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When would you see a Sports Psychiatrist?

Sports psychiatrists are a small but growing group of physicians who are passionate about helping athletes improve and maintain their mental health. 

Teams
They are useful in consulting liaison roles for professional and college sports teams, educating both athletes and teams about mental health. Just as an athlete would see a sports medicine physician for an athletic injury, an athlete should also be able to see a sports psychiatrist for mental health concerns.  There has been immense shifts in the athlete culture and mental health is now being realized as a big part of athlete well-being and performance.  

Athletes
While sports psychiatrists can often be found in team settings, they also work individually with elite, college, and recreational athletes who have psychiatric illness.  Because of the special considerations in athletes such as therapeutic use exemptions and the impact that medications can have on athletic performance, sports psychiatrists have specialized training in prescribing psychiatric medications to athletes.  They can provide treatment options for and identify conditions such as bipolar disorder, depression, anxiety disorders, eating disorders, exercise addiction, ADHD, psychosis, body dysmorphia, insomnia, traumatic brain injuries, and post traumatic stress disorder.  

Being an athlete can have an impact on your mental health in so many different ways.  For example, athletic pursuits and exercise can worsen, mask, or even improve mental health symptoms.   I encourage you to reflect on your own relationship with sport and exercise and what type of impact, if any, your mental health has on your sport and what impact your sport has on your mental health. 

It is okay.
It is so, so common to feel uncomfortable bringing up your mental health concerns with your coach, doctor, parents, or fellow athletes.   Oftentimes, sports psychiatrists were or are athletes themselves ,which helps them truly understand and empathize with athletes.  They will partner with you by helping you process and identify patterns that are not serving you, establishing goals, and providing treatment options, like medication, therapy, or lifestyle changes. 

Don’t know where you can find a sports psychiatrist?  Ask your coach if your team has one.  Google is a good place to start but your best bet will be checking out the International Society for Sports Psychiatry directory.

 

By |2020-06-19T20:32:14+00:00June 19th, 2020|Mental Health|0 Comments

Brain Agility during COVID-19: Part 1

One thing I love about working with athletes is their ability to view problems as obstacles they need to overcome in order to improve.   Just like a bad race, it can be helpful to view the pandemic as a challenge that will push us to grow in ways we haven’t grown before in order to get closer to what is most important to us.  Adapt, pivot, grow.

Have 10 minutes to spare?  Finding yourself reading the news more than you’d like? Hoping to feel more inspired and less hopeless as we navigate life? Let’s go.

Looking at your values

Catastrophes can cause our values to shift.   They might be different from the values that you had last month or even last week.  The thing we know about values is that they can and do change, either due to crisis, developmental changes as we age, or actively changing them.

When we are living in alignment with our five core values, we are using the highest level of executive functioning in our brain.  We are self-regulated, able to focus, and able to plan.   The more we live according to our top five values, the more inspired and energetic we feel.

So what is most important to do right now is to understand what your current values are right now, notice if they have shifted, and completely own that.

Write out your five values that matter most to you right now.

(Stumped on all this values talk? That’s okay!  Set aside some time today to dive into this.  Watch TED talk videos on motivation and values (such as this one)  You can buy a great book called The Values Factor.  The author of The Values Factor, Dr. John Demartini has a questionnaire you can also fill out to help you get a better sense of what your values are).

Once you have established your value hierarchy, your goal is to link your actions, behaviors, and thoughts that you have throughout the day to your values.  This takes the emotional brain out of the equation.

Let’s do an example together.

Let’s say your top priority suddenly shifted to family.

Then let’s say that an activity you’ve been doing lately: Spending a lot of time reading the news.

Next: Are you able to link spending 5 hours a day reading the news to your top priority of family?

When we do that we are not being connected to our highest values.  I challenge you to NOTICE when you are acting in a lower value set at the moment (which is different from adding emotion to it, such as shame or guilt) and ask yourself in that moment, what is most important to me right now (refer to your 5 core values).  If spending a lot of time reading the news isn’t actually important to you and you can’t link it to your values, take action and do something instead that links to your 5 highest values.

One of the best things we can do right now is regulate ourselves and operate from a headspace of calm and inspiration.  This is how we stay healthy, sleep better, and grow.

