Sporting performance also depends on mental health. Elite athletes are not protected from psychological distress and face specific challenges that deserve specialist assessment.
Physical strength and discipline do not make anyone immune to anxiety, depression or burnout. In many cases, sporting culture makes it harder to ask for help.
Specific challenges
pressure for results, media exposure and social media;
injuries, surgery and long periods out of competition;
training overload, travel, disrupted sleep and time zones;
an identity strongly centred on sport and the transition at the end of a career;
weight control in sports with weight categories or aesthetic demands;
head injuries and concussions, with possible effects on mood and cognition.
Performance anxiety
Injuries and time out
Sleep and travel
Career transition
Medication and anti-doping
Frequent topics in consultations with elite athletes.
Warning signs
A drop in performance with no physical explanation, loss of motivation or enjoyment in training, irritability, pre-competition anxiety that does not ease, persistent insomnia, changes in appetite or weight, use of alcohol or other substances and withdrawal from the team are signs that warrant an assessment.
Mental health and performance
Anxiety, depression, sleep deprivation and burnout affect concentration, reaction time, decision-making and recovery. Treating these conditions protects the athlete’s health and often their performance too. Working with the coaching staff, sports medicine, sport psychology and, when indicated, cardiology allows an integrated plan.
Medication and sport
Choosing medication for an athlete takes into account its effect on performance, sleep and the cardiovascular system, as well as anti-doping rules. Some substances used in psychiatry are on the prohibited list and require a therapeutic use exemption. These decisions should be made with knowledge of the rules in force.
Follow-up
The consultation is confidential, including with regard to clubs and federations, unless the athlete consents. Pedro Zuzarte has given talks and training on mental health and performance, notably for cardiology scientific societies and athlete support services, and sees athletes in consultation.
Is information from the consultation shared with the club?
No. The consultation is protected by medical confidentiality. Any sharing with coaches, clubs or federations only happens with the athlete’s explicit consent.
Can I take antidepressants and keep competing?
In many cases, yes. The choice considers the effect on performance and anti-doping rules, and some substances require a therapeutic use exemption.
When should an athlete see a psychiatrist?
When there is persistent distress, an unexplained drop in performance, insomnia, substance use or difficulties after an injury or at the end of a career.
References
Reardon CL, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med. 2019;53(11):667–699.
Gouttebarge V, et al. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53(11):700–706.
World Anti-Doping Agency. Prohibited List, updated annually.
This page is for information only and does not replace an individual medical assessment. Clinical review: Pedro Zuzarte, psychiatrist · Published and reviewed: .