BIPOLAR PSYCHOTIC DISORDERS IN ATHLETES WORLDWIDE
Benjamin Butler
General Manager - Sofex Pharmaceutical - Alternative Medicine - Alchemy - Cannabis Healer - REUP WORLDWIDE - Docannabis
Diagnosis of bipolar disorder Bipolar disorder is a recurrent and often chronic mental health disorder. It is characterized by episodes of elevated mood (‘mania’, or when less severe, ‘hypomania’) and also commonly of depressed mood, with associated change in functioning.2 Mania is characterized by an abnormally and persistently elevated, expansive or irritable mood and disinhibited behaviour.2 Increased energy and reduced need for sleep are typical, and insight is frequently diminished. Psychotic symptoms such as delusions or hallucinations can occur and, if present, are usually consistent with the individual’s elevated mood (‘mood congruent’). Symptoms of mania must be present for at least 7 days and associated with significantly impaired function to permit diagnosis of a manic episode. Lesser degrees of functional impairment, or simply a change in functioning without impairment, for at least 4 days are consistent with a diagnosis of a hypomanic episode.2 Episodes of mania and hypomania tend to be less frequent, and shorter, than depressive episodes.3 4 Episodes of depression are characterised by some or all of the following: low mood; loss of interest or pleasure; reduced energy; changes in sleep and appetite; feelings of guilt or worthlessness; thoughts of death or suicide; psychomotor agitation or retardation; and poor concentration.2 Symptoms can last for weeks or more. For diagnostic purposes, a minimum of five symptoms and duration of 2 weeks is specified for a major depressive episode. If psychotic symptoms are present, they are usually congruent with the individual’s depressed mood. Features of both hypomania or mania and depression can be concurrent (described as having ‘mixed features’).2 For example, an individual may exhibit increased activation and social disinhibition, but be dysphoric in mood. This combination may appear counterintuitive, but it is more common than often recognised.5 Individuals in such states are at particularly high risk for suicide.6 Two main specific subtypes of bipolar disorder are recognised.2 In bipolar I disorder, there has been at least one manic episode (with or without?schizophrenia. In schizophreniform disorder, the duration is shorter and there is less functional impairment (often a provisional diagnosis). In schizoaffective disorder, mood symptoms occur alongside, and sometimes separate from, psychotic symptoms and may be primarily depressive or manic. Attenuated psychosis syndrome is not an official Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis but is noted within the DSM as a Condition for Further Study,2 with manifestations that reportedly include delusions, hallucinations or disorganised speech in attenuated (or subthreshold) form but still sufficient to be distressing or disabling. A proportion of individuals with attenuated psychosis syndrome will progress to a full psychotic syndrome,8 even when symptoms appear to have resolved.9 Individuals with attenuated psychosis syndrome are at risk for developing many non-psychotic disorders that may need treatment, particularly given their associations with suicidality.10 11 Secondary bipolar and psychotic disorders Substance/medication-induced bipolar disorder and bipolar disorder due to another medical condition are secondary bipolar disorders.2 Similarly, psychotic symptoms may also be substance/ medication induced or due to another medical condition.2 Within the general population, some of these secondary disorders are more commonly a consideration when there is a later age presentation12 as they may be associated with conditions such as thyroid disease, multiple sclerosis and right-sided cortical or subcortical brain lesions, which are more common in older populations.13 Of more relevance in sporting populations are traumatic brain injuries, where secondary bipolar disorder is a possible although uncommon sequela,14 and stimulant or anabolic androgenic steroid (AAS) use contributing to depressive or hypomanic symptoms, an unstable mood or psychotic symptoms.15–17 Sports-specific diagnostic issues A diagnosis of bipolar disorder or a psychotic disorder may be more difficult to make in an elite athlete. Exercise may be an outlet for the excess energy seen in mania or hypomania, which could delay diagnosis. In addition, overactivity may be obscured or normalised in the context of athletic training.18 AAS may be misused by athletes for performance reasons16 19; the mood disturbance and psychotic symptoms that have been reported in association with their use can confuse diagnosis. Importantly, though, hypomanic symptoms secondary to AAS are usually subsyndromal and typically only seen when high doses of multiple agents are used (often called ‘stacking’).17 20 Depressive symptoms have been described among athletes withdrawing from AAS use.17 20 Again, there is an association between high dosages and ‘stacking’ and depression.20 21 However, many studies of this topic had small sample sizes, no control groups, multiple potential confounders and cross-sectional designs. Other substances used by some athletes—including stimulants, cannabis and glucocorticoids—may be associated with psychotic symptoms.16 19 It is important to distinguish primary mood and psychotic disorders from substance-induced forms, as the latter may be self-limiting or require only short-term treatment.21 A comprehensive history—supplemented by appropriate urine testing and toxicology—is necessary to confirm the diagnosis.22 Table 2 provides a list of features that may help distinguish between primary bipolar and psychotic disorders and those secondary to substance misuse by elite athletes. Assessment For an elite athlete who may have bipolar disorder, the standard assessment begins with a detailed history of mood episodes schizophrenia. In schizophreniform disorder, the duration is shorter and there is less functional impairment (often a provisional diagnosis). In schizoaffective disorder, mood symptoms occur alongside, and sometimes separate from, psychotic