 

 

 

 

By |2020-04-01T17:35:31+00:00April 1st, 2020|Mental Health|0 Comments

Keeping Yourself Well During the Age of Coronavirus

I’m going to take a hunch that Coronavirus has majorly impacted your athletic life as well as the other parts of your life.  I have friends who signed up for big running races like Western States who are no longer able to compete since the race is cancelled.  Or you were training for the Olympics, high school track, really loving your pilates community or the gym you were going to regularly.

It is okay to feel anything that you are feeling.  I will repeat, it is okay to feel anything that you are feeling. You can feel sad, angry, guilty, scared, anxious – anything.  It helps to give space to these feelings and acknowledge their presence. And know that you are not alone.

First: Taking Time for Reflection

You might be finding yourself with more time than you know what to do with.  Seize this moment to inventory on our own behavior patterns – how am I living, what in my life is not in balance, where can I live more alignment with my values, where am I in denial about the things I’m doing?

How can we come out of this feeling more empowered and stronger rather than more hopeless or helpless?

Reviewing the Literature: Integrative Prevention Considerations

There are lots of things that we know can reduce our risk of catching Coronavirus.  The foundations to a healthy immune system apply here too.  I combed through the most recent literature about preventing coronavirus and these are the things to prioritize.

  • Get.Adequate.Sleep.  Sleep deprivation increases different inflammatory markers in the body.  Adequate sleep also ensures adequate amounts of melatonin (see below!).  Aim for 7 to 9 hours.
  • Reducing stress.  This seems kind of impossible right now but I challenge you to pursue this with the same dedication you have to your sport.  What worked for you in the past might not be what you have access to right now so it is time to be creative and maybe try something new.  I’ve been looking into experimenting with making kimchi and making it my number one priority to make sure I meditate everyday.  A bunch of different mindfulness activities such as meditation, breathing exercises, guided imagery, etc. reduce stress, reduce activated NFkB, may reduce CRP (a measure of inflammation).
  • Melatonin – scientists have found that melatonin reduces certain cytokines that lead to inflammation.  Since children have higher levels of melatonin, it might be why children are less likely to get coronavirus.  The easiest way to get enough melatonin is by sleeping enough.
  • Anti-inflammatory eats.  Easiest way to do this is increase your fruit and vegetable eating.  Now is not the time to subsist on Oatly ice cream (though very good) but focus on eating lots of colors.  Extra credit for:
    • Onions and apples (high in quercetin)
    • Nuts, berries, tomatoes and oranges (high in myricetin)
    • Turmeric (curries or golden milk)
    • Green tea, which is high in epigallochatechine gallate -EGCG, which has been found to have anti-viral activity especially in early stages of infection.  Now might be the time to learn how to concoct at-home matcha lattes with honey.
  • Elderberry.  This one is tricky and would heed thoughtfulness on your part.  There is emerging evidence that indicates that Sambucus nigra (elderberry) at doses of 10 mL to 60 mL daily for adults inhibits replication and viral attachment of Human coronavirus NL63 (HCoV-NL63).  This is not the same as COVID-19 but is still in the same family.  It increases inflammatory cytokines (markers) in the body so it is important to stop taking it if you start having symptoms or test positive.
  • Vitamin C (Ascorbic Acid).  Again, we have no direct data on the effects of Vitamin C on preventing COVID-19.  But we do know that ascorbic acid inhibits some inflammatory action in the body and can lessen the duration, frequency, and severity of colds.  Dosing recommendations range from 500 to 3000 mg daily.

Let’s dig deep together and remember to love ourselves just as much as we love others.  I’d love to hear how you are doing, how you’re coping, etc.  Please drop a comment below!

 

 

Disclaimer: This content is intended for general informational purposes only and is not intended to constitute or substitute for (i) medical advice or counseling (ii) the practice of medicine including but not limited to psychiatry, psychology, psychotherapy, or the provision of healthcare diagnosis or treatment, or (iii) the creation of a patient-physician relationship. If you have or suspect you have a medical problem, contact your healthcare provider promptly.  Information regarding dietary supplements has not been evaluated by the Food and Drug Administration and is not intended to diagnose, treat, cure, or prevent any disease.  In the event you use any information in this article, Endurance Psychiatry assumes and accepts no responsibility for your actions.

