Depression in Elite Sports – Causes, Symptoms & Treatment

Depression in elite sport

Depression in elite sportattracted media attention at the latest after the suicide of goalkeeper Robert Enke. However, the topic has not yet been adequately addressed. Although the disease has long since arrived in society, there has not yet been a bridge to top-class sport, despite many calls for help from the athletes and those responsible. On the contrary, it must be assumed that the topic will continue to be taboo, despite prominent stakeholders and widespread dissemination. To this cloak of silence it must also be added that despite the alarming figures from Deutsche Sporthilfe (9.3% of the athletes surveyed suffer from a depressive illness), little initiative has been taken to counteract the problem.Survey by the Federal Institute for Sports Science . Although 49.8 percent stated that they were not depressed, another 40.9 percent abstained from the question. This shows that the topic is still taboo in sport.

What is depression?

In order to be able to present the topic adequately, it is first necessary to explain what depression actually is and what symptoms can occur.

Definition: ” Depressions are mental disorders in which characteristic symptom patterns with pronounced mood changes, in particular depression, joylessness, emotional emptiness, lack of interest and loss of drive persist over a longer period of time. Various physical complaints often occur in connection with this. “(Source: Institute and Polyclinic for Medical Psychology – University Hospital Hamburg-Eppendorf)

First, the causes that can cause depression are explained in one chapter. Stress , excessive demands, injuries and the associated failure to perform as required are particularly relevant here . Another point to be mentioned is the experience and processing of failures as a cause of depression. Chapter two deals primarily with the preventive measures that have been established after Enke’s death.

In chapter three some prominent cases are described. This is not only in view of the wide spread of the disease, but rather in view of the prevailing taboo and shame of athletes to go public about the disease.

The last chapter subsumes the results. In addition, an outlook is dared. Is breaking a taboo realistic and how will society deal with the disease in the future? What development can be expected? These are the key questions that need to be answered in the end.


Athletes are mostly judged on their performance. A player who also defines himself through his performance is under a lot of pressure and is particularly prone to depression if he fails to perform. The triggers of depression also include several factors. On the one hand, there are biological reasons, i.e. stress hormones and messenger substances in the brain .

These neurotransmitters carry information between synapses and affect daily life. On the other hand, some psychological factors play an overriding role. Constantly being overwhelmed at work or stressful life events are situations that can trigger depression. Applied to the field of top-class sport, the following triggers can be named.

Symptoms, Ailments & Signs

Depression in a top athlete is usually very difficult to diagnose because the environment often lacks the necessary attention. Nevertheless, it is a very common clinical picture that can be triggered by the pressure to perform and succeed in combination with self-doubt and sometimes setbacks.

Most sufferers try to hide their illness and the associated mood swings as best they can and often develop great skill in doing so. The symptoms, however, are just as severe as with any other depression: the joy in one’s own life dwindles, lethargy sets in and leads to lack of motivation and lack of drive.

This has a negative effect on training behavior and training effects. In addition to the pressure to perform, the person affected is also under pressure to hide their lack of performance and the illness, which they often do not recognize themselves.

As a result of the repression, other symptoms appear, which can range from loss of appetite and insomnia to psychosomatic illnesses. Disturbed eating habits, digestive problems and symptoms that are mistakenly classified as allergies are also very common .

With progressive, unrecognized and untreated depression, the clinical picture develops so severely that sooner or later the patient is no longer able to exercise at a high level of performance.

Triggers or triggers

Stress: Many athletes mention the enormous amount of stress placed on athletes. A distinction is made between competition-related and everyday stressors. Fear of failure and conflicts with trainers, partners or family are particularly noteworthy here.

The sports psychologist Nixdorf and her colleagues Beckmann and Hautzinger described this condition in their publication: “Prevalence of depressive symptoms and correlating variables among German elite athletes: First insight. J Clin Sport Psychol” applied to elite sport and identified a correlation between chronic stress and depression. Other sports psychologists, on the other hand, argue that psychological stress is not enough as the sole trigger.

Excessive demands: The physical stress that an athlete is subjected to is another reason for the development of depression. These high loads are necessary to increase performance. The demands on athletes are increasing and they can no longer meet expectations without permanent increases in performance. The problem, in such cases, the recovery period is often ignored. As soon as the relationship between stress and recovery becomes imbalanced over a longer period of time, the risk of overtraining increases. This is due to fatigue , weight loss , loss of appetite , emotional lability as well as trouble sleepingmarked. A comparison to a conventional depression shows the similarity of the symptoms and also makes it clear how quickly the athlete can fall into this trap.