symptoms and may be primarily depressive or manic. Attenuated psychosis syndrome is not an official Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis but is noted within the DSM as a Condition for Further Study,2 with manifestations that reportedly include delusions, hallucinations or disorganized speech in attenuated (or subthreshold) form but still sufficient to be distressing or disabling. A proportion of individuals with attenuated psychosis syndrome will progress to a full psychotic syndrome,8 even when symptoms appear to have resolved.9 Individuals with attenuated psychosis syndrome are at risk for developing many non-psychotic disorders that may need treatment, particularly given their associations with suicidality.10 11 Secondary bipolar and psychotic disorders Substance/medication-induced bipolar disorder and bipolar disorder due to another medical condition are secondary bipolar disorders.2 Similarly, psychotic symptoms may also be substance/ medication induced or due to another medical condition.2 Within the general population, some of these secondary disorders are more commonly a consideration when there is a later age presentation12 as they may be associated with conditions such as thyroid disease, multiple sclerosis and right-sided cortical or subcortical brain lesions, which are more common in older populations.13 Of more relevance in sporting populations are traumatic brain injuries, where secondary bipolar disorder is a possible although uncommon sequela,14 and stimulant or anabolic androgenic steroid (AAS) use contributing to depressive or hypomanic symptoms, an unstable mood or psychotic symptoms.15–17 Sports-specific diagnostic issues A diagnosis of bipolar disorder or a psychotic disorder may be more difficult to make in an elite athlete. Exercise may be an outlet for the excess energy seen in mania or hypomania, which could delay diagnosis. In addition, overactivity may be obscured or normalized in the context of athletic training.18 AAS may be misused by athletes for performance reasons16 19; the mood disturbance and psychotic symptoms that have been reported in association with their use can confuse diagnosis. Importantly, though, hypomanic symptoms secondary to AAS are usually subsyndrome and typically only seen when high doses of multiple agents are used (often called ‘stacking’).17 20 Depressive symptoms have been described among athletes withdrawing from AAS use.17 20 Again, there is an association between high dosages and ‘stacking’ and depression.20 21 However, many studies of this topic had small sample sizes, no control groups, multiple potential confounders and cross-sectional designs. Other substances used by some athletes—including stimulants, cannabis and glucocorticoids—may be associated with psychotic symptoms.16 19 It is important to distinguish primary mood and psychotic disorders from substance-induced forms, as the latter may be self-limiting or require only short-term treatment.21 A comprehensive history—supplemented by appropriate urine testing and toxicology—is necessary to confirm the diagnosis.22 Table 2 provides a list of features that may help distinguish between primary bipolar and psychotic disorders and those secondary to substance misuse by elite athletes. Assessment For an elite athlete who may have bipolar disorder, the standard assessment begins with a detailed history of mood episodes.
Competitive athletes have unique vulnerabilities to mental health challenges such as anxiety, depression, and bipolar. Despite the inherent stigma, professional athletes continue to publicly share their mental health struggles to help others.
Elite athletes endure intense pressure to perform, often contending with fierce public scrutiny while competing in a culture that historically discourages them from seeking help for mental health concerns. From an early age, these competitors are coached to be invincible, to be physically and mentally superior. Yet anxiety-based fears about performance and depression following an injury can lead to psychological distress. The personal stigma among athletes is lessening, thanks to the sporting legends and current competitors who are speaking out and breaking barriers to help create an environment supportive of mental well-being.
This motorsport champion in off-road trucks and motorcycles told?bp Magazine?that racing is part of his treatment regime, and the only time he feels in control of his thoughts and experiences “true” mental peace. “I’ve always said that the helmet is my medication … there’s something about being able to put my helmet over my face right before I race that takes away the outside chaos and keeps me focused. It’s pretty amazing.”
Former pro golfer (with 10 international wins) turned commentator and humorist Feherty has lived a life with several challenges including, ADD and bipolar depression. “You know, I tell people I don’t suffer from bipolar disorder, I live with it,” he told?Rolling Stone?magazine. As an upside: “I see from a different side of the street than most people. And I think one of the reasons I got hired to do commentary is the ability to describe something differently.”
This former basketball superstar and Olympic gold medalist was initially diagnosed with major depression in 2004, then was re-diagnosed with bipolar disorder?when antidepressants triggered mania and sent her into over-the-top spending sprees. Her message to others living with bipolar: “I want them to understand it can get better. I went through a period when I had no hope, when I didn’t want to be here,” she revealed to?bp Magazine. “I hope they see my journey and get inspired to keep moving forward every day … and utilize the resources around them.”
The most decorated Olympian in all of history opened up in?esperanza?magazine about how his life spiraled into a deep depression while he was battling anxiety issues and substance abuse and how he regained his passion again. “With athletes or celebrities, people think they’re so much different than everybody else. But I’ve gone through the same troubles. Sharing these stories, and having people come up [and say you’ve helped], it’s almost like I feel more human. That’s what I love the most.”
