athlete kneeling

Athletes Facing Mental Health Challenges

The invisible battle of mental health discriminates against no one, including professional athletes. We’ve seen Olympic World Record Setter Michael Phelps bravely address depression on national television. We’ve watched MMA superstar Jon Jones repeatedly commit drug and alcohol-related crimes. We’ve lost prolific performers like San Diego Chargers fan favorite; Junior Seau, who succumbed to the void that calls to some of us, all too loudly. For those of us who are the best at what we do, what do we do when our current “best” isn’t enough? 


Brain Matter, Matters

Most athletes sustain a significant injury at some point in their careers, and the brain is not exempt from that category. Some athletes experience injuries alarming enough to lead to a diagnosis of a Traumatic Brain Injury (TBI), and some collect many minor injuries and quietly slip into Chronic Traumatic Encephalopathy (CTE). Many athletes are hesitant to try traditional medications for depression and anxiety since side effects can include weight gain, fatigue, nausea, blurred vision, headaches, etc. which makes TMS is a viable option for those who are seeking a non-invasive, medication-free treatment. Here are some alternative therapies Achieve Concierge offers:

  • Transcranial Magnetic Stimulation (TMS) has become popular for athletes who sustain brain injuries. TMS is also effective for treatment-resistant depression, OCD, ADD, autism spectrum disorders, and in Europe, is used to treat PTSD, stroke after-effects, bipolar depression, schizophrenia, Parkinson’s, Alzheimer’s, multiple sclerosis, and chronic pain. TMS stimulates neuron activity, and “clears traffic” on neural pathways to optimize Alpha, Beta, Gamma, and Theta brainwaves. Each kind of brainwave corresponds to a mood or function, so many recipients of TMS initially experience a lift in brain fog (that “why did I walk into this room? What was I looking for?” feeling), and eventually find that their ability to function on a higher level increases. TMS continues to work even after treatment has ceased and many patients report feeling like they “got their life back” and have been able to build a life they “never thought would be possible.” Bellator MMA fighter Cat Zingano famously documented her success with TMS treatment on the Joe Rogan Experience MMA Podcast, Episode #29, explaining that the symptoms of depression and anxiety affected her memory, her startle reflex, and sleep quality, her adrenal system, and even digestive system. For many, those symptoms get “band-aid” treatments without a deep-dive investigation into how optimal the brain and body function and synergy are.
  • Bioidentical Hormone Replacement can make a world of difference for athletes. Hormones are traditionally measured within a “healthy range,” but if someone is at the lower end of “healthy,” nudging them toward the higher end of the “healthy range” can result in an increase in recovery time, endurance, maintaining their optimal body composition, and overall energy levels. Male-identifying athletes may experience drops in testosterone earlier than is biologically “normal” since the physical challenges are consistently far greater than that of someone whose physical activity is more casual. Some female-identifying athletes can experience increased testosterone levels as a result of the physical demands that training and performing at an elite level and a subsequent rise in estrogen, as the body attempts to meet the elevated testosterone levels. Naturally elevated levels of testosterone, or being at the higher end of the “healthy range” can mean just an increased performance. However, acceptable levels of testosterone have been a long-standing point of contention within athletic commissions, including historical cases such as the one that ordered two-time Olympic track champion, Caster Semenya, to decrease her testosterone before becoming eligible to compete. Estrogen levels that rise to meet elevated testosterone in female-identifying athletes can cause symptoms such as poor circulation, fatigue, and chronic exhaustion, sleep disturbances, memory problems, bloating, weight gain, mood swings, anxiety, and panic attacks. Any or all of those symptoms can significantly affect an athlete’s ability to train well, recover effectively, and mentally be present when it counts.
  • Medication Efficacy Testing helps your clinician determine what class of medications and what doses are ideal for your body. Gone are the days of trial-and-error, and waiting two weeks to see if something will “maybe” work. If non-medicated options have not been effective enough, ask an Achieve clinician for more information about the testing process as well as medical-grade food, herbal supplement, and naturopathic options to integrate. 

Okay, Okay I’ll Take Time off. What Can I Do in the Mean Time?

Proper nutrition for healing is crucial; you wouldn’t put low-grade fuel in a Ferrari, right? Your body is a fine-tuned machine that requires the proper fuel to perform optimally. Undergoing food sensitivity and allergy testing can identify nutritional factors that may be negatively affecting your performance. 

Low-impact activity such as Functional Movement Patterns, plyometrics, yoga, and swimming can help maintain cardiovascular endurance, VO2 output, and keep fresh, oxygenated blood circulating. Any activity that engages core stabilizers builds skeletal muscle mass, and you are able to participate in without aggravating an injury, will help you stay in a positive mindset as well as help you feel like you aren’t “wasting” all your hard work. 

