Apathy Symptoms: Apathy is a symptom that occurs in at least 50% or more of HD people [Paulsen JS 2001] and increases as the disease progresses. Symptoms include lack of interest and motivation, inability to start activities, social withdrawal, and emotional flatness. Though many of these symptoms are similar to those that occur in depression, apathy is often present in HD even after depression is treated. Studies in HD mice suggest that treatment of insomnia will lessen apathy [Pallier PN 2007].

Apathy Treatments: Antidepressants should always be used because depression may be causing or worsening apathy symptoms. Even when depression is not present, some studies suggest that treatment with antidepressants may treat apathy directly, at least in other neurologic diseases like Alzheimer's and Parkinson's [Boyle PA 2004]. Improving sleep patterns with improved sleep hygiene, or selective drugs may be helpful. In other studies, psychostimulant or activating drugs (like Ritalin® and Dexedrine®) have been helpful in Parkinson's [Chatterjee A 2002], and Alzheimer's [Jansen IH 2001], but have not been studied in HD. Atomoxetine (Strattera®) is a psychostimulant drug that has been studied in HD where it had no cognitive benefit.

Stimulant drugs can increase anxiety, irritability and cause agitation, and aren't routinely recommended for use in HD.

References

Paulsen JS, Ready RE, Hamilton JM, Mega MS, Cummings JL. Neuropsychiatric aspects of Huntington's disease. J Neurol Neurosurg Psychiatry. 2001 Sep;71(3):310-4. PubMed abstract

Pallier PN, Maywood ES, Zheng Z, Chesham JE, Inyushkin AN, Dyball R, Hastings MH, Morton AJ. Pharmacological imposition of sleep slows cognitive decline and reverses dysregulation of circadian gene expression in a transgenic mouse model of Huntington's disease. J Neurosci. 2007 Jul 18;27(29):7869-78. PubMed abstract

Boyle PA, Malloy PF. Treating apathy in Alzheimer's disease. Dement Geriatr Cogn Disord. 2004;17(1-2):91-9. Epub 2003 Oct 15. PubMed abstract

Chatterjee A, Fahn S. Methylphenidate treats apathy in Parkinson's disease. J Neuropsychiatry Clin Neurosci. 2002 Fall;14(4):461-2. PubMed abstract

Jansen IH, Olde Rikkert MG, Hulsbos HA, Hoefnagels WH. Toward individualized evidence-based medicine: five "N of 1" trials of methylphenidate in geriatric patients. J Am Geriatr Soc. 2001 Apr;49(4):474-6. PubMed abstract