It’s Giro time again, which summons memories of the late Marco Pantani on an epic climb in the Dolomites.Marco, however, suffered an untimely death secondary to a cocaine overdose earlier this year in a possible suicide.It is known that Pantani had been battling depression and other mental health problems. He'd checked into a clinic for depression last year after his surprising return to form in the Giro d'Italia, where we again saw glimpses of Pantani’s greatness as he battled fiercely on multiple climbs.Cyclists are not immune to mental illness, particularly depression. Several notable cyclists have suffered from depression including Luis Ocana, Graeme Obree, and more recently Jose Maria Jimenez.
Depression is very common.20-30 percent of women and about 10-15 percent of men will experience depression at some time in their lives.Sources indicate that 19 million people in the US are depressed at any one time.Depression is a mental illness defined as two weeks of either decreased mood (blue, down in the dumps, sad) or substantially decreased interests or pleasure (no longer wanting to pursue hobbies or pleasurable activities; diminished pleasure when those activities are attempted). In addition to these symptoms, people will experience changes in their sleep, feelings of guilt and self-blame, decreased energy, decreased concentration, change in appetite, changes in speed of cognitive and physical movement, and most seriously thoughts of death or suicide.
High level athletes may present with unique aspects of depression.Because of enormous talent and success, athletes at the highest levels may experience failure, or a decline in performance for the first time, and they may not have the skills to cope with these changes.Depression is often triggered by loss, and athletes may experience many forms of loss: loss of an event, loss of competitiveness due to aging or injury, and finally transition from sport to life-after-sport, in which they may not be well prepared.This lack of preparation and subsequent lack of coping skills leads to low self esteem, diminished sense of self worth, and ultimately may lead to depression.
Although the exact cause of depression is unknown it is felt to be due to an imbalance of the brain chemicals serotonin, norepinephrine, and dopamine.It is likely however, that environmental factors also contribute to depression.Stress is a major contributor with medication and substance use contributing as well.Athletes frequently encounter stress of competition, but more commonly face the stress of overtraining.Overtraining leads to a chronic state of being overtired and under-recovered.Elite cyclists, especially those training for and participating in stage races, are constantly teetering between being well conditioned and over trained.It is also speculated that performance enhancing agents, most notably human growth hormone, may also alter the normal levels of brain chemicals potentially contributing to depression.
There are two main forms of treatment for depression: cognitive behavioral therapy (talk therapy) and pharmacologic (medications).Cognitive therapy aims to help the athlete develop coping skills and come to realization with why they might be depressed.Medications aim to restore the natural balance of brain chemicals causing the symptoms.Depressed athletes may need more encouragement from physicians and trainers to seek treatment for their illness because seeking treatment may be interpreted as a sign of weakness or lack of mental toughness.Following treatment, most people can return to normal levels of function.
In conclusion, depression is a very common but under-recognized disease especially in high level athletes.Treatment is safe and effective and may restore athletes back to previous level of training or competition.If you suspect that you or someone you know is depressed, encourage them to see their health-care provider for further evaluation.
