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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

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    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

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    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

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causes of drowsiness, weakness and fatigue

Periods of moral fatigue occur even in stress-resistant people. By unconsciously pausing emotions, a person protects himself from the more severe consequences of mental stress. Therefore, a short-term decrease in social and psycho-emotional activity is considered the norm. We can talk about violations of mental health, if the depressed state drags on - indifference to life appears.

In clinical psychology and psychiatry, apathy is considered as an independent syndrome of loss of motivation or a symptom that accompanies mental disorders, addiction, neurological diseases. It is quite difficult to get out of this state without the help of a specialist. Especially if the situation is aggravated by misunderstanding of relatives. How does it manifest itself, why does apathy arise? Should she be treated with medication as a mental illness? We will answer these other questions in the article. nine0003

What is apathy?

Apathy and demoralization belong to a group of symptoms that combine deviations in the psychobehavioral, emotional, and cognitive spheres. There are several opinions about the typological affiliation of apathy in the structure of psychopathological disorders. Many experts characterize the apathetic state as the suppression of goal-directed behavior against the background of preserved intelligence and physical capabilities. Banal laziness and apathy are not identical concepts. A lazy person tries to avoid duties, but at the same time does not lose emotions, motivation for things that interest him. An apathetic patient lacks any initiative, cognitive activity and emotional response sharply decrease. nine0003

Along with mental and motor retardation, apathy is included in the symptom complex of depression. This allows us to classify the apathetic state as a psycho-emotional dysfunction:

  • Anhedonia is the loss of the ability to experience positive emotions: pleasure, delight, joy. A person cannot enjoy pleasant things, people, situations. The brain refuses to act because it does not receive a “reward” in the form of positive emotions.
  • Abulia - lack of will, psychological inability to perform actions, seek and make decisions. The patient does not lose consciousness, but cannot do anything. nine0016

Sustained decrease in mood (hypothymia), indifference to ongoing events are characteristic of different types of depressive disorders. With true major or minor depression, a person is haunted by feelings of guilt, obsessive negative thoughts about the past, present, and future. With apathetic depression, there is no concern about what happened, the desire to participate in what is happening, the motivation for life planning. A person does not care about either negative or positive events. Relatively speaking, the toggle switch "desires - feelings - interest" is turned off. nine0003

Types of apathy

Many clinical cases are presented by passive apathetic depression. Loss of motivation is accompanied by severe symptoms that are noticeable to others. A person is changing before our eyes, without hiding it. From a sociable and hardworking employee, an attentive relative, he turns into a closed "beech", devoid of emotional reactions.

Active apathy is much less common. The patient loses interest in what is happening, loses the meaning of life, but diligently disguises it with imaginary activity. With difficulty, a person continues to perform daily duties, experiencing severe mental discomfort. This condition is considered more dangerous, since it gradually destroys the psyche, leads to the degradation of the personality, and provokes suicidal thoughts. nine0003

The difference between apathy and anhedonia is the lack of separation of life aspects. Anhedonia can be partial, that is, cover one side of life - social, physical or intellectual-aesthetic. An apathetic state is almost always total - a complete loss of interest in any aspect of life.

Causes of psycho-behavioral and emotional disorders

The basic trigger for apathetic depression in healthy people is mental exhaustion resulting from:

  • occupational burnout;
  • prolonged psychological stress;
  • exhausting and unbearable loads against the background of lack of proper sleep;
  • hypertrophied responsibility, perfectionism, "excellent student syndrome";
  • long-term struggle with severe illness.

