Member Case Study: Anti-depressants and Performance

author : AMSSM

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When dealing with athletic performance and medication usage, there are three additional questions that must be considered.

Question

Taking anti-depressant/anti-anxiety meds—do you think it hinders athletic performance, or is it a non issue?

Answer

Physicians and patients must always balance the risk of side effects against the potential benefit when prescribing any medication. Evaluation of whether that medicine will interact adversely with other medications being taken, including homeopathic and alternative substances, is also important. When dealing with athletic performance and medication usage, there are three additional questions that must be considered:

Is the athlete participating in a sport or venue that has a list of banned substances?
Those of us old enough can remember a swimmer losing his Olympic medal because he used a standard asthma medication that, at the time, was not considered performance enhancing but was banned. None of the ingredients in the anti-depressants and anti-anxiety medications are presently on the banned substance lists of any policy groups to the best of my knowledge.

Does the medication provide any direct or indirect benefit to the user?
Although there are additional groups of medications, the selective serotonin reuptake inhibitors, “SSRI”, (Prozac, Paxil, Zoloft, etc) and the tricyclics (Imipramine, desipramine, etc) make up most of the anti-depressants and anti-anxiety medications and will be the prime focus of these answers. There is very little information in the medical literature specifically about the impact of these medications on athletic performance. One study suggested a positive impact on several motor cortex excitability tasks that correlated with an increased speed in a finger tapping test. Another study identified an effect on platelet aggregation from SSRI use but not tricyclic use, which appeared to decrease the risk of heart attacks.

Although neither of these studies suggested a direct benefit to athletic performance, it is possible that further study will show some positive impact. An indirect result, intuitively, would be that if these medications improve the depression or anxiety, the improved quality of life and sense of well-being could improve all aspects of activities of daily living, including sports. No specific direct or indirect benefit has been reported in the literature for these medications, but further study may confirm some benefits.

Does use of this medication present any danger to sports participation?
No study or anecdotal case report was found in a review of the literature to suggest any real adverse impact on athletic participation from use of these medications when prescribed and utilized for an appropriate medical indication and at an appropriate dosage. No “Superman” effect has been reported in their use in general or specifically in sports. The common side-effects of these medications generally include neurological (22.4%), psychiatric (19.5%), and gastrointestinal (18%).

Drowsiness, dizziness and dry mouth are also common and theoretically might impact sports participation negatively if the athlete is not 100% alert or is not hydrating adequately during participation. However, again, no studies have confirmed any increased risk to dehydration or slowed performance because of drowsiness. The tri-cyclic anti-depressants and, to a lesser extent, the SSRI medications have been associated with increased incidence of cardiac arrhythmia. Although no direct effect on sports participation has been reported, this could present some risk to a specifically vulnerable athlete.

In summary, always consult carefully with your physician about the pros and cons of these medications in your situation and whether any new data suggest a problem. At this point I would generally consider the use of these medications in sports participation a non-issue, but individual health issues are relevant.

Vito A. Perriello, Jr. M.D.

Member AMSSM
 

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date: November 27, 2005