Good sleep hygiene will go a long way. The body repairs and restores at night, getting quality rest is essential. Tracking Heart Rate Variability (HRV), amount of time spent in REM sleep and SWS sleep cycles, and respiratory rate can help you assess how much effort you can afford to exert, and for how long. Quality sleep also helps manage stress and cortisol levels, ensuring a rapid recovery. 

Accepting nature’s medicine by being in awe of the world around us, and appreciating that the sun manages to rise and set every day without us controlling it, helps us stay “right-sized” and on the path to fulfilling our purpose. Spend some time in nature, among trees or near the ocean, take deep breaths, and find things to be grateful for. 

When your body is your primary vehicle for expression, overcoming mental health challenges can seem daunting. Years of ignoring our bodies’ pleas to slow down, and pushing past pain and exhaustion can disconnect some of us from all the other facets of our identity, and we lose sight of who we are as people, in the grand scheme of things. Outside of our athlete identities, we have basic needs which include varying levels of care to handle life on life’s terms. Achieve Concierge is available in-office or via TeleHealth to create a custom continuum of care to optimize your brain, body, and performance.

To schedule an appointment, call (858) 221-0344.

The Link Between Athletes and Depression

More high school and college athletes are experiencing depression than ever before. According to the Depression & Bipolar Support Alliance (DBSA), depression affects approximately 17.3 American adults, or just over 7% of the U.S. population age 18 and older. Yet recent studies have found that among high school and college athletes ages 18-25, anywhere from 15-21% of them suffer from depression — that’s nearly double the rate of American adults.

This dramatic increase indicates that athletes are under higher amounts of stress and are more likely to be depressed. At this age, athletes who continue to major universities are under enormous amounts of pressure to perform well for the college. They must entertain a large student body and fan population while maintaining their class schedule, workout schedule, study routine, and free time. They may be told to push through their pain and ignore injuries to stay on the field. Sadly for many, this pressure seems to be an acceptable part of student-athlete life.

Injuries and Depression

For starters, there is a proven link between concussions and depression. Scientific research has concluded that sports concussions have a lasting impact on one’s personality and emotional state. Athletes who experienced three or more concussions have reported a higher likelihood of being diagnosed with depression than athletes who have had zero concussions. Other injuries can have the same damaging effects as concussions — or worse.

When researchers compared athletes who had concussions to those with torn anterior cruciate ligaments (ACL), they found that athletes with an ACL injury were even more likely to experience depression than those with a concussion. Numerous studies have found similar links between injuries and depression. One study of more than 900 NCAA athletes found that 33% of athletes with an injury and 27% of uninjured athletes could be considered depressed.

Another study found that 51% of surveyed athletes who sustained an injury experienced mild to severe depression symptoms, suggesting that the athletes may feel pressured to come back after an injury at equal or better performance levels than before. They may also feel depressed if they are unable to play their sport or if they are limited to specific physical therapy activities. They will almost certainly feel distanced or different from the rest of their teammates.

Athletic Performance and Depression

Depression typically comes with a stigma attached to it. One of the decorated Olympians, Michael Phelps, recently opened up about his battle with depression and its relation to his pressure to be the best father, husband, and professional swimmer. Again, scientific research has found a correlation between athletic performance and symptoms of depression.

A study conducted with 50 elite professional swimmers showed that 34% of athletes reported lasting depression episodes, which could last for the rest of their lives. The top quartile of the elite swimmers had depression scores that nearly doubled their respective competitors. Athletes who fail or lose during a competition are more likely to experience depression as well. It is increasingly vital for mental health professionals to be aware of this issue when treating athletes who did not win a major game, race, event, etc.

The athlete and the trainer/mental health provider must be mindful of the bouts of depression that can arise after experiencing a loss or setback. It may not only be the athlete’s ideas and self-expectations that are causing the depression to occur — but it can also stem from expectations that were set by coaches, teammates, and family.

Mental Health for Athletes

At this time, there is limited evidence linking athletes’ high-performance levels and their mental health experiences. It is likely that the utilization of mental health benefits for athletes might be underreported or hardly used for many reasons. Sports medicine teams are often encouraged to provide psychiatric care and mental health services to athletes in lieu of licensed professionals. Ideally, these sports medicine teams should implement mandatory mental health briefings for athletes, make mental health resources readily available at any time, and help them schedule appointments with licensed professionals if needed.

Warning Signs

Atypical warning signs of depression in athletes could present themselves as anger and irritability, engagement in unhealthy coping mechanisms, overtraining, or substance abuse. Watch for these signs in all athletes and assess when it is the right time to seek mental health help.

At Achieve Concierge, we believe that we can help athletes and all types of individuals with their depression. — including athletes — with their depression. We help determine the best course of treatment for each patient by choosing one or a combination of treatment options, such as psychotherapy, exercise, and medication. To speak with one of our mental health specialists, call us today at (858) 221-0344.