Authors: Rafael Zini, João Maurício Castaldelli-Maia, Malte Christian Claussen, Maria Olivia Pozzolo Pedro, Renner Santos Borges, André Furtado de Ayalla Rodrigues, Lara Ferreira Camacho, Gustavo Bonini Castellana
Categories: Scoping Review, Elite athletes, Antidepressants, Sports psychiatry, Depression, Anxiety, Pharmacological treatment, Mental health
Source: Sports Medicine - Open
Authors: Rafael Zini, João Maurício Castaldelli-Maia, Malte Christian Claussen, Maria Olivia Pozzolo Pedro, Renner Santos Borges, André Furtado de Ayalla Rodrigues, Lara Ferreira Camacho, Gustavo Bonini Castellana
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.
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.
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.
Among the 34,131 records screened, 15 met the inclusion 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.
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.
Elite athletes face unique mental health challenges throughout their careers and lives. Although symptoms of depression and anxiety are prevalent in this population [1–3], research on how to support these individuals effectively remains limited.
A major limitation of the current literature is that most epidemiologic studies are based on questionnaires and not clinical assessments [4, 5]. However, psychiatric disorders are clinical diagnoses that cannot be diagnosed with a questionnaire. These important limitations in the literature were accounted for in this scoping review.
Depression disorders, such as major depressive disorder (MDD) and bipolar depression (BD), have long been overlooked in the context of elite sports, and studies are arguably still lacking. As Beable [2] noted, the prevailing belief is that to compete at the highest level, elite athletes must not display any form of “weaknesses”, as they are expected to be naturally mentally tough [6]. In some athlete populations, depressive symptoms may impact up to 68% of individuals in the period preceding competition [1]. Several risk factors specific to this group were presented by Beable [2], such as injuries, which can postpone or terminate a career; constant relocations, which can lead to the disruption of strong social bonds and increased distance from friends and family; the presence of eating disorders, which is a frequent comorbidity; and specific stresses due to the sport itself. Edwards et al. [7] further highlighted how some athletes are treated as commodities within the sports business, a dynamic that may contribute to psychological vulnerability. In addition, compared with team sports, a greater percentage of people who participate in individual sports have been reported to have depressive symptoms [8]. However, the prevalence of bipolar disorder in this population remains unclear, and data regarding the prevalence of manic or depressive episodes specifically are even more limited [9], although the prevalence tends to range from 1 to 2% in the general population [10].
Anxiety symptoms, including those associated with generalized anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder, appear to have prevalence rates among the athlete population comparable to those reported in the general population, with individual disorders affecting approximately 9% of athletes, depending on the condition and study [3, 11]. Reardon et al. [3] described specific risk factors for anxiety symptoms in athletes, such as the pressure to perform, public scrutiny, sports career dissatisfaction or uncertainty, injuries, and harassment. Similar to depression, people who participate in individual sports activities appear to have more anxiety than those who participate in team sports do [12].
The primary aim of this study is to investigate the available evidence on whether, when, and how antidepressant medication benefits elite athletes. Our focus extends beyond whether antidepressants impact athletic performance; compared with their mentally healthy peers, athletes who experience psychiatric symptoms are likely to underperform. Rather than focusing solely on performance outcomes and side effects, we prioritized identifying treatment recommendations explicitly tailored to the elite athlete population, emphasizing mental health and well-being.
This scoping review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). The protocol was registered in the Open Science Framework (OSF) and is available at http://osf.io/32wmc/.
We conducted a comprehensive search using the PubMed, Embase, and PsycINFO databases. In PubMed, we used the following (athlete OR elite athlete OR physical performance OR sport psychiatrist OR sport*) AND (antidepressants OR antidepressive drugs OR SSRI* OR SNRI* OR bupropion* OR wellbutrin OR mood stabilizer OR stimulants OR antipsychotic drugs OR depress* OR anxiety OR mood OR bipolar) AND (treatment* OR manag* OR psychiatric medication). Equivalent terms were used in the other databases. The searches were conducted between the 18th and 20th of February 2025 by a reviewer and an experienced librarian. Initially, no publication type, date, or language limitations were applied. Two reviewers (RZ and RB) independently screened the titles/abstracts and full texts of the articles. Discrepancies were resolved through discussion with a third and fourth reviewer (GBC and JMCM).
