Depression, Apathy and Fatigue

These three are all symptoms that people with Lewy body (PwLB) disorders often experience. How do you know which is which? They can all make your loved one (or you!) feel so tired that they can hardly move and all they want to do is sleep.

Depression causes changes in mood, thinking, physical well-being and behavior. It generates such feelings as sadness, misery, unhappiness, anger, loss and frustration. Besides decreasing quality of life, it adds stress and decreases one’s ability to deal with illness. A person who is depressed has the motivation to improve but not necessarily the ability to do so. They will complain about being too tired and wish they had the energy to do more.

Situational depression is usually short term, caused by a distressing event. When a PwLBD’s depression doesn’t leave, or appears to get worse, it is probably not situational but is instead a neurological symptom of the disorder. Depression makes it more difficult to do tasks, make decisions or interact with others, all abilities that can also be decreased by dementia. Like LBD, it cannot be cured but can be treated. There are some Lewy-safe antidepressants which may improve cognitive functioning.

Apathy is the loss of motivation, without associated feelings of depression. It damages one’s self-starter—that extra push we need to overcome the inertia of inactivity. As it increases, it also decreases the ability to keep going.  With apathy, nothing is easy. Everything takes effort, often more effort than a person can muster up.  They may appear to have given up, accepting things as they are, voicing few complaints or wishes for change.

Fatigue is an extreme loss of energy. The loss may come from working hard. This doesn’t necessarily mean hard physical labor. If there are language difficulties, then talking can be exhausting. With motor problems, walking can wear your loved one out very quickly. Dealing with stress or illness can be tiring. Depression and apathy both deplete energy and leave a person feeling fatigued.

Negative feelings such as sadness or loss along with the presence of motivation suggest depression.
Ex: “I wish I didn’t feel so down all the time.” Or “I wish I had more energy.”

Negative feelings without motivation suggest both depression and apathy.
Ex: “I feel so down. I can't do anything. Just go away and leave me alone.”

The lack of both negative feelings and motivation suggests apathy alone.
Ex: “I don't care that I can't do that any more. Leave me alone; I just want to sleep.”

For the PwParkinson's, apathy without depression is a sign that dementia may soon appear. Consider a test for MCI.