 

By |2020-03-30T00:53:39+00:00March 29th, 2020|Mental Health|0 Comments

Integrative Approaches for Depression in Athletes

 

Dear everyone:

Athletes aren’t immune to depression. 

Our media and culture shine a one-dimensional view regarding athletes- resilient, strong, unflappable, stoic.  Athletes are truly a resilient, disciplined, and motivated population but that doesn’t mean that they cannot have depression.  Athletes experience mood disorders at the same rate as the general public.

Fortunately, media sources are starting to athletes’ stories about living with mental illness.  Ultra-runner Rob Krar recently shared his experiences living with depression in Outside Magazine, speaking about the healing power of connection and leading running camps.

Just as anxiety symptoms can vary widely on an individual basis, depression symptoms can too.  In athletes, injury can be a significant trigger for depressive symptoms (appetite changes, energy level changes, sleep changes, low motivation, feeling down, sad, guilty, worthless, negative more days than not, suicidal thinking).  However, an athlete’s depression might not have anything to do with their athletic performance or abilities.

Taking Inventory

If you are struggling with depression symptoms, it is helpful to reflect on what has been going in your life that may have triggered how you are feeling and get to the root cause.  Ask yourself:

Am I missing…

  • effective tools for digesting traumatic experiences
  • meaningful work
  • enough time to: rest, reflect, take care of myself, sleep, eat, spend time with others
  • nourishing and clean food
  • emotionally connected relationships
  • adequate physical movement
  • the ability to get outside my own perspective

Am I…

  • overtraining
  • injured

What goes in, stays in:  Lifestyle Considerations

This really doesn’t change much from what I wrote about in my article about integrative approaches to treating anxiety.

Movement: For athletes, I recommend incorporating different ways of moving your body that involve strengthening the mind-body connection (such as dancing, pilates, or yoga) that won’t cause or worsen an injury.

Mindfulness and Compassion Practice: A mindfulness practice can teach grounding and relaxation techniques that can help you feel less anxious.  There are a million different ways to do this and I recommend trying out a bunch of styles and see what fits best with you.

Options include enrolling in a Mindfulness Based Stress Reduction (MBSR) course which are relatively easy to find in the community, practicing yoga or qigong, or trying out a meditation app such as Calm or Insight Timer.  Insight Timer is my personal favorite because a) it’s free! and b) you can choose to simply use a timer for your own meditation or one of their guided meditations.  You can also choose the length of the guided meditation too.

I recommend aiming to practice meditation on a daily basis (even just for 10 minutes) and if that doesn’t work with your life, aim for a few days a week.

Therapy

Athletes often have their exercise and nutrition dialed in, which is great!  If you feel like you’ve addressed the lifestyle pieces, the real and hard work can be found in the deep diving – discovering what your thought patterns are (and how they might be no longer serving you), reworking relationships, or exploring past trauma and attachment styles.

I wish I could magically help connect you with a therapist who will be a good fit, covered by your insurance, and has an office within a 5 mile radius of your house.  Unfortunately, finding a therapist who meets all of these criteria can be super challenging.

If you plan on using your insurance to pay for therapy (with a co-pay), my recommendation is to call your insurance company and first find out who is in your network.  If you plan on paying out-of-pocket, I like to look on google maps with patients and see who is in their neighborhood.  Convenience is important!  There is a directory of therapists on Psychology Today that provides a description of who the therapist is and how they practice – not perfect but still helpful.  You can use your gut intuition to guide your decision on who to see.

Neutraceuticals/Supplements

Both antidepressants and neutraceuticals can be incredibly powerful tools to treat depression.  I prescribe both on a daily basis.  What they do is help set the chemistry in motion for growth opportunity to assist you in getting to the root cause of your low mood.  However, they do not on their own get to the root cause.

Pills can be expensive. A rule of thumb I like to use is that if buying supplements is causing you financial distress or problems, they are not worth it!  It is best to work with an integrative medicine physician or naturopathic doctor, who is comfortable with adjusting doses of neutraceuticals and aware of any drug interactions.