Studies were included if they met the following [1] the population was elite athletes (Olympic, professional, collegiate, or high-performance sports); [2] antidepressants (SSRIs, SNRIs, TCAs, MAOIs, or atypical antidepressants) were used; [3] the participants had major depressive disorder (MDD) or bipolar disorder (BD), focusing on only bipolar depression and generalized anxiety disorder (GAD); and [4] were RCTs, cohort studies, case reports, reviews, expert opinions, or qualitative studies. The exclusion criteria included the [1] the inclusion of recreational athletes, amateur athletes, the general population, children, or adolescents; [2] the use of nonpharmacological interventions (e.g., psychotherapy-only studies); [3] the absence of specific mentions of antidepressant use or side effects in the treatment of depression or anxiety; and [4] non-peer-reviewed articles, editorials, and non-English or non-Portuguese studies.
Data, including the title, authors, year, study design, population, key findings, limitations, and whether the antidepressants were merely used to treat any condition or if they were further analyzed, were charted for each study. Two reviewers (RZ and RB) separately obtained these data, and discrepancies were resolved through discussions with a third and fourth reviewer (GBC and JCM). The results were synthesized mainly by the study design, from simple reviews to systematic reviews. We utilized narrative descriptions to present, compare, and assess each article included.
From an initial 34,131 files in the databases (PubMed, PsycINFO, and Embase), 3489 articles were retrieved after the advanced tool for screening on the basis of the title/abstract was applied. A total of 986 duplicates were identified and removed using Rayyan. We screened the titles and abstracts of 2503 articles, among which 75 were finally included. We could not retrieve six references (three articles from before 1998, two from 2016, and one from 2013), resulting in 69 articles being included in the full-text review. Among those articles, 15 met the inclusion criteria (see Fig. 1 for the PRISMA flow diagram).
We summarized information on the types of studies addressing the use of antidepressants among elite athletes in Table 1. For each article, we outlined the key findings and whether antidepressants were merely mentioned or critically analyzed. With respect to the level of evidence, we included 11 narrative reviews, two systematic reviews, one survey (transversal), and one position statement.
Fig. 1PRISMA flow diagram
Table 1Included studies on antidepressant use among elite athletesAuthors (Study)Study designPopulationAntidepressant useKey findingsLimitationsReardon et al.3Narrative ReviewAthletes (Various levels)SSRIs were mostly used to treat anxietyAthletes experience anxiety disorders at comparable rates to the general populationLimited longitudinal studies on treatment outcomesBeable 2Narrative ReviewAthletesPresents SSRIs, SNRIs, and bupropion as possible choicesDepression prevalence is similar to or higher than the general population; stigma is a barrierLimited data on long-term medication effects among athletesReardon 13Narrative ReviewAthletesSSRIs and bupropion are indicated for MDD. Cites SSRIs for GAD.Depression, anxiety, and other disorders are common among athletesLack of athlete-specific data in many studiesReardon et al. 14Narrative ReviewElite Athletes (COVID-19)Generalized comments on SSRI. Caution with side effects on SNRIs and tricyclicsCOVID-19 increased mental health stressors among elite athletes, affecting medication managementCOVID-19’s effects may not generalize postpandemicGlick et al. 15Narrative Review + casesElite AthletesShows case reports in which antidepressants were used to treat elite athletesChallenges in diagnosing and treating psychiatric conditions in elite athletesLimited controlled trials on the use of psychiatric medications by athletesOnate 16Narrative ReviewUltraendurance AthletesPresents side effects of SSRIs and quotes TMS and ECT resultsDepression and suicide risk may be higher in ultraendurance athletesFew studies specifically focus on ultraendurance athletesEdwards 7Narrative ReviewAthletesConsiders adverse side effects and prevalence of medicationDepression in athletes requires functional treatment approachesChallenges in athlete mental health disclosureDaley and Reardon 9Narrative ReviewAthletesShould not be used as monotherapy in patients with BD I and without