Injury: A serious injury is another trigger that can lead to depression. Injuries such as a cruciate ligament tear or a broken tibia or fibula can put athletes out of action for several months. Not everyone has the patience and motivation to fight their way back into the ranks of top athletes. Furthermore, if the recovery does not proceed according to the wishes of the athlete, but is protracted and he can no longer reach the previous level of performance, the risks of a depressive illness increase.

Because in such cases, the athlete falls short of his own expectations and those of the fans and supervisors. This article provides information on ways to prevent these injuries. Accordingly, the three most important aspects of prevention are often disregarded. Every athlete should heed proper warm-up, stretching and cooling down during higher loads.

The survey by German Sports Aid also revealed that female athletes in particular suffer from depression after an injury. This was also confirmed by the psychologists Appaneal, Levine, Perna and Roh in their 2009 publication: “Measuring postinjury depression among male and female competitive athletes”. The Sporthilfe study also revealed that around 10 to 20 percent of injured top athletes suffer from depression. Here, however, the number of unreported cases is very high, so the true number is rather speculative.

Failures: Failure to process common failures is another trigger for depression. In addition, professional sport now represents an important economic factor. In particular, the advertising money that flows in every year is immense. Athletes who act as advertising media are usually also the top performers and are particularly prominent in public life. It becomes critical when these players in particular have to deal with frequent failures. On the one hand, because they enjoy a lot of media attention and are therefore shown regularly, and on the other hand, because supporters and fans of the teams are more likely to hold the “lead wolves” to account than those who are less in the limelight.


According to studies, an athlete reaches the mentioned state of overtraining at least once in his career. This is accompanied by depressive symptoms, which in the worst case can end in depression. But how is this noticeable? Some of the symptoms have already been mentioned in bullet points.

Basically, depression is not only noticeable through sadness . This rumor is circulating in society, which shows how little this disease is reflected in the population. The symptoms of depression are varied. In addition to the increased pessimism, a loss of sexual interest is also evident.

This can culminate in suicidal thoughts. In addition, depression manifests itself as a lack of concentration and inability to make decisions. Physical symptoms such as tightness in the chest area, diarrhea and constipation should also be mentioned.


In the worst case, depression in top-class sport can lead to suicidal thoughts and ultimately to suicide. In most cases, suicide is preceded by long periods of sadness and depression. The psychological complaints have a strong negative effect on social contacts and also on athletic performance.

The patient often feels sad and weak and loses the meaning of life. Often there are also feelings of shame and inferiority complexes, which can further intensify the psychological symptoms and depression. Physical complaints and complications such as dizziness, headaches and vomiting with diarrhea often occur as a result of depression in top-class sport.

This also leads to problems concentrating and impaired perception. It is not uncommon for patients to suffer from anxiety and no longer have complete control over their lives. In most cases, treatment is provided by a psychologist. In serious cases or in the event of a self-injurious condition, admission to a closed clinic may be necessary.

In most cases, it takes a long time before the treatment of depression in top-class sport kicks in and the patient becomes aware of their illness. The treatment is often successful and no further complications arise. However, there is a risk that the patient will relapse again.

When should you go to the doctor?

Top athletes very often suffer from the emotional pressures that come with their careers. As soon as you notice a listlessness that lasts for several days, you should consider working with a therapist to support you. Since depression develops slowly, early contact is recommended.

If several wins occur as a second place, in most cases the feeling of failure increases and doubts about one’s own abilities set in. It is therefore advisable that the inner perceptions are always discussed with a doctor after a competition. This person can assess more neutrally whether further help is needed. If the person concerned has the feeling that their performance does not correspond to their potential, a doctor or therapist will help to find a solution.

If the athlete feels that his coach and team members do not understand him, he needs someone he trusts. He can often find this outside of the club members with a therapist. If the joy and fun in sport is lost, the causes for this must be investigated. If, despite having a sense of achievement and having won competitions, you repeatedly do not feel happy, you should see a therapist. If you have thoughts of suicide or a persistent lack of drive, the top athlete needs help and emotional support from a psychologist or psychotherapist .

treatment routes

Athletes who experience these symptoms repeatedly in themselves should consult a doctor. It is advisable to first visit the family doctor for an initial objective assessment, recommends Dr. dr Frank Schneider, specialist in psychiatry, psychotherapy and psychological psychotherapist.

If the family doctor thinks depression is possible, the affected athlete is referred to a specialist in psychiatry and psychotherapy . There are several psychiatric-psychotherapeutic treatment options that not only try to prevent athletes and coaches, but can also intervene early in an emergency.


