Medication and high performance athletes

Times to beat, medals to win and supporters to please – for many high performance athletes, coping with the mental stress of competition can be as challenging as physical training.

Anxiety and depression is just as prevalent in high performance athletes as the rest of the population, but master’s student Ethan Ruderman of the Faculty of Kinesiology & Physical Education says that the formula for prescribing medication to athletes with mental health issues may need rethinking.

Currently, prescription dosage is determined based on factors such as age, sex, weight and ethnicity, with little or no consideration of how a patient’s fitness level affects drug metabolism.

With funding from the Ontario Ministry of Tourism, Culture and Sport, Ruderman is studying how the most widely prescribed antidepressant, sertraline — commonly known by its brand name, Zoloft — behaves in athletes’ bodies. Through blood analysis, Ruderman (pictured below) is monitoring concentration levels of the drug in subjects when they are active and when they are sedentary.

His theory is that drug levels stay higher and remain in the system longer in an active person.

“It’s well-established that exercise causes blood to move away from the internal organs to get to the working muscles,” he explains.

Since less blood gets to the liver, where the antidepressant is metabolized, Ruderman’s hypothesis is that the drug breaks down at a slower rate during activity, meaning athletes may not need to replenish the body’s supply of medication with the same dosage as those who are sedentary.

Getting too much sertraline, Ruderman says, can have adverse effects – potentially even contributing to feelings of anxiety and depression.

“Too much of the drug affects your motivation and your energy levels, which can be especially difficult to cope with for a high performance athlete in training,” he explains.

Ruderman plans to finish gathering data by May but is keen to see the results, as his project also has potential to impact the broader population. Taking up physical activity will impact anyone’s metabolism, meaning that doses of the medication could lower across the board if mental health patients are prescribed physical activity in conjunction with the drug.

"Our ultimate goal is to ease the burden of both the disease and the medication by improving on the optimal dosage," says Ruderman, pointing out that avoiding medication, when possible, is ideal.

“But prescription drugs are often necessary. If we can achieve a more accurate dosage and at the same time encourage sufferers to be more active, that is a much healthier outcome for everyone."