rapid cycling or mixed statesBipolar disorder is underdiagnosed among athletes; sport-specific management is neededLimited research specific to bipolar disorder among athletesPires et al. 17Narrative ReviewElite AthletesSSRIs reported as the first choice for treating anxiety and general side effectsAnxiety is prevalent among elite athletes; performance pressure contributes to riskLack of standardized athlete anxiety assessment toolsCurrie et al. 18Narrative ReviewElite AthletesGeneral recommendations; select SSRIs over SNRIs or tricyclics with mood stabilizersBipolar and psychotic disorders are underresearched among elite athletesLimited empirical studies on disorder prevalenceHirschbeck et al. 19Systematic ReviewGeneral population & AthletesFluoxetine, paroxetine, bupropion and reboxetineEffects of psychiatric medications on physical performance remain inconclusiveHeterogeneous study designs limit conclusionsReardon 20, 21Narrative ReviewAthletesAnalyzed studies in which fluoxetine, paroxetine, bupropion and reboxetine were usedConsiderations for prescribing psychiatric medications to athletes, including performance impactSmall sample sizes in the reviewed studiesReardon and Factor 22Systematic ReviewAthletesAnalyzed studies in which fluoxetine, paroxetine, bupropion and reboxetine were usedSummarizes psychiatric disorders and medication effects among athletesFew RCTs, mostly expert opinionsChang et al. 23Position StatementAthletesConsiders the use of SSRIs to treat anxiety without the use of anxiolyticsPosition statement on mental health in sports medicineGeneral recommendations; lack specific athlete interventionsReardon and Creado 20SurveySports PsychiatristsBupropion was the most commonly used treatment for MDD without anxiety, followed by SSRIs. SSRIs were used to treat GAD. SNRIs may be used to treat both MDD and GADSports psychiatrists prefer medications with minimal side effects on performanceSurvey-based data; lacks treatment outcome measuresBD I bipolar disorder type I, ECT electroconvulsive therapy, GAD generalized anxiety disorder, MDD major depressive disorder, SNRI serotonin and norepinephrine reuptake inhibitor, SSRI selective serotonin reuptake inhibitor, TMS transcranial magnetic stimulation
With respect to treating depressive disorders among elite athletes, clinical rationale supports differentiating depressive presentations into depression with anxious symptoms, depression without anxious symptoms, and bipolar depression, as the symptom profile directly influences medication choice, tolerability, and the risk of adverse outcomes [2, 3, 7]. One of the main concerns presented throughout the reviewed literature was the advantage and disadvantages concerning the side effects of psychotropic medication [2, 7, 13, 15, 23], including sedation, constipation, fatigue, irritability and arrhythmias. This was especially relevant during the COVID-19 pandemic, in which up to 21% of hospitalized patients reported cardiac complications [14].
In cases of unipolar depression, selective serotonin reuptake inhibitors (SSRIs) tend to be used as first-line treatments because of their efficacy and mild side effects, especially if the patient has associated anxiety symptoms. In such cases, selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are more activating and less sedating than other treatments and therefore may worsen anxiety [2, 7]. Another alternative to SSRIs or SNRIs for athletes with depression without anxiety is bupropion, which also has activating properties [2, 13, 22].
Furthermore, the survey by Reardon and Creado [20] identified that most International Society for Sport Psychiatry (ISSP) physicians reported prescribing bupropion for their patients with depression without anxious symptoms, followed by escitalopram, fluoxetine, and sertraline, in that order. On the other hand, tricyclics and mirtazapine should be avoided as first-line treatments because of their side effects, such as sedation, weight gain, and potential arrhythmia [2, 7, 16, 24].
For patients with bipolar depression, antidepressant monotherapy is not recommended, as it is associated with a risk of treatment-emergent mania [9]. Antidepressants should also be avoided in patients with rapid cycling or mixed feature episodes [25]. If prescribed, they must be combined with at least one antimanic medication. Compared with SNRIs and tricyclics, SSRIs are associated with a lower risk of causing a manic switch [18, 26, 27].