In order to alleviate the depressive thought patterns and symptoms, psychotherapy is divided into three steps. On the one hand, a normal daily structure should be established. This means that on the one hand the patient should consciously carry out pleasant activities, but on the other hand he also has to cope with duties in everyday life.

The second step deals with breaking down negative thought patterns. The person concerned should recognize that the one-sided, negative thought patterns can also be viewed from a different perspective, which may lead to a more positive conclusion.

The third aspect is the training of social skills. This is particularly important because depressed people need to learn both how to connect with other people and how to be confident about their own perspectives.


It is not uncommon for antidepressants to be used in depression . For athletes, this means that drugs must be checked against the World Anti-Doping Agency list. Various substances have been declared as doping substances and are banned in professional sport. This additional information helps you to find out which means are prohibited in competitive sports. For this reason, it is important to check the prescribed medication against the list. In principle, however, antidepressants are not on the list, but the guidelines must be taken into account.

Outlook & Forecast

The prognosis of depression in top-class sport is individual and depends on various factors. The course is unfavorable as soon as further mental illnesses occur. These often require intensive therapy over several years.

The prognosis improves when the disease is dealt with openly and in an understanding social environment. Many athletes experience this as a relief. The combination of psychotherapy and medication is also helpful for a good prognosis . Since the medicines are subject to the strict sporting guidelines of the anti-doping agency, special care must be taken. Alternatively, you can switch to using natural remedies.

Top athletes are subject to special attention and public interest. This represents a challenge in the treatment of depression that must be addressed. Since the private activities of top athletes are often monitored by the press and passed on to the public, the athlete’s privacy is violated. This has a negative impact on the prognosis for many of those affected and can increase the risk of another depressive phase.

In the absence of sporting success, there is also the risk of a negative impact on the health of the top athlete. If the patient manages to build up a sense of achievement outside of sport, their well-being usually improves.

preventive measures

The Chair of Sports Psychology at the Technical University of Munich has issued a series of proposals for preventive measures that are intended to help both athletes and those responsible in clubs to combat depressive symptoms. Coaches and supervisors should be mentioned here in particular, who can objectively assess the behavior of the players and thus recognize the disease at an early stage.

One of the preventive measures is adjusting the training load, because overtraining is a permanent danger in competitive sports. In addition, regeneration should be promoted. Varied recovery phases help the athletes to counteract the stress. The stress factor should be considered more in competitive sports anyway, because if an athlete can cope with it, then he reduces the risk of depressive symptoms.

Dealing with these situations also helps to process failures. Some athletes who cannot cope with failure run the risk of breaking down from permanent failure. In addition, it is important that the athletes are offered an environment in which they can access help at any time in the event of any symptoms and, if necessary, are also given appropriate attention during training and competitions.


Depression in top-class sport is a common but mostly taboo phenomenon. This sentence already gives rise to the problem of aftercare. If the sports world dealt openly with this topic, every depressed competitive athlete could go to the therapist during the day and in public. He could receive adequate acute treatment and follow-up care so that he remains mentally stable afterwards.

The problem is that many competitive athletes with burnout, eating disorders, anxiety disorders, sleep disorders or depression have to hide their suffering. Some top athletes secretly go to a psychiatrist or a specialist clinic under a false name. Others remain without any treatment for fear of their reputations. Under such conditions, follow-up care is difficult to implement. In addition, hospital stays are often reported as injury-related hospital stays. This should not raise any suspicion of mental illness.

Psychiatric follow-up would be particularly useful among competitive athletes. Most depressed elite athletes stay in elite sport. They are therefore still exposed to stress, the need to succeed and the pressure to perform. Some of them also take antidepressants. Some may replace or supplement these with tranquilizers and the like of their own accord. Therefore, top athletes with depression should be medically monitored – and not just in terms of the physical.

Preventive measures would be just as necessary by the sports clubs as aftercare for depressed top athletes by trained specialists.

Consultation with a sports psychologist

Athletes and clubs should employ a sports psychologist on their advisory board. The psychological department of the German Football Association looks after both players and coaches of the national teams.

Hans-Dieter Hermann has been the psychologist of the men’s national team for ten years and confirms the findings that have been published in research to date. The fact that national players have to perform both on and off the field and their behavior off the field can affect the mental performance of the athletes. Furthermore, it should not be forgotten that professional athletes also have a private life in which there can be crises from time to time. Accordingly, the sports psychologist does not necessarily only act as a sports therapist, but also as a contact person when private life gets out of joint.

