Prescribing Antidepressants for Elite Athletes: Is There Evidence to Support Best Practices in Sports Psychiatry? A Scoping Review.

Abstract

Background: Elite athletes face unique mental health challenges, yet the use of antidepressants in this population remains underresearched. Despite the prevalence of depressive and anxiety symptoms, there are no specific pharmacological guidelines tailored to athletes' mental health needs or performance demands.

Objective: This scoping review aimed to explore the current literature on the use of antidepressant medications among elite athletes with symptoms of or who were diagnosed with depressive or anxiety disorders, focusing on treatment effectiveness, safety, performance, and, mainly, the athlete's well-being.

Methods: A systematic search of PubMed, Embase, and PsycINFO (February 18-20, 2025) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Predefined terms related to athletes, antidepressants, and psychiatric disorders were employed. Studies were included if they involved elite athletes treated with antidepressants for major depressive disorder, bipolar depression, or generalized anxiety disorder. The data were charted and narratively synthesized.

Results: Among the 34,131 records screened, 15 met the inclusion criteria: 11 narrative reviews, 2 systematic reviews, 1 survey, and 1 position statement. Most studies provide recommendations on the basis of the general population, offering limited data on elite athletes with formal diagnoses. Few studies have reported treatment durations or mental health outcomes. While performance effects have been emphasized, psychological recovery is rarely addressed. Selective serotonin reuptake inhibitors-particularly escitalopram, fluoxetine, and sertraline-were the most commonly suggested drugs.

Conclusion: There is a lack of robust evidence to guide antidepressant use among elite athletes. Future research should prioritize trials involving clinically diagnosed athletes, structured protocols, and outcomes centered on mental health and well-being rather than merely performance.