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