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Apathy and depression are different
Pure apathy
Pure apathy turned up in a patient who lost his job and his apartment and still looked forward to good things in life. An antidepressant made no difference to him.
Pure depression
Pure depression is the mirror pattern: sadness and hopelessness about the future, with motivation intact. A third group meets the criteria for both syndromes and sits in the overlap between them.
Reading the past
Depression also comes with a way of reading the past. Everything attempted seems to have had a terrible outcome, and the belief of being bad at everything can be an unreliable measure of how the person actually performed. Working out the biology that separates depression from the loss of motivation in apathy is an active area of research.
How do clinicians tell apathy from depression?
Robert Marin defined apathy in 1990 as a lack of motivation that cannot be explained by reduced consciousness, cognitive impairment, or emotional distress. Depression is marked by low mood, guilt, and hopelessness, which are absent in pure apathy. Scales built on this distinction score interest and initiative separately from sadness.
Why might antidepressants leave apathy untouched?
The most widely prescribed antidepressants work mainly on serotonin. The circuit behind motivation leans heavily on dopamine, which those drugs do not target directly. Some people taking serotonin-based antidepressants even report a dulling of emotions and drive, which clinicians call emotional blunting.
Why does depression color memories of the past?
Mood shapes memory, so people who feel low retrieve negative events more easily than positive ones. Research by J. Mark G. Williams and Karen Broadbent in 1986 found that depressed patients recalled general, vague memories rather than specific ones when given cue words. This overgeneral memory style has since been found in many depressed groups.
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