This former Olympic swimmer and seven-time medalist has battled bulimia, unhealthy relationships, drug abuse, clinical depression, and self-harm. “Some days, it was hard to just get out of bed,” Beard told?esperanza?magazine. “There were all these great things going on in my life, but on the inside, I hated everything about [myself].”?Her life turned around when she found medication and therapy.
The former NFL linebacker had a long history of battling heavy drinking, anxiety, depression, and manic episodes, until he was finally diagnosed with bipolar disorder. “I was mentally in a cold, dark, sad place, and no one could help me,” he told?bp Magazine. “Finding the right medications, along with my faith, has made all the difference in the world.” He’s now tackling stigma and helping to raise awareness about mental health.
The former NHL goaltender is best known for surviving a devastating injury on the ice in 1989—witnessed by a nation of TV viewers tuned into a Buffalo Sabres game—when a skate blade slashed his neck. Following that incident, post-traumatic stress disorder (PTSD), alcoholism, and obsessive-compulsive disorder (OCD) plagued Malarchuk. Pulling himself out of depression with the help of medication, talk therapy, and meditation, he says, “I realize now that playing hockey gave me the platform for my real purpose—to raise awareness of mental illness, and to help reduce the stigma surrounding depression and anxiety so that no one has to feel alone.”
The former Olympic runner experienced intense?hypersexuality?linked with her bipolar I disorder?and struggled with acute peripartum depression. “In my case, my bipolar was driving me toward sex. It could have just as easily been driving me toward drugs and alcohol or gambling,” she told?bp Magazine. “The message, though, is that it can be treated if diagnosed correctly, with the help of medical people and family and friends. There is hope, and I’m living proof.”
领英推荐
While celebrated as an NFL star quarterback, Bradshaw is also a broadcaster, writer, musician, and actor. He was diagnosed with clinical depression in 1999 after experiencing anxiety attacks, intense anger, alcohol abuse, and sleeplessness. He now maintains his mental health with medication, therapy, and faith. “You know what, I’m not ashamed of who I am,” he told?esperanza?magazine.?“It’s the way I was made.?I just got some issues here, and I dealt with them. And I’m proud of it.”
This Olympic figure-skating legend was diagnosed with depression in 1993 and has a strong familial history of anxiety and depression. She attests that having a core support group, medication, and therapy helped her find happiness. She is now a motivational speaker for others with mental health challenges. “I think it’s important for people to know that just because it looks like everything’s fabulous on the outside, it isn’t always.”
Haley was the first five-time Super Bowl champion, from his time with the San Francisco 49ers and the Dallas Cowboys, and he was inducted into the Pro Football Hall of Fame in 2015. In 2002, a few years after he left the NFL, Haley was diagnosed with bipolar disorder, after which he spent a decade battling?substance abuse, a common symptom of bipolar. At 56, he says he found balance through medication, regular therapy, and participating in a men’s prayer group. He also does charity work and mentors football players.
Greg Montgomery
When an injury in high school meant Montgomery couldn’t play linebacker anymore, he re-created himself in a new position—becoming a star punter with the Houston Oilers, Detroit Lions and Baltimore Ravens.
When he got a?bipolar diagnosis?in his ninth season in the NFL, Montgomery set about learning to handle this new challenge with the same spirit. And from the beginning he discussed his illness in interviews. In recent years he has become more active in outreach and advocacy.
Now 49, he is still on a spiritual journey. As he said in his 2011 video Madness in the NFL, “I’ll never stop growing.”
Jordan Matechuk
A long snapper with the Canadian Football League’s BC Lions (Vancouver), Matechuk is a rare example of a player who openly manages bipolar and a pro career at the same time. Matechuk, 28, has been in treatment since his early 20s.
A run-in with the law in 2011, during a period when he’d gone off his meds, made him more committed to his wellness plan. “I have worked hard to make my mistakes help me become a stronger person,” he told his hometown newspaper in Yorkton, Saskatchewan.
Matechuk became a spokesman for the Canadian Mental Health Association, with a focus on informing young people “that other people have fought through their struggles, so they can too.”
Edited RePosted By Reup Worldwide
ABOUT THE AUTHOR
Tanya Hvilivitzky has spent more than 30 years in the communications field—a career that has included stints as an investigative journalist, managing editor for a lifestyle & wellness magazine, corporate communications director, and researcher/writer. She has been with?bp Magazine?and?esperanza Magazine?since 2016, serving in roles such as features editor, interim editor and, currently, editor. She also writes and edits digital content for bphope.com and hopetohope.com. As an award-winning writer/editor, Tanya received the?Beyond Borders Media Award?for her 2012 investigative exposé about human trafficking for Niagara Magazine. Her work on this important topic also earned the Media Freedom Award “Honoring Canada’s Heroes” from the?Joy Smith Foundation?to Stop Human Trafficking.