Psychiatric treatment preferences of sports psychiatrists for athlete-patients across competitive levels: a 2024 update

OBJECTIVES: Only two small, prior studies ascertained psychiatric treatment preferences for athletes among sports psychiatrists. This study aims to build upon and update those results by describing comprehensive psychiatric treatment preferences and rationales for those preferences, across competitive levels of athletes, among practicing sports psychiatrists. METHODS: In 2024, organizations with large concentrations of sports psychiatrists were provided an invitation regarding an anonymous, web-based survey on psychiatric treatment preferences in working with athletes with mental health symptoms and disorders. RESULTS: Seventy-five respondents who identified as psychiatrists or psychiatrists in training and who had treated athlete-patients within the past 3 years completed the survey. Top choices of psychiatric medications for athletes included bupropion for depression without anxiety; escitalopram for depression with anxiety, generalized anxiety disorder, and social anxiety disorder; sertraline for obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder; melatonin for insomnia; methylphenidate extended release osmotic-controlled release oral delivery system for attention-deficit/hyperactivity disorder; aripiprazole for bipolar spectrum disorder (manic/hypomanic phase); lamotrigine for bipolar spectrum disorder (depressive and maintenance/prophylaxis phases); and aripiprazole for psychotic disorders. Regarding side effects, respondents reported being most concerned about sedation/somnolence, weight gain, and reduction in performance. The majority of respondents indicated they order a variety of medical evaluations at least as often or more often with athletes compared to non-athletes. The first choice of psychotherapy setting was individual psychotherapy, followed by family therapy, and then a tie between couples therapy and group therapy. The preferred type of psychotherapy was cognitive behavioral therapy followed by a tie among behavioral therapy, dialectical behavioral therapy, and mindfulness. CONCLUSION: Sports psychiatrists tend to prefer medications that are relatively more energizing and less likely to cause weight gain. They undertake medical evaluations for their athlete-patients with relatively great frequency. Their preferred psychotherapy types are skills-based and can be completed within relatively short time-frames.