Regulations and Athletes’ Mental Health
Elite gymnast Simone Biles drew widespread attention in 2021 when she withdrew from the team and individual all-around finals at the 2020 Tokyo Olympics for mental health reasons. Prior to this, Biles’s confidential medical records, along with those of dozens of other athletes, had been leaked from the World Anti-Doping Agency (WADA) database by hackers, revealing that some athletes were using banned substances from the WADA Prohibited List to treat medical conditions. This raises the question: should the therapeutic use of banned substances be considered doping?
The Role of TUEs in Protecting Athletes
The International Olympic Committee (IOC) responded to the hack by emphasizing that the attack aimed to tarnish the reputation of clean athletes who had lawfully obtained clearance to use such medications through Therapeutic Use Exemptions (TUEs). TUEs are medically approved exemptions that allow athletes to use substances normally banned by their sport’s regulatory bodies.
The violation of athletes’ privacy reignited discussions about doping, especially regarding TUEs that permit the use of opioids, corticosteroids, or stimulants. While opioids and corticosteroids are used to treat physical conditions, stimulants fall under psychotropic drugs, presenting unique challenges in elite sports.
Understanding Psychotropic Medications
Psychotropic medication refers to substances that affect mood, thoughts, perception, or behavior. This category includes:
Antidepressants: Treat acute or chronic depression.
Anti-anxiety medications: Manage generalized anxiety and panic disorders.
Antipsychotics: Treat schizophrenia and similar conditions.
Mood stabilizers: Used in the treatment of bipolar disorder.
Stimulants: Commonly used to treat attention disorders, such as ADHD.
Psychotropics are key treatments for mental health disorders, often used in combination with psychotherapy. Data from 65 countries showed that in 2019, the global sale of psychotropic medicine was about 35 doses per 1,000 people daily, increasing by about four percent annually over the past decade.
The Olympic Games and Psychotropics
Stimulants like amphetamines have been in use since 1935 and were used by athletes as early as the 1940s, long before their ban by the IOC. Anti-doping testing in the Olympics began in the 1960s, with organized testing debuting at the 1968 Winter and Summer Olympic Games. WADA was established in 1999 to further regulate doping.
A 2022 systematic review indicated that different drugs affect athletic performance differently. Antipsychotics likely impair performance, while stimulants can enhance it. The effects of antidepressants were inconclusive or contradictory. This helps explain why stimulants are the only psychiatric drugs on the WADA Prohibited List, although athletes with TUEs can still use them.
Complexities of Medication Use for Athletes
Taking medications is complex for professional athletes. Substances meant to treat medical conditions can have unintended effects, some of which might be considered doping. For example, track and field athlete Brenda Martinez was caught doping due to an unlisted diuretic in her antidepressants. Diuretics can cause rapid weight loss and are thus banned as performance-enhancing substances by WADA.
Similarly, beta-blockers, used to regulate blood pressure and reduce anxiety, can lower heart rate, potentially impairing performance in some sports but enhancing it in others, such as archery and shooting.
Future Challenges in Psychotropic Use for Athletes
Mental health disorders are common worldwide. A recent study suggested that by age 75, nearly half the global population will develop at least one of 13 mental disorders. Since the incidence of mental disorders in athletes mirrors that of the general population, this issue is crucial for the sporting world.
The IOC acknowledges the complexity of psychotropic medication use and published a consensus paper in 2019 on mental health in elite athletes, emphasizing the need for scientific research to ensure fair competition.
Athletes like Simone Biles and Noah Lyles, both gold medalists, are fostering important conversations about mental health in sports. Lyles’s viral tweet about his mental illnesses encouraged others to confront their own struggles. As awareness grows, future Olympics may see more athletes with diagnosed mental conditions and TUEs.
Ensuring fair play while addressing mental health needs remains a challenging yet essential task for the future of sports.
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