Inositol: Derived from plant wall phytin and is available in a white powder or a capsule form.  Studies have found that people with depression have low levels of inositol in their cerebral spinal fluid.  The powder can be easily mixed in water (it tastes mostly like nothing but mildly sweet) and sipped throughout the day. The dose is 3-6 grams daily.

Curcumin: Found to be effective as an anti-depressant in a small study and crosses the gut best when combined with black pepper. The preparation called “Meriva” is thought to be absorbed most readily by the gut.  Dose recommendation is 500 to 1000 mg twice daily.

SAM-e: S-Adenosyl methionine is a major methyl donor in the body. This is one of the best studied supplements for depression.  Controlled trials have found that it is more efficacious than placebo and equal in efficacy to tricyclic antidepressants (a pharmaceutical treatment for depression).  Starting dose recommendation is 400 mg in the morning.

Disclaimer: This content is intended for general informational purposes only and is not intended to constitute or substitute for (i) medical advice or counseling (ii) the practice of medicine including but not limited to psychiatry, psychology, psychotherapy, or the provision of healthcare diagnosis or treatment, or (iii) the creation of a patient-physician relationship. If you have or suspect you have a medical problem, contact your healthcare provider promptly.  Information regarding dietary supplements has not been evaluated by the Food and Drug Administration and is not intended to diagnose, treat, cure, or prevent any disease.  In the event you use any information in this article, Endurance Psychiatry assumes and accepts no responsibility for your actions.

 

 

 

 

 

By |2019-12-29T02:37:04+00:00December 27th, 2019|Mental Health|0 Comments

Integrative Approaches for Anxiety in Athletes

As an integrative psychiatrist, I approach helping people who have anxiety from a variety of approaches including medications, therapy, neutraceuticals, mind-body therapies, and helping change lifestyle habits.  It’s important to realize that anxiety can feel SO very different to different people! Your neighbor might feel their heart racing when they climb a ladder. Maybe your partner feels anxiety primarily in their body such as stomachaches or diarrhea.  And perhaps you can’t get ideas or thoughts out of your head. How you were raised, who raised you, your beliefs and unique personality, and many other factors are all at play.  It can be helpful to try to understand where you feel anxiety and what triggers come up.  Be curious about your anxiety!

What goes in, stays in: Lifestyle Considerations

What we eat, our habits, the people we spend time with, whether or not we exercise, and sleep all can have a major impact on anxiety levels.  It helps to go through these areas (nutrition, connection, movement, sleep) and reflect on if there are any changes you can make that would steer you closer towards health.  

  • Movement: As an athlete, you likely already have exercise in your life. Great! If you are injured or in your off-season, consider ways of moving most days of the week that YOU ENJOY and won’t cause (or worsen) injury!  Movement is critical for addressing anxiety but if you are injured, this might not be practical or possible to do at the same intensity as you may have been exercising previously.
  • Mindfulness and Compassion Practice: A mindfulness practice can teach grounding and relaxation techniques that can help you feel less anxious.  There are a million different ways to do this and I recommend trying out a bunch of styles and see what fits best with you.  Options include enrolling in a Mindfulness Based Stress Reduction (MBSR) course which are relatively easy to find in the community, practicing yoga or qigong, or trying out a meditation app such as Calm or Insight Timer.  Insight Timer is my personal favorite because a) it’s free! and b) you can choose to simply use a timer for your own meditation or one of their guided meditations.  You can also choose the length of the guided meditation too.  

Neutraceuticals

These are substances that can be considered an alternative to pharmaceutical medications as a way to improve health.  Similarly to medications, they can have side effects and interact with drugs and other neutraceuticals. It’s important to know that they can be pricey, they’re not regulated by the FDA, and also may not address the root issue but rather, suppress anxiety.  Nonetheless, they can be a helpful option.  I highly recommend working with an integrative practitioner (whether that be a naturopathic doctor or integrative medicine physician) to help formulate an individualized treatment plan and receive guidance on dosing.

