DRUGS AND DIET FOR MENTAL INJURIES
Certain drugs are sometimes recommended for patients with chemical imbalances because they manipulate brain chemistry in an attempt to balance neurotransmitters. The depressed athlete may be given medication to enhance or block certain neurotransmitters. Prozac, Wellbutrin, Effexor, and Celexa are examples of antidepressants that affect the balance of serotonin and norepinephrine, thereby changing the way you feel. (Tranquilizers, such as Valium and Ativan, function other ways through different neurotransmitters.)
Most people don’t need antidepressants. But these drugs are among the most prescribed in the United States, with well over 100 million prescriptions a year! That’s even more than drugs prescribed to lower cholesterol and blood pressure. In those patients who are considered for antidepressants, conservative measures should be tried first; improving diet and lifestyle factors can often resolve a mental injury.
But with drug manufacturers openly advertising antidepressants, which results in many patients asking for antidepressants, and too many health-care professionals not taking the time to properly evaluate patients, the dramatic rise in the use of these drugs continues, and too often without success.
In 2010, The Journal of the American Medical Association published a study that called into question the efficacy of antidepressant drugs. While the research team, led by Jay C. Fournier and Robert J. DeRubeis of the University of Pennsylvania, acknowledged that the drugs make a positive difference in cases of severe depression, the study found that for most patients—those with mild to moderate cases—the most commonly used antidepressants are generally no better than a placebo. “The message for patients with mild to moderate depression,” Dr. DeRubeis told The New York Times, is that “medications are always an option, but there’s little evidence that they add to other efforts to shake the depression—whether it’s exercise, seeing the doctor, reading about the disorder, or going for psychotherapy.”
For those athletes with mild or moderate depression, especially those with symptoms associated with other mental injuries, making the right diet and lifestyle changes can often rapidly change the brain with dramatic improvements in mental health. If the diet can affect the mental state, then clearly certain nutritional supplements can do the same. That’s because specific vitamins and minerals, along with the appropriate amino acids tryptophan and tyrosine, are required for the brain to make both serotonin and norepinephrine. Some of the more common ones include vitamin B6, folic acid, niacin, iron, and vitamin C. All these nutrients—except for tryptophan—are available over the counter. (Tryptophan was banned by the FDA in 1990 due to contaminated sources that made some people ill.)
However, before taking a dietary supplement, improving the quality of the diet is the first step, as this usually provides these nutrients.
The bottom line: Taking too many serotonin-precursor nutrients, including a high-carbohydrate diet, may contribute to a mental injury. Or another way to view the problem is that consuming a diet not very well balanced in these nutrients can cause an imbalance of neurotransmitters.

Overtraining is frequently preceded by too much anaerobic work. While we’re familiar with the importance of lactic acid and anaerobic exercise, most have not heard of its adverse effect on the mental state. For a long time, scientists have known that increased lactic acid—more specifically, lactate—in the body may provoke depression, anxiety, and phobias. (Even the production of very high amounts of lactate by relatively normal subjects can produce anxiety, depression, and panic.) Given this, either Robert’s high level of anaerobic activity produced too much lactic acid from training and racing, or he didn’t have sufficient levels of nutrients for proper regulation of lactate.

Yet, was Robert training beyond his ability? Was he racing too much? More often it’s a combination of actions. By sitting down together, Robert and I were able to assess each aspect of his life. Being objective was the hardest part for him. Accepting that there really was a problem was a difficult hill to climb. Making the appropriate changes, whatever they may be, can often result in a speedy remedy. In Robert’s case, decreasing the amount of sugar and other high-glycemic carbohydrates in his diet, and increasing protein foods and balancing his training, helped get him out of his funk. Within a couple of weeks, or sooner, Robert was feeling significantly better, and within a month his training also became noticeably improved. Two months later, his first race was dramatically better, and he would continue improving.

Injuries in the physical, chemical, and mental body can occur in any combination in any athlete. Sometimes it’s a physical problem that appears first, and at other times a hidden chemical injury triggers a physical or mental one. In some, all three injuries are evident, the result of many dominoes falling throughout the body and brain—this is something that commonly exists in chronic overtraining.

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In the vast majority of athletes, the resolution of an injury—fixing the problem—is relatively quick once the cause is found and properly addressed. The actual time frame of recovery depends on many factors, including whether one is seeing a health-care professional, addressing the problem oneself, and whether many changes are needed such as with one’s diet, training, and stress management. Overall, most athletes should be resuming training and seeing improvements within a week or two once the problem is found, sometimes even after a day or two. At times, longer care may be needed, such as in the case of an athlete who is chronically overtrained or one who needs three months of aerobic base building.