Among those with anxiety disorders and related symptoms, SSRIs appear to be the preferred first-line treatments [3, 17, 22]. In a survey conducted by Reardon and Creado [20], escitalopram was the first choice among physicians for treating GAD, followed by sertraline and fluoxetine. Although the American Medical Society for Sports Medicine (AMSSM) position statement supports the use of SSRIs for treating anxiety disorders such as generalized anxiety disorder and competitive performance anxiety, the routine use of anxiolytics, particularly benzodiazepines, is not recommended because of their potential negative effects on cognition and psychomotor performance and the risk of dependence [23]. Other non-benzodiazepine agents, such as buspirone, may be considered for the management of anxiety among athletes. Beta-blockers such as propranolol are sometimes used to reduce peripheral autonomic symptoms of anxiety; however, propranolol is prohibited during competition in certain sports, including archery, golf, darts, and billiards, according to World Anti-Doping Agency (WADA) regulations [28].
Among the systematic reviews, Reardon and Factor [21, 22] and Hirschbeck et al. [19] independently analyzed specific antidepressants using similar references. Notably, only one of the experimental trials involved an adequate duration of drug use to achieve clinical improvement in individuals with MDD or GAD [29], and fluoxetine was used for 14 days in another study [30]. Among all the studies examined, only one presented participants with MDD evaluated according to the Hamilton Depression and Anxiety Scale [29], whereas the other studies involved healthy individuals or did not disclose the mental health status of the participants. The primary aim of the trials reviewed was to assess the functional and performance-related side effects of antidepressant use, with physical performance measured through standardized exercise protocols or physiological markers (e.g., VO2max).
Regarding the use of fluoxetine, the systematic reviews by Reardon and Factor [22] and Hirschbeck et al. [19] reported that exercise performance [31] was not altered during cycling when participants received two 20 mg doses of fluoxetine. Similarly, no change in muscle extension force was observed with either acute (40 mg 6 h before the experiment) or chronic (40 mg daily for 14 days) administration of fluoxetine in another study [30]. Another RCT [29] cited by Hirschbeck et al. [19] reported an increase in isokinetic muscle force in patients with depression after the use of selective serotonin reuptake inhibitors over a 3-month period. However, whether elite athletes were included in the study population was not disclosed.
With respect to paroxetine use, the systematic reviews [19, 21, 22] focused exclusively on studies examining performance outcomes. One study revealed that the administration of 20 mg of paroxetine 4 h before exercise exacerbated central fatigue during prolonged sustained contractions [32]. In another study, Reardon [21] reported that compared with the placebo group, healthy participants who took 20 mg of paroxetine in a single dose before cycling to exhaustion exercised for a significantly shorter duration until exhaustion compared with the placebo group [33]. However, Hirschbeck et al. [19] cited another study in which 10 and 40 mg doses of paroxetine were compared, revealing that physical performance was not influenced by the use of paroxetine [34].
Among the studies focusing on bupropion analyzed in the systematic reviews [19, 21, 22], in one trial [35], participants performed significantly better in terms of performance time when they took bupropion at a dosage of 300 mg twice daily using an immediate-release formulation in warm temperatures (30 °C); however, they also presented elevated core temperatures beyond 40 °C and elevated heart rates, raising explicit safety concerns about the risk of heat illness. Notably, the trial had a small sample size (n = 9). Similarly, in another trial [36], bupropion was administered chronically at doses up to 300 mg/day using sustained-release formulations over 10 days, resulting in elevated core temperatures during prolonged cycling in hot environments, with no performance improvements and a notable risk of overriding hyperthermia-related inhibitory signals. In a subsequent study in which bupropion was administered acutely as a single 300 mg dose using an immediate-release formulation, the time to exhaustion at 30 °C was significantly increased; however, this was accompanied by an increased core temperature and unchanged perceptual responses [37]. Similarly, findings in a female cohort revealed significantly better endurance performance following acute bupropion use at a dosage of 150 mg twice daily using an immediate-release formulation, along with higher core temperatures (39.5 °C) and heart rates, although perceptual markers remained unchanged [38]. However, another study revealed that the use of this bupropion did not improve cycling performance in either temperate or warm conditions [39]. Although these studies were conducted with small sample sizes and with patients without any specified mental disorder, their results justify why the WADA included this bupropion in its monitoring program [28].
