Mental Health in Athletes

Mental Health in Athletes

Dusty Narducci, MD; Heidi James, MD; and Vanessa Cardy, MD

Dusty Narducci and Heidi discuss the mental health care of athletes.

• Several factors put athletes at higher risk of developing mental health disorders than their peers: 
• Inadequate sleep
• Lack of balance between social, academics, and sport
• Worry about scholarship eligibility and future sports career
• High internal and external expectations
• Being an athlete also offers protective factors:
• Positive self-esteem and body image 
• Built-in support network
• Enhanced medical and academic support
• Hazing and bullying puts athletes at higher risk.
• Conditions commonly seen in athletes are similar to those in peer groups:
• Depression with or without suicidality
• Anxiety 
• Attention deficit-hyperactivity disorder/attention deficit disorder (ADHD/ADD)
• Management
• Non-pharmacologic treatments are first line:
• Cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT)
• Biofeedback, neurofeedback
• Some medications may be considered performance-enhancing drugs and should be avoided:
• Stimulants for ADHD
• Medications that are energizing rather than sedating and those with a positive metabolic profile are preferred.
• Recommended pharmacologic therapies:
• Depression without anxiety - bupropion
• Anxiety - escitalopram; consider serotonin-norepinephrine reuptake inhibitors (SNRIs), buspirone, and hydroxyzine hydrochloride when appropriate
• Insomnia - melatonin 
• Bipolar disorder - lamotrigine maintenance treatment in bipolar 1; atypical antipsychotics like aripiprazole but be aware of potential cardiac toxicity.

PEARL: Athletes face unique challenges that make them susceptible to mental health disorders. Clinicians can help athletes by addressing these concerns and by choosing management approaches that address their sport-specific needs. 

References

When college athletes face depression
Flanagan, L. The Atlantic, March 2014. https://www.theatlantic.com/education/archive/2014/03/when-college-athletes-face-depression/284484/

Predictors and prevalence of postconcussion depression symptoms in collegiate athletes
Vargas G, Rabinowitz A, Meyer J, et al. J Athl Train. 2015;50(3):250-255.

Depression as a modifying factor in sport-related concussion: A critical review of literature
Solomon G, Kuhm A, Zuckerman S. Phys Sportsmed. 2016;44(1):14-19.

American College Health Association, National College Health Survey Spring, 2016. American College Health Association. https://www.acha.org/documents/ncha/NCHA-II%20SPRING%202016%20US%20REFERENCE%20GROUP%20DATA%20REPORT.pdf

American College Health Association-National College Health Assessment, Fall 2008, Spring 2009, Fall 2009, Spring 2010, Fall 2010, Spring 2011, Fall 2011, Fall 2012 ACHA-NCHA II, ACHA-NCHA IIb. American College Health Association. https://www.acha.org/ACHA/Resources/Survey_Data/NCHA/NCHA/Data/Publications_and_Reports.aspx

Mental health issues and psychological factors in athletes: detection, management, effect on performance, and prevention: American Medical Society for Sports Medicine position statement
Chang CJ, Putukian M, Aerni G, et al. Clin J Sport Med. 2020;30(2):e61-e87. doi: 10.1097/JSM.0000000000000817.