However, it must always be remembered that the sports psychologist was hired by the “employer”. Especially when it comes to the taboo subject of depression, it should be borne in mind that the athlete “outes” himself to his club. Independent therapists or psychologists are therefore another alternative if the subject is not given the necessary attention within the association.

Reactions of associations & clubs

The suicide of Robert Enke five years ago not only woke up the public, but also the clubs and associations. The German Football League (DFL) has now obliged the clubs to hire a psychologist. According to a report by the news magazine Focus, the scene has still not been sufficiently sensitized.

Maximilian Türk from the DFL confirmed that the clubs are obliged to do so. The focus is on preparing young players in particular for the tough business of professional football. In the fan camps, however, club initiatives count for relatively little. Only success counts here and if this does not happen, individual players have to face the insults and whistles.

The Robert Enke Foundation

After the goalkeeper’s suicide, the German Football Association, the League Association and the Bundesliga club Hannover 96 set up a non-profit foundation that supports education about depression.

The Robert Enke Foundation informs the sport and the general public through studies and discussions about the disease. The initiative is very popular. For example, a five-day special exhibition was recently held in Hanover to commemorate the goalkeeper and to give people an idea of ​​what depression can “feel” like.

This was presented in a separate room through different acoustic, social and visual stimuli. In addition, the foundation offers counseling services for people who also suffer from this disease.

Known examples

Sebastian Deisler

The former professional soccer player made his illness public in 2003. In doing so, he broke a taboo in professional sports. At the time, the national team’s playmaker was just 23 years old. Four years later, he officially ended his career after undergoing multiple therapies. Overall, Deisler had seven knee and groin surgeries during his career. Although he gained understanding for his step, he was also described by some from the scene as a “care case”.

Gianluigi Buffon

One athlete who managed to beat the disease and later played as a professional goalkeeper is Gianluigi Buffon. “The problems came at a crossroads in my life. In the transition phase between adolescence and growing up. A lot of things have changed in my head. Now I’m fine again,” said Buffon, who was able to overcome the depression within six months.

Robert Widow

Enke’s death in 2009 was a moment of shock for German football. Before his suicide, the goalkeeper ran the gauntlet of professional football. First celebrated as an absolute talent in the youth selections and Bundesliga goalkeeper at Borussia Mönchengladbach and later at Hannover 96. In the meantime, Enke went through various ups and downs that shaped him, but also plunged into depression. For German professional sport, the suicide represented a turning point, after all, it was only from this point in time that the first initiatives to combat the disease in sport were started.


What has happened in public with regard to depression in top-class sport? This question is not easy to answer. The initiatives launched by the DFL on the one hand and the foundations that deal with the topic should certainly be highlighted positively. In addition, it must be recognized that a large number of studies examine the topic from a wide variety of perspectives. The study by Deutsche Sporthilfe should be mentioned here as an example, which showed the urgency through an anonymous survey in professional sports.

breaking a taboo

The thesis put forward at the beginning that depression is still taboo in professional sports cannot be completely refuted.

Although some prominent examples have shown that the disease poses a high risk of suicide on the one hand and that it can be overcome by professional therapeutic measures on the other hand, there is still little public understanding for athletes who are struggling with depression.


It is therefore very difficult to venture an outlook on this sensitive topic. The fact is, however, that as long as society’s opinion of the disease does not change, professional sport will continue to make the subject taboo. The fan camps in particular continue to be characterized by ignorant tendencies that will not change unless the overall impression of the disease within society changes.

You can do that yourself

The illness of depression can negatively impact the lives and success of elite athletes. Anyone suffering from depression should immediately consult a specialist in the form of a psychiatrist or psychotherapist . In addition to medical treatment, numerous self-help tips can also have a positive effect on the clinical picture of depression.

Since top athletes are usually under great pressure to perform, it is important to relax sufficiently. In addition to the tension phases, there should also be sufficient relaxation phases in the athlete’s everyday life. Athletes should follow their inner voice and engage in activities that are good for them more often – whether it’s a hot bath , a good book, relaxing music or a quiet walk. Everyone is different and has individual preferences and hobbies. Relaxation techniques such as autogenic training or progressive muscle relaxation can also reduce physical and mental tension and thus increase the satisfaction and well-being of athletes.

In addition, athletes should always ensure a balanced diet that is adapted to the increased physical activity. A good diet provides the body with all the nutrients it needs to function properly. Since a high level of pressure to perform is usually part of the life of a top athlete, athletes should always work on their self-esteem and mental strength.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.