The abovementioned systematic reviews [19, 22] included some RCTs in which reboxetine was used. These trials did not include elite athletes as participants; instead, physically active men from the general population were enrolled. In one RCT, compared with the placebo group, there was no difference in performance among those who used reboxetine [40], whereas in some studies, performance decreased following reboxetine use compared with the placebo group [41–44]. Reardon [21] analyzed these findings and suggested that the dopaminergic component of some drugs is more likely to enhance performance than the noradrenergic component is.
In this scoping review, we identified 15 studies addressing the use of antidepressants among elite athletes, with the main goal of treating depression and anxiety; these studies were published prior to February 2025. Our most important question was whether we could determine the best medication for each situation on the basis of sufficient evidence for this specific population. We found a lack of research on this topic.
Most of the available literature consists of guidelines or specialist recommendations, with the indications of antidepressants extrapolated on the basis of studies involving the general population and an extensive understanding of their side effects. Many of these articles offered recommendations on the basis of biological plausibility and personal experience. Although biological plausibility and personal experience are important in research, they both involve deductive reasoning rather than empirical reasoning, which represents the gold standard for providing formal recommendations on when, how, and why medications would help elite athletes. Even if we analyze articles in which performance-related side effects were comprehensively investigated, the participants usually did not have any psychiatric disorders, nor did the participants take the medication at a proper dosage or for the correct amount of time. We identified only one study, which was mentioned in one systematic review [28], in which patients who met the criteria for “psychiatric disorders” utilizing the Hamilton Depression and Anxiety Scales and who took medication with adequate times and dosages were included; however, the patients were not elite athletes [29]. In this context, we emphasize the importance of having a formal psychiatric diagnosis provided by a qualified clinician. The tendency to consider questionnaire outcomes as equivalent to clinical diagnoses raises significant concerns. This issue is particularly important in terms of the internal validity of depression and anxiety diagnoses—conditions that emerged as the most prevalent in our review—as well as the overall reliability of the reported findings [4, 5].
Systematic reviews that focused on analyses of specific medications have attempted to elucidate plausible disadvantages of some medications in terms of whether they affect physical performance [19, 22]. Fluoxetine did not alter performance in the studies analyzed [30, 31] when it was used acutely or for up to 14 days. Some mixed findings have been reported for paroxetine, with one study reporting that it did not alter physical performance [45], while many other studies reported that its use resulted in worse performance [33, 34, 46]. Bupropion is currently monitored by the WADA [28] because some preliminary research has suggested that it may enhance performance in warm temperatures [35]. However, in these studies [35, 37, 38], the drug was taken acutely at doses ranging from 300 to 600 mg per day using immediate-release formulations; these doses are higher than those typically recommended in routine clinical practice, based on samples of 9–10 participants who were not athletes or had any psychiatric diagnosis, making it difficult to extrapolate these performance related findings to the general population or elite athletes in particular. Furthermore, some of the studies on bupropion use have raised safety concerns regarding the increases in body temperature, heart rate and risk of heat illness associated with bupropion use [35–38]. Moreover, No performance enhancement effects were observed with the use of reboxetine, a selective noradrenergic reuptake inhibitor [40].