Post-traumatic stress disorder (PTSD) can cause lethargy. Indifference to the outside world develops against the background of psychotrauma. For example, the death of a loved one, a difficult divorce, loss of property. The degree of indifference depends on the personality accentuation - personal vulnerability to certain psychogenic factors. Etiologically, the condition is comparable to a protracted reactive psychosis - a distortion of the worldview in the patient's mind. nine0003

Other factors that provoke an indifferent attitude to life include:

  • Shift in the level of hormones and neurotransmitters, damage to the frontal lobes of the brain. Changes are typical for infectious lesions of the membranes of the brain, craniocerebral injuries, neurogenic, endocrine diseases. Endogenous disorders play a leading role in the development of apathetic depression in women in the postpartum or menopausal period.
  • Mental disorders. These are all types of schizophrenia, schizoid psychopathy, Alzheimer's disease, especially uncompensated forms (lack of treatment with specific drugs). The condition is complicated by the loss of the ability to separate the main from the secondary, to establish connections between phenomena. nine0016
  • Addictions - alcoholism, drug addiction. The loss of motivation and the meaning of life is associated with severe withdrawal symptoms when alcohol and drugs are given up. The withdrawal syndrome is accompanied by a feeling of fear, irritability, psychosis, which is replaced by complete indifference.
  • Side effect of sleeping pills. Medicines inhibit the synaptic transmission of nerve impulses, so in the morning many people feel detached, indifferent.

In men, the causes of psycho-emotional dysfunction are more often associated with the professional sphere, in women - with interpersonal relationships, hormonal changes. Despite this, women are less prone to apathy. The gender imbalance is explained by the lability of the female psyche, the high involvement of women in social and family ties, and the excess of social roles. nine0003


In case of mental disorders, endogenous disorders, neurogenic diseases, addictions, apathy accelerates the impairment of cognitive functions and reduces the quality of life. Apathy is manifested by refusal of treatment. Melancholy grows, unwillingness to perform any actions - get out of bed, leave the house, wash, comb your hair.

In contrast to depressed patients, who usually acknowledge their hopelessness and the need for medical help, apathetic people rarely acknowledge their condition. The following symptoms help to suspect psycho-emotional dysfunction in a person:

  • Detachment from family, social, professional problems. A person does not want to take part in discussions, take the initiative.
  • Striving for loneliness, seclusion.
  • Exhausted look - a haggard face, circles under the eyes, a detached look.
  • Absence of emotional reactions. Do not cause reciprocal experiences sad or joyful news.
  • Reticence, reticence, monotonous and poor speech. An apathetic patient avoids communication with relatives, colleagues, friends, easily breaks off old ties, refrains from making new acquaintances. nine0016
  • Stingy facial expressions, gestures. A smile practically does not appear on the face, the movements are constrained, a little clumsy.
  • Decreased appetite, physical activity. There is a retardation of attention, thinking.
  • Changing habits. It includes giving up hobbies, participation in family and friendly gatherings.

In women, the symptoms of lethargy are reflected in appearance. They stop wearing make-up, dressing beautifully, because appearance, like everything else, ceases to be significant. nine0003

Internal state is characterized by:

  • Chronic fatigue. Physical and moral weakness is always present (regardless of the time of day).
  • Daytime sleepiness, decreased quality of night sleep. There are different types of insomnia - frequent awakenings at night, inability to fall asleep quickly.
  • Oppression of sexuality. There is no libido, psychophysical pleasure from tactile sensations.
  • Indifference to former pleasures. For example, a person refuses delicious food, outdoor recreation, SPA treatments, etc.
  • Loss of desire to develop, contemplate the beautiful - listen to music, travel, watch movies, read books.

Psycho-emotional state affects physical health. There are regular headaches that are difficult to remove with painkillers. Aches in the bones, dyspepsia, problems with bowel movements appear, muscle tone decreases.


When the psyche is not destroyed, and the patient himself is aware of the causes of apathy, rest, good sleep, healthy nutrition, and physical activity help to cope with indifference. If apathy continues for two weeks or more, specialist help is required. Therapy is aimed at stabilizing the functioning of the nervous system, restoring mental health, and maintaining physical fitness. nine0003

Comprehensive treatment includes:

  • Medicines. Taking into account contraindications, age, severity of the disorder, tranquilizers, antidepressants, antipsychotics are prescribed. Special therapy can be supplemented by cardiological drugs, anti-pressure drugs.
  • Psychological and psychotherapeutic assistance. To restore motivation, various methods and psychotechnics are used. Cognitive Behavioral Therapy - recognition and correction of behavioral attitudes. Gestalt therapy is the development of self-awareness (understanding, acceptance of one's state, liberation from it). Art therapy is the return of emotionality, the development of creativity. Personal growth training is the stimulation of the desire to return to the old life, to learn something new. At the first stage, classes are held one-on-one with a psychologist, at the second - in groups. nine0016
  • Recovery of physical health. Includes sports, massage, walks in interesting places, a varied diet, taking vitamins, biologically active food supplements.

