Prescribing antidepressants for elite athletes: Is there evidence to support best practices in Sports Psychiatry? - A Scoping Review

Background Elite athletes face unique mental health challenges, yet the use of antidepressants in this population remains under-researched. Despite the prevalence of depressive and anxiety symptoms, there are no specific pharmacological guidelines tailored to athletes’ mental health needs or performance demands. Objective This scoping review aimed to explore the current literature on the use of antidepressant medications in elite athletes with symptoms of or diagnosed with depressive or anxiety disorders, focusing on treatment effectiveness, safety, performance, and, mainly, the athlete`s well-being. Methods A systematic search was conducted in PubMed, Embase, and PsycINFO (February 18–20, 2025) following PRISMA-ScR guidelines employing predefined terms related to athletes, antidepressants, and psychiatric disorders. Studies were included if they involved elite athletes treated with antidepressants for Major Depressive Disorder, Bipolar Depression, or Generalized Anxiety Disorder. Data were charted and narratively synthesized. Results Of 34,131 records screened, 15 studies met inclusion criteria: 10 narrative reviews, 3 systematic reviews, 1 survey, and 1 position statement. Most studies extrapolated recommendations from general populations, offering limited data on elite athletes with formal diagnoses. Few reported treatment durations or mental health outcomes. Performance effects were often emphasized, while psychological recovery was rarely addressed. Selective serotonin reuptake inhibitors—particularly escitalopram, fluoxetine, and sertraline—were the most commonly suggested. Conclusion There is a lack of robust evidence to guide antidepressant use in elite athletes. Future research should prioritize trials involving clinically diagnosed athletes, structured protocols, and outcomes centered on mental health and well-being rather than merely performance.