Reardon and Creado [20] conducted a survey involving physicians connected to the ISSP and reported that bupropion was the first choice for treating depression without anxious symptoms, followed by escitalopram, fluoxetine and sertraline, and escitalopram for treating GAD [20]. A recent study by Reardon [47] revealed that most prescribers remained consistent in their treatment choices for depression without anxious symptoms, with bupropion, escitalopram, and fluoxetine being favored in that order. However, when anxious symptoms were present, prescribing preferences shifted slightly, with escitalopram being the most frequently chosen, followed by fluoxetine and sertraline. For patients with a primary diagnosis of GAD, escitalopram was the preferred first-line treatment, followed by sertraline and fluoxetine. In the context of bipolar depression, the most commonly prescribed medications were lamotrigine, aripiprazole, and lurasidone.
These options were considered adequate in most of the available literature. Nevertheless, the current evidence should be viewed as provisional rather than as a definitive standard, underscoring the need for further, higher-quality research, as performed for other disorders. In clinical practice, athletes frequently report prominent somatic depressive symptoms, including fatigue, slower psychomotor responses, numbness, and sensations of bodily heaviness. Such symptoms may overlap with conditions such as overtraining syndrome, chronic fatigue, or athlete burnout, which share phenomenological similarities with depression but differ in etiology and management [48]. This overlap raises the question of whether antidepressants with a more activating profile, such as SNRIs, could be more suitable than other classes in specific clinical contexts and dosing regimens.
Nonetheless, some reviews emphasized performance-related aspects, which we acknowledge as important, rather than focusing on the mental health and overall well-being of athletes. Furthermore, to obtain high-quality evidence regarding the use of these medications among elite athletes, research should focus on athletes who have been diagnosed with psychiatric disorders by trained clinicians. The goal should be to evaluate whether the well-being of these individuals could be ensured with medication use rather than merely assessing improvements in athletic performance.
This scoping review has several limitations that should be acknowledged. First, the available literature on the use of antidepressants among elite athletes is scarce, with a predominance of narrative reviews and expert opinions rather than empirical studies or randomized controlled trials. The few studies that mentioned depressive or anxious symptoms performed evaluations on the basis of scales and questionnaires, and the diagnosis was not performed by a trained clinician. In most studies, findings were extrapolated from the general population to athletes without addressing the specific physiological, psychological, and performance-related variables that differentiate this group. In addition, many studies involved deductive reasoning rather than more formal empirical evidence.
Second, only a small number of studies examined athletes with formally diagnosed mental disorders, and among those studies, few reported adequate dosages or durations of pharmacological treatment aligned with clinical guidelines. Consequently, empirical evidence on the real-world effectiveness of antidepressants among elite athletes beyond short-term or performance-related outcomes is very limited.
Third, in several of the included studies, physical performance was measured as the primary outcome, while key mental health indicators such as symptom remission, quality of life, and functional recovery were neglected. This imbalance may have introduced a performance-centric bias that undermines the assessment of therapeutic efficacy in terms of mental health.
Finally, the heterogeneity of methodologies, populations, and outcome measures across the reviewed studies hindered the ability to provide a quantitative synthesis or conduct a meta-analysis. The exclusion of non-English and non-Portuguese studies may also have led to language-related bias.
This scoping review highlights a significant gap in the literature regarding the pharmacological management of depression and anxiety among elite athletes. Although certain trends, such as the preference for SSRIs in the treatment of anxiety disorders and SSRIs and bupropion in the treatment of depression without anxiety symptoms, were identified, the current evidence is largely derived from expert consensus and studies on the general population. We could not find any studies with a large sample size, a study population consisting of elite athletes with diagnosed mental disorders, a double-blind design, or athlete well-being as the primary outcome.
The current literature emphasizes performance outcomes at the expense of mental health and functional well-being, reflecting a conceptual misalignment with the core principles of psychiatric care. To establish evidence-based recommendations, future research should prioritize studies involving elite athletes with formal psychiatric diagnoses, appropriate treatment protocols, and outcomes focused on mental health recovery rather than solely on athletic performance.
Ultimately, the treatment of psychiatric disorders among elite athletes must be guided not only by performance implications but also, above all, by the ethical and clinical imperative to promote psychological well-being. Therefore, the focus of sports psychiatry should shift toward more person-centered, evidence-driven approaches that respect the athlete not merely as a performer but also as an individual with complex mental health needs.