Use of Psychotropic Medications in Athletes: Clinical and Legal Aspects - Narrative review

Background:Mental health disorders are increasingly recognized among athletes and may affect performance, well-being, and career longevity. Pharmacological treatment is often required; however, the use of psychotropic medications in athletes raises specific clinical concerns related to safety, performance, and adverse effects, as well as legal issues associated with anti-doping regulations. Aim:The aim of this narrative review was to summarize evidence on the clinical safety, performance-related effects, and legal implications of psychotropic medication use in athletes, with emphasis on anti-doping regulations. Materials and Methods:A narrative review of the scientific literature was conducted using publications from PubMed, clinical guidelines, and official documents from the World Anti-Doping Agency (WADA). Original studies, systematic reviews, meta-analyses, clinical guidelines, and regulatory documents addressing psychotropic medication use in athletic populations were included. Articles focusing exclusively on non-athletic populations without relevance to physical performance or regulatory aspects were excluded. Results:Available evidence indicates that selective serotonin reuptake inhibitors (SSRIs), bupropion, atomoxetine, and melatonin are among the most frequently preferred pharmacological options in athletes suffering from mental health disorders such as depression, ADHD and insomnia due to their favorable safety profiles and limited impact on physical and cognitive performance. Stimulant medications, although recommended as first-line therapy for ADHD in the general population, require careful consideration in athletes because of regulatory restrictions and the need for Therapeutic Use Exemptions (TUEs). Available evidence on antipsychotic use in athletes is limited. Importantly, untreated mental health conditions were associated with poorer functional outcomes than those observed with appropriately monitored pharmacotherapy.