Pharmacotherapy of Psychiatric Symptoms and Disorders in Elite Athletes Based on an IOC Consensus Statement

Abstract

International research on the mental health of elite athletes has been increasing. Based on this research, the International Olympic Committee (IOC) published a consensus statement on mental health clinical practices for elite athletes in 2019. In keeping with the global trend, interest in the mental health problems of elite athletes has recently begun to increase in Japan as well, and national demand for mental health care, including the management of psychiatric symptoms, is expected to rise as a result. At present, however, primary care physicians, psychiatrists, and other clinicians do not yet have clear guidelines for the mental health care of elite athletes. Therefore, to help address this omission, the present study documented prescribing preferences based on the IOC consensus statement for managing the psychiatric symptoms of elite athletes focusing on pharmacotherapy for sleeping disorders, depression, anxiety, eating disorders, attention-deficit/hyperactivity disorder, and bipolar and psychotic disorders. For each symptom and disorder, the prevalence rate, the statement’s content regarding pharmacotherapy, and the state of approval of the medications in Japan were noted. Four considerations were found to be relevant to prescribing psychiatric medications for elite athletes. The first was their potential, therapeutic and performance-enhancing effects. For example, an athlete experiencing poor performance due to high levels of anxiety may obtain a therapeutic, performance-enhancing effect from a selective serotonin reuptake inhibitor. The second was the potential for adverse effects on athletic performance. Sedation, weight gain, electrocardiographic changes, and tremors may occur as side effects of psychotropic medications. The third was their potential, non-therapeutic, performance-enhancing effects. For example, among psychotropic medications, psychostimulants can have the potential to enhance performance beyond their purely therapeutic effects, and their use in competitions is prohibited unless there is a therapeutic use exception. The fourth was potential safety risks. For example, medications such as lithium, whose blood concentration must be strictly controlled, may be affected by the state of hydration, making calibration difficult. Our efforts will hopefully contribute to improving the mental healthcare of elite athletes in Japan by enabling earlier intervention and faster recovery from mental health issues. The number of psychotropic medications that have been evaluated for efficacy in athletes is limited. In addition, some of psychotropic medications frequently used by sports psychiatrists overseas are unapproved in Japan, so research on athlete mental health should be promoted in Japan.