these times I feel totally inert. I can't get started on my own, but if someone else gets something started I can engage with it, contribute well and even enjoy it. I'm not blocked by fear or depression; this is different. I wouldn't say everything else is completely normal, but inertia is the main thing.
I've thought about using a buddy system to try to stay on task (having a coworker partner on projects and leaning on them to set the pace), but that’s quite a burden and not really their job.
Good luck figuring this out. I hope someone has some good insights and strategies.
Posted by HelenInCalif on September 20, 2006, at 20:22:54
In reply to Re: Apathy and no motivation, but otherwise fine, posted by BryanII on September 20, 2006, at 17:28:30
> Though I've had apathy during depression, I've also experienced paralyzing apathy without depression as well as depression without apathy. The "apathy-only" is sometimes transitional to depression, but sometimes it is its own problem.
A good way of breaking things down. I'm familiar enough with depression to feel that (know that?) this isn't depression- it seems entirely unrelated to it. i.e. I could imagine getting depressed, and it would be affecting an entirely different part of me.
The apathy during depression seems more like a "I can't possibly do anything well or right, so why start."
This apathy now is more like "well, I could start my overdue project. I could also learn to weld. Maybe someday..."
> Caring about something and initiating action about it seem to be separate processes and might be biologically distinct. Maybe animal behaviorists or neurobiologists have studied this?Exactly!
> I have periods where I just can't initiate (work, social contacts, etc) even though I feel OK emotionally. Normally I'm very self-motivated and independent, but at these times I feel totally inert. I can't get started on my own, but if someone else gets something started I can engage with it, contribute well and even enjoy it. I'm not blocked by fear or depression; this is different. I wouldn't say everything else is completely normal, but inertia is the main thing.
>
I could have written this myself. If I have a slight push, I'll do fine. If I'm working with someone else, I'll do fine. But when I have to initiate, nothing. So for example if the choice is between reading a book I've already read, or zipping down to the library to get an exciting new book, re-reading the old book seems like just as good of a thing. Even though all the rest of the time I'd prefer the new book.In effect- as far as getting tasks done- it's like a depression. Except that all the usual symptoms of depression aren't there, and I've certainly gone through depression before. But if I can't get my work done- and I'm a consultant, so I have to initiate things- then that's bad.
Posted by HelenInCalif on September 20, 2006, at 20:31:00
In reply to Do you ever take Ritalin vacations? » HelenInCalif, posted by Racer on September 20, 2006, at 12:20:11
I take short, 2 to 3 day ritalin vacations reasonably often- during weekends, or when I don't have consulting projects. Last week I was off of it for 3 days.
But starting and stopping it seem unrelated to the apathy. As I wrote, when I'm taking it I'm focused and apathetic, when I'm not taking it I'm less focused but still apathetic.
Would a much longer vacation be good for my dopamine system?
This apathy seems entirely unrelated to depression. I know what a depression feels like, coming on, and it's nothing at all like now. The feel of it is new to me. It's like I've pulled a muscle- a mental muscle- that I didn't even know existed. Or, to put it slightly better, it's like a mental foot falling asleep. To get up and do something is difficult, when it's never been difficult before.
Posted by Racer on September 20, 2006, at 22:42:52
In reply to I do take ritalin vacations, including recently, posted by HelenInCalif on September 20, 2006, at 20:31:00
>
>
> This apathy seems entirely unrelated to depression. I know what a depression feels like, coming on, and it's nothing at all like now. The feel of it is new to me. It's like I've pulled a muscle- a mental muscle- that I didn't even know existed. Or, to put it slightly better, it's like a mental foot falling asleep. To get up and do something is difficult, when it's never been difficult before.Oh, I believe you... And I think I know what you're describing... Kinda like a rubberband that's stretched out? If that makes sense?
I'm not sure -- maybe I feel that way, too, about now... I think I'm depressed, too, though.
Or, I know I'm depressed -- I think I am also apathetic in an unrelated sort of way... But, it's hard for me to tell...
Good luck, and do let us know what your doctor says...