Treatment of apathy requires attention from relatives and friends. The support of relatives increases the effectiveness of the work of a psychologist, speeds up recovery. For this, family psychotherapy, family psychological counseling are provided. The involvement of relatives helps to find the root cause of an apathetic state, to form the correct behavior model to create a healthy environment in the family. nine0003

What is the feeling of apathy in a person. What to do if there is complete apathy for life

Most people know firsthand what apathy is. Frustration and fatigue are part of life, and the emergence of apathy is one of the reactions to stress. Traditionally, this concept is considered as a state that is manifested by the loss of interests, vitality and emotional responses. Each of us has periods of moral fatigue, depression and indifference to what is happening. All this negatively affects work, prevents you from maintaining personal relationships and enjoying life. nine0003

Apathy is a painful state of lethargy, indifference, lack of strength and motivation. There may be a loss of interest in hobbies and in things that previously seemed exciting and important.

Such signs are, of course, not uncommon. However, they should not be underestimated. You cannot be sure if you have apathy that this is a trifle that you should not pay attention to. In some situations, this condition not only reduces the quality of life, but can also be dangerous. For example, if a person is sick with a somatic disease, apathy will prevent him from gaining motivation for treatment. Also, apathy can be a symptom of a number of mental and neurological disorders. nine0003

Therefore, if you notice warning signs in yourself or a loved one, it is better not to ignore the problem, but try to figure it out.

Causes of apathy

All the reasons why apathy appears can be divided into two large groups: external and internal.

External causes are factors that act on the brain from the external environment or from other areas of the body. What causes apathy in such people: nine0003

  1. Severe stress - loss of a loved one, dismissal from work, man-made or natural disaster; can lead to the development of post-traumatic stress disorder.
  2. Emotional burnout - chronic stress, work with high responsibility, stressful lifestyle; high probability of developing neurasthenia, there may be reactive depression.
  3. Somatic diseases - diseases of organs that indirectly affect the brain; for example, atherosclerosis of the vessels that cause a stroke
  4. Endocrine disorders.
  5. Side effects of drugs: drugs that reduce blood pressure, sleeping pills, contraceptives.


Apathy can be a symptom of a number of mental and neurological disorders: depression, schizophrenia, Alzheimer's disease.

All of the above is not uncommon for a person who lives in a modern city. The emotional reaction in the form of situational apathy in these cases is a variant of the norm and passes along with the elimination of the stress factor. nine0003

Why does apathy set in for everything that happens when there are no external causes and reasons? Here, internal causes come to the fore. Apathy can be a symptom of a number of mental and neurological disorders: depression, schizophrenia, Alzheimer's disease.

Apathy in depression. Apathy can occur both in major depressive disorder and in dysthymia and masked depression. The latter is a type of depression, in which somatic complaints (pain in the spine, itching, respiratory failure) come to the fore in the absence of objective signs of the corresponding diseases. These are the so-called "masks" of depression, such conditions often cause difficulties in making a diagnosis. nine0003

Apathy in simple schizophrenia. This form of schizophrenia is characterized by slow progressive development and loss of natural mental functions. Emotional coldness, pathological indifference, thought disorders come to the fore. Delusions and hallucinations are not observed at all or almost, which is why the disease can go unnoticed for a long time. Without the intervention of a specialist, it leads to complete social isolation and disintegration of the individual.

Apathy in Alzheimer's disease. Alzheimer's disease is a neurodegenerative disease that primarily affects the frontal lobes. The occurrence of apathy is associated with the defeat of these particular parts of the brain, as well as with the development of dementia. Apathy develops in most patients with this disease. nine0003

What apathy looks like: symptoms and signs

Apathy deprives a person of interest in life, desires and motivation. The absence of these important incentives adversely affects behavior and performance. A low level of energy will interfere with both daily routine activities and taking on new challenges.


