Mental health, suicide, and psychedelics among athletes

Chapter 7 excerpt from The Revolutionary Ketamine

May 30, 2024

Athletes are imperfect role models for both physical and mental health. The term unhealthy athlete sounds a bit like a paradox. An athlete can be fit but unhealthy both physically and mentally. Clearly, athletes have lower rates of heart disease, stroke, and smoking-related cancers. Images of athletes performing portray the perception of perfect health, but internal fitness is more important than the veneer. Our culture celebrates harder, faster, stronger, and the ethos of "just play through it." Mental health is seldom spoken about in professional sports. Athletes often experience disordered eating, depression, insomnia, mood disorders, loss of motivation, reduced mental concentration, and anxiety. On the physical side, athletes often overtrain themselves. The stakes are often high, and professional and amateur athletes are not known for prioritizing their mental health. The mantra that struggling teammates are weak is common in college and professional sports. Even more, signs of mental weakness strike fear into athletes because they might not be able to do their job and risk being replaced in a highly competitive environment. Subsequently, athletes fear the stigma of "being soft." Solomon Thomas of the Las Vegas Raiders says, "It's like you are being judged for everything you do; guys are cut, traded, and signed every day. As much as you want to say it should be different, it's hard because you might open up to someone one day, and they're gone."

Although hundreds of athletes suffer from mental illness, not enough have opened up about it; some notable examples of NFL athletes who have are Darren Waller, Solomon Thomas, D.J. Chark, Demario Davis, Aaron Rodgers, A.J. Brown, Calvin Ridley, and Adam Thielen (NYTs). In professional tennis, Naomi Osaka appeared on the cover of time with the cover reading, "IT'S O.K. TO NOT, BE O.K." She opened up about her struggles with depression and anxiety before the 2021 French Open, from which she withdrew (Time, new yorker). The former US. Open champion Bianca Andreescu announced she would not compete at the Australian Open, citing depression and sadness due to the frequent lockdowns during COVID. In July 2021, Olympic gymnast Simone Bails withdrew from the finals, citing "the twisties," a heightened state of anxiety.

Many athletes, such as Michael Phelps and Terry Bradshaw, have come out after their careers about their bouts of depression and suicidality. Numerous athletes fall into depression after their careers are ended. Boxing legend Sugar Ray Leonard famously said, "Nothing could satisfy me out of the ring." Leonard's struggles with retirement and severe depression were well documented. Some professional athletes even commit suicide after their careers. One such example was professional cyclist Jonathan Cantwell.

Athletes and addiction

Athletics and mental health are closely connected and are not separate from each other. Addiction is a complex mind, body, and brain disorder that doesn't have a single cause. Athletes are a setup for addiction, and research has shown that sport increases the risk factors for addiction. A common trait among athletes is hyper-competitiveness, a risk factor for addictive behaviors. Athletes strive to be the best at whatever they do, including being the best heroin user if that's their drug of choice.

The environment athletes are placed in promulgates addiction. Athletes are constantly adored and stared at constantly by fans and the media. They are pampered and repeatedly told that they are the best and that their actions, right or wrong, are positively affirmed. Athletes form strong social bonds, affiliations, and a tribal mentality, especially in team sports. Many professional athletes harbor a false notion of "being chosen" to do their respective sport and are devoted to being famous or known. Everyone is paying attention to the athlete.

From a biological perspective, the neurotransmitter dopamine is one reason for athletes' success, but it also partially explains why they become addicted to drugs, sex, and gambling. We know that dopamine plays a role in addiction, but it's one piece of a massive puzzle. Athletes are constantly looking for dopamine. The same dopamine when a child repeatedly plays video games or the feeling an emotional eater obtains after devouring an entire box of pastries. An athlete's life is one of searching for subsequent success. Whether in practice, or competition, the athletes' journey is filled with peaks and valleys of dopamine. When the career ends, the dopamine hits the end with it, leaving the brain asking for more.

Dopamine is one reason substance abuse is entrenched in sports culture; glaring examples are the locker rooms and bars filled with alcohol after a victory. Painkillers and other drugs are readily available, including performance-enhancing drugs. Drugs and alcohol are surprisingly available to adolescent athletes. This is especially relevant with the advent of high school and collegiate players now being paid exorbitant amounts of money to play sports. A recent example is high school football star Nico Lamaleava who reportedly signed a deal worth 8 million dollars to play for the University of Tennessee at Knoxville.

All addicts are dopamine fiends. While dopamine isn't the sole cause of addiction, its motivational properties certainly play a role. For all of their careers, they receive dopamine rush after dopamine rush. For instance, sex addiction has little to do with a high sex drive and everything with dopamine. Being a pro athlete is a dopamine addiction, and this dopamine roller coaster predisposes athletes to mental illness and even suicide.

One athlete who overcame major addiction is Darren Waller of the Las Vegas Raiders. Before becoming one of the NFL’s best tight ends, Waller battled through drug addiction that started in high school. During an interview, he told me that he drank alcohol daily and took MDMA, Xanax, cocaine, and Oxycontin painkillers. Even surprising himself, he made it to the NFL, where he was spending hundreds a day on drugs; he failed multiple drug tests and was banned for a year. In 2017, he had a near-death experience after taking fentanyl. He entered rehab, and since August 11th, 2017, he has never touched another drug. Waller is involved with several foundations that deal with addiction and are trying to make a change. He is also part of the Better U Foundation, a health startup trying to help eradicate the stigma of mental illness.

Ketamine and the Elite Athletes

It’s difficult to say if psychedelics can enhance sports performance. No one has studied it to any extent, and psychedelics are still returning from their 60-year hiatus. Interestingly, the use of psychedelics in sports dates back to at least the 70s when Doc Ellis, a pitcher for the Pittsburgh Pirates, threw a no-hitter against the San Diego Padres while on LSD and other substances. Endurance athletes, surfers, rock climbers, and extreme sports athletes have used psychedelics for years. Many exclaim that psychedelics “put them in the zone or a mythical heightened state.” Psychedelics provoke an immersed engagement with any activity, allowing the athlete to analyze the movements and patterns in ways impossible while not under the influence. The enhancement is more psychological than physiological.

Former UFC champion Miesha Tate questions how psychedelics might affect some athletes. She highlights that many athletes view sports as a coping mechanism or a “healthy” addiction. In this sense, athletes feed off of their mental issues, which helps them to compartmentalize their situations and gives them the incredible focus and determination it takes to win a championship; it also helps them to be nervous at the right moments to be successful. When Miesha beat Holly Holmes for the world championship, she was competing at her best. She remembers that fighting was an obsession and simultaneously her coping mechanism, which helped her overcome adversity and ultimately led her to become a champion. Admittingly she recognizes that this type of mental outlook is ideal for being a successful athlete but probably not optimal for long-term mental health. Her hesitation with using psychedelics while competing is that it could take away that relentless edge many athletes depend on to drive forward toward their goals. She points out that psychedelics make you feel much more at peace with yourself and questions what effect this may have on the athlete. Perhaps peace has a price. Could it be that if psychedelics help an athlete with mental issues, would they still feel the same drive? These are difficult questions, and no studies are out there to support or