Background

Athletes and active individuals are not immune from mental illness. In fact, depression and anxiety disorders may occur in athletes at least as commonly as the general population. Sometimes, sport serves as a tool to help an athlete cope with symptoms of mental illness, but sometimes the pressures of the sport may cause or contribute to anxiety and depression.

Symptoms/Risks

Anyone can develop anxiety and depression. The same genetic and environmental risk factors for the general population also apply to athletes. Risk factors specific to athletes include:

• injury

• competitive failure

• retirement from sport

• overtraining

• concussion

Symptoms of depression and anxiety include:

• sadness

• loss of interest

• changes in sleep

• changes in appetite

• impaired concentration

• loss of self esteem

• risk-taking behavior

• excessive worry or fear

Athletes or coaches may notice a worsening in athletic performance as well. Depression can also be associated with thoughts of self-harm or suicide.

Sports Medicine Evaluation & Treatment

Anyone experiencing thoughts of self-harm or suicide should immediately seek help. The first step to treating anxiety and depression is recognizing the problem. An experienced sports medicine physician may work with mental health professionals (general psychologist/sports psychologist/psychiatrist) to develop the best treatment plan for an athlete. The physician may recommend therapy and/or medications with a focus on minimizing impact on sport performance.

Injury Prevention

Sports medicine providers often screen athletes for mental health disorders during their pre-participation examination. An athlete presenting with any of the signs above should undergo a more in-depth evaluation for depression and/or anxiety.

Parents, coaches and teammates are often the first people to recognize these symptoms in an athlete. Recognition of signs of depression and anxiety by these individuals can lead to earlier evaluation and treatment.

Return to Play

A decision about continuing or returning to exercise/sport should be made with a doctor. The vast majority of athletes are able to continue their current level of participation. However, if the sport itself is contributing to symptoms, the risks and benefits of continued participation must be considered.

AMSSM Member Authors
Kenzie Johnston, MD and Kelly Waicus, MD

References
Reardon C. Psychiatric Comorbidities in Sports. Neurologic Clinics. 2017; 35(3):537-46