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Ask the Doctor – with Prentice Steffen

Please send your sports-related medical questions to “Ask the Doctor” in care of WebLetters@7Dogs.com. We will forward a selection of questions to one of three physicians currently working with this site.

Dealing with depression

Dear Doc,
Recently, I’ve found myself understanding the ups-and-downs, erratic behaviors and occasional bouts of stupidity exhibited by certain famous cyclists in Europe these days.

While I haven’t (and my wife really can attest to this) done anything illegal, I have found myself having to rediscover my love of cycling. Personally, I suspect a bit of depression, mostly because I’ve felt down, uninterested in my hobbies, spending time with my wife, etc, for several weeks now.

Just because I recognize the symptoms doesn’t mean I know what to do. I don’t trust the medicines many doctors insist on prescribing. In fact I would prefer to avoid the med’s if possible, but I’m at a loss.

Any suggestions or ideas that you have would be greatly appreciated. Yes, I do have a family doctor, but I don’t feel comfortable talking to him about this. Right now, I’m looking for another doctor with whom I’m more comfortable.

Thank you in advance.
— Chris

Dear Chris,
Thanks for your question. It’s a really good one and is no doubt one that many people would (or should?) like to ask. I especially appreciate the insight that you have about the situation you find yourself in.

Depression, in all its forms and severities, takes a huge toll on our society. Not only does it cause suffering for individuals and their families, but the overall social costs run in the billions of dollars annually. Estimates are that 10 to 20 percent of the general population will experience depression at some point in their lives. Studies indicate that at least half of these go undiagnosed and, therefore, untreated. There is no reason to think that the incidence of depression in athletes should be any different from that of the general population.

Depression, in fact, is not terribly difficult to diagnose. It is defined as the presence of some of the following symptoms for longer than two weeks:

—Depressed mood during most of the day and nearly every day
—Loss of appetite or weight loss or the reverse, increased appetite or weight gain
—Insomnia or excessive sleeping
—Loss of energy
—Loss of pleasure from activities normally enjoyed
-General agitation or the reverse, general slowing of thinking and acting
—Poor concentration and indecisiveness
—Feelings of worthlessness, hopelessness, or guilt
—Thoughts of suicide

It’s unfortunate that so many people with symptoms like these go untreated and is probably largely due to the stigma that is still wrongly attached to any form of mental illness.

It is worthwhile and scientifically correct to think of depression as a medical illness similar to Type 1 diabetes. Both are the result of a chemical imbalance that can be effectively treated with medication. Would we fault a diabetic for having diabetes and needing to take insulin?

Your reference to the behavior of some riders raises the very interesting topic of the correlation between depression and chemical dependency (alcoholism being a type of chemical dependency). We get into a “chicken and egg” situation as it is unclear whether depression causes chemical dependency or vice versa. It’s likely true that it works both ways.

It’s clear in some cases that alcoholics and drug users are chronically depressed and are simply trying to self-medicate with alcohol and drugs. No doubt people with chemical dependency also develop depression. One rider is said to have been to multiple drug rehabilitation facilities relating to cocaine use. Another faced a suspension because of the “recreational” drug ecstasy and not a classic ergogenic doping substance.

Chemical dependency has been shown to occur like depression in 10 to 20 percent of the population and I believe that figure probably holds for athletes (elite and non-elite) as well.

I strongly recommend that you talk with your personal physician about your concerns. A good family medicine or general internal medicine doctor can rule out medical causes of depression such as low thyroid, medication side-effect, primary chemical dependency, cancer, or vitamin deficiency. They can then consider the best treatment option for you. If you are not satisfied with your current doctor, ask around and try someone else who you may like better. If you’re pretty clear that you are healthy, you may want to seek care by directly contacting a psychiatrist, psychologist, or other psychotherapy provider.

Treatment options include psychotherapy alone, medication alone, or a combination of the two. There is some good evidence to support the use of St. John’s Wort for mild to moderate depression. This is something you may even consider trying on your own. The current mainstay of medical treatment for depression are the selective serotonin uptake inhibitors (SSRI) with PROZAC (fluoxetine) being the most well known of these. Other medications may be used depending on the many details of a specific situation.

The interplay between depression and exercise is interesting to consider as well. While loss of interest in exercise is a sign of depression, exercise itself probably plays both a therapeutic and preventative role in the treatment of mild to moderate depression.

Again I want to thank you for your question about this important topic and I wish you the best in your efforts to get on top of this.

Good luck
— Prentice

Dr. Prentice Steffen, board certified in both Emergency Medicine and Sports Medicine, is currently serving as team doctor for the Prime Alliance Cycling team. He has served as team doctor for several teams including Mercury, Spago and U.S. Postal. Steffen has also served as medical director and event physician for major races including the Tour Du Pont, New York City Marathon and the Tour de Trump. Steffen also serves as the Sports Medicine section editor for the Journal of Emergency Medicine.

Important Notice: The information provided in the ASK THE DOCTOR column does not constitute formal medical advice. The information provided on this public web site is provided solely for general interest of the visitors to the site. The information contained in this column applies to general medical practice and may not reflect current medical developments or be interpreted as medical advice. Understand that reading the information contained in this column does not mean that you have established a doctor-patient relationship with Dr. Prentice Steffen. Readers of this column should not act upon any information contained in the web site without first seeking medical advice from their personal physician.

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