Posted by craiggetty on September 22, 2006, at 16:17:04
In reply to Re: Apathy and no motivation, but otherwise fine, posted by HelenInCalif on September 20, 2006, at 20:22:54
I can relate to what you're saying. It's a slippery slope. A month ago I felt fine except for low motivation. I'd re-read that same book, too. Now I'm feeling too disinterested to read at all. Lying on the couch all day is fine (though I know it's not).
My gameplan is to switch from dexedrine to adderrall, up my wellbutrin, and resume taking cymbalta which I *coincidentally* stopped taking a month ago. My new pdoc has suggested lithium, but I don't want to go there yet.
"Just when I thought I was done, they keep pulling me back in...."
> > I have periods where I just can't initiate (work, social contacts, etc) even though I feel OK emotionally. Normally I'm very self-motivated and independent, but at these times I feel totally inert. I can't get started on my own, but if someone else gets something started I can engage with it, contribute well and even enjoy it. I'm not blocked by fear or depression; this is different. I wouldn't say everything else is completely normal, but inertia is the main thing.
> >
> I could have written this myself. If I have a slight push, I'll do fine. If I'm working with someone else, I'll do fine. But when I have to initiate, nothing. So for example if the choice is between reading a book I've already read, or zipping down to the library to get an exciting new book, re-reading the old book seems like just as good of a thing. Even though all the rest of the time I'd prefer the new book.
>
> In effect- as far as getting tasks done- it's like a depression. Except that all the usual symptoms of depression aren't there, and I've certainly gone through depression before. But if I can't get my work done- and I'm a consultant, so I have to initiate things- then that's bad.
>
Posted by notfred on September 24, 2006, at 17:38:30
In reply to Apathy and no motivation, but otherwise fine, posted by HelenInCalif on September 20, 2006, at 3:08:44
I find apathy and no motivation to be some of the last things to go when treating my depression.
A "better but not yet well" condition. Presently
I find Provigil effective in treating this.
Posted by iforgotmypassword on September 25, 2006, at 14:02:44
In reply to Re: Apathy and no motivation, but otherwise fine, posted by notfred on September 24, 2006, at 17:38:30
http://www.neuropsychiatryreviews.com/aug00/npr_aug00_apathy.html
Posted by kimcrazylady on September 26, 2006, at 17:27:08
In reply to Apathy and no motivation, but otherwise fine, posted by HelenInCalif on September 20, 2006, at 3:08:44
Wow. I think I could have written that. I am so unmotivated it's unreal. My mood is ok, even good, and my meds seem to be working, but I just cannot seem to motivate myself to do things.
If a group of friends are doing something, I will join and have a blast, but I don't plan things. My house is a mess and I want to clean it, but I just can't seem to care.
Heck, even knowing my bills will be overdue doesn't motivate me to pay them, even though I have the money. My performance at work sucks.
I know I am not depressed in the way I usually get. I'm not on a downhill slide either. I have no idea what is wrong, but something sure is.
Posted by craiggetty on September 30, 2006, at 18:43:00
In reply to possible acetylcholine,anteriorcingulate relevance, posted by iforgotmypassword on September 25, 2006, at 14:02:44
Thanks for posting the link. My pdoc has brought up the possibility of dysregulation of my cholinergic system inducing apathy, and has raised the possibility of supplements (amino acids? taurine?). As of yet, I'm not going for the supplements. Too expensive, and I haven't had any substantial results with natural cures in the past.
> http://www.neuropsychiatryreviews.com/aug00/npr_aug00_apathy.html
Posted by Questionmark on October 6, 2006, at 19:50:18
In reply to Apathy and no motivation, but otherwise fine, posted by HelenInCalif on September 20, 2006, at 3:08:44
I've had this problem for years, and quite bad. I think I'm a little better-- not sure why. Maybe my daily caffeine use now. I dunno.
But yeah I think that many people have this problem to some degree, too-- though not as much as you or I or some others. I think just about all chronic procrastinators suffer from this, and among many other things is caused by an inability to ***feel*** those almost necessary emotions of motivation, concentration and even desperation and whatever else even while intellecually *knowing* that they should do some particular task. The feelings that actually bring about action arrive too late and are brought about by the deadline that is looming all too soon.
There are many other factors that are often involved such as perfectionistic... ah forget it.You might wanna take a look at one of those self-help-for-procrastination books. As far as increasing the important feelings & decreasing apathy, though, I'm not sure.
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