Over time, despite the actual deterioration of the condition, patients talk less and less about their problem, but go deeper into it. nine0003

Emotions are blunted, which is why everything that used to be of interest now does not give an emotional response. Bouts of apathy take away interest in almost all aspects of life. A person may be indifferent when long-awaited events occur, or when meeting new people. It is difficult to make an effort even to solve personal problems. The accumulated problems at work and in personal life only exacerbate the situation, because apathy is one of the ways the psyche isolates itself from a difficult situation and overstrain. nine0003

At first, when manifestations have not reached their maximum, people may express similar complaints: “I have some kind of apathy, I don’t want anything”, “I’m tired of everything, I can’t concentrate, I have no desire.” Over time, despite the actual deterioration of the condition, patients talk less and less about their problem, but go deeper into it. If your loved one complains to you about painful feelings, you should not ignore these words - the person may need help.

The main signs of apathy: nine0003

  • decrease or lack of aspirations and motivation;
  • changes in emotions and behavior: decreased interest in life, communication, old hobbies and new events, difficulty in performing current tasks, lethargy, lethargy, poor concentration, decreased mental functions, and more;
  • impact on quality of life: changes in behavior negatively affect professional success and personal life;
  • changes in behavior are not associated with the use of drugs and alcohol. nine0016

Clinically significant is the presence of these signs in a person for four weeks. Nevertheless, if you notice apathy in yourself or in your loved one, which lasts less, but causes significant discomfort and interferes with life, you should not postpone contacting a specialist. A professional will quickly help you understand the situation and understand whether it is just a bad mood, fatigue, or a condition that, in order to prevent complications, requires correction. nine0003

Diagnostic measures that can be carried out in a person with complaints of a feeling of apathy:

  1. Consultation of a psychiatrist-psychotherapist
  2. Pathopsychological research: helps in more depth
  3. to explore such mental functions as thinking, attention and memory. The method helps to detect disorders in the early stages and prevent the occurrence of severe manifestations
  4. Laboratory and instrumental procedures to confirm
  5. diagnosis: Neurotest, Neurophysiological test system, EEG, CT, MRI of the brain (if organic pathology is suspected)
  6. Allied specialist consultation (neurologist)

How to cure apathy

Eliminating any mental problem takes time. If you or your loved one has signs of apathy, an experienced specialist will tell you how to help in this situation most quickly and effectively. It is necessary to establish and analyze the cause of this condition. It is up to her to choose the right combination of the following therapeutic approaches. nine0003

First of all, psychotherapy and pharmacotherapy will help.

Individual psychotherapy is one of the most effective methods. If the stressor cannot be eliminated, the doctor will help find a way to cope with it in a different way. During the sessions, patients learn to better understand the problem, fight fears and think positively. During the conversation, you will understand how to survive apathy and other painful feelings.

Pharmacotherapy. If the cause is a mental disorder or anxiety, then, depending on the problem, the doctor will prescribe the appropriate modern drugs. For example, mild tranquilizers are used that effectively relieve anxiety, or antidepressants that normalize mood have a positive effect on mental activity. Antipsychotics may be used. nine0003

Additional help:

  • family and friends support: if you want to know more exactly how to help a person with apathy, then a specialist will tell you how best to do it in your case
  • normalization of lifestyle, sufficient sleep, elimination of the stress factor: this item is important for apathy of any etiology
  • physiotherapy, massage, vitamin therapy, adaptogens: recovery of the body after difficult, exhausting periods (processing, past illnesses)

Remember that health is not limited to physical parameters. The World Health Organization defines it as an optimal state of not only physical, but mental and social well-being. Only with such a combination is it possible to fully realize one's potential and enjoy life. Emotions, interest, and desires are essential for an optimal mental state. As we can see, a person who suffers from apathy does not quite meet the definition of health. nine0003

All people can experience apathy, which makes them painfully passive and lethargic.

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