  • L-Theanine:  Extracted from green tea and can help with relaxation and focus.  It has been found to increase GABA (the main inhibitory neurotransmitter in the nervous system) and help with sleep. The starting dose is 200 to 400 mg daily.
  • Inositol: Derived from plant wall phytin and is available in a white powder or a capsule form.  The powder can be easily mixed in water (it tastes mostly like nothing but mildly sweet) and sipped throughout the day. This is particularly helpful for athletes who struggle with panic symptoms or obsessive compulsive disorder.  The dose is 2-3 grams daily.
  • N-acetylcysteine (NAC): An amino acid that makes glutathione, which reduces cell damage and inflammation.  Evidence is particularly strong for hair-pulling, skin-picking, and obsessive compulsive disorder. The recommended dose to start out with is 600 mg twice a day.

Nutrition

Another great treatment option that also tastes delicious is to take a closer look at what you’re eating.

  • The first aspect of food to think about is if you are eating enough and regularly throughout the day.   Low blood sugar (hypoglycemia) can make people feel more jittery and anxious.
  • Aim for whole foods free from artificial colors, flavors, sweeteners, and chemical additives.
  • Consider the possibility of food intolerances or allergies.  Foods such as wheat, gluten, corn, soy, milk, or peanuts can cause people to feel uneasy or more anxious if they have a sensitivity to them.  It might be worthwhile to remove these foods from your diet for 4 weeks and slowly reintroduce them.  It’s best to work with a nutritionist or integrative doctor if you’d like to go this route.
  • Coffee.  You probably knew that was coming.  For people prone to anxiety, coffee can often worsen things.  Consider cutting it out of your life for a month but prepare for a week or two of caffeine withdrawal.  You might find yourself surprised at how better you feel without it.  There are lot of great coffee alternatives out there including mushroom cacao and matcha lattes and hip herbal teas  that can still leave you feeling excited to get up for your morning beverage ritual.
  • Fish is brain food!  The Omega-3 fatty acids found in fish promote optimal brain functioning.  Aim for eating sardines, salmon, or mackerel twice a week

 

Disclaimer: This content is intended for general informational purposes only and is not intended to constitute or substitute for (i) medical advice or counseling (ii) the practice of medicine including but not limited to psychiatry, psychology, psychotherapy, or the provision of healthcare diagnosis or treatment, or (iii) the creation of a patient-physician relationship. If you have or suspect you have a medical problem, contact your healthcare provider promptly.  Information regarding dietary supplements has not been evaluated by the Food and Drug Administration and is not intended to diagnose, treat, cure, or prevent any disease.  In the event you use any information in this article, Endurance Psychiatry assumes and accepts no responsibility for your actions.

 

By |2019-12-08T03:58:56+00:00December 4th, 2019|Mental Health|0 Comments

What is a sports psychiatrist, anyways?

Sports psychiatry is a relatively new discipline in mental health and the main goal of the sports psychiatrist is to carry the science of psychiatry into the athlete population, whether that be elite, college, or recreational athletes. The athlete population, in general, tends to be hesitant about seeking mental health help, whether that be a therapist or a psychiatrist, often due to the stigma of seeming weak. Sports psychiatrists obtain specialized training specific to the unique needs of an athlete such as how psychiatric medication may or may not affect performance, understanding the role of overtraining as well as the significance of a sports injury on one’s emotional health. They are also keenly aware of how mental illnesses can manifest from and/or within sport such as as traumatic brain injuries, eating disorders, bipolar disorder, and ADHD. Sports psychiatrists can work in private practice, college, or academic settings.

Sports psychiatrists receive different training from sports psychologists. Whereas sports psychologists primarily focus on performance enhancement, sports psychiatrists focus on the diagnosis and treatment of mental illness amongst athletes. Psychiatrists complete medical school as well as a four year residency in psychiatry. They can discuss the pros and cons of psychiatric medications, as well as alternative treatments. Psychologists, on the other hand, complete graduate school and are experts of the function of the brain specifically. They perform both psychological testing and provide psychotherapy.

In the future, we will likely be seeing psychiatrists and more psychologists embedded within the sports medicine field, working alongside coaches, athletic trainers, sports medicine physicians, and psychologists.

By |2019-11-05T23:44:25+00:00November 5th, 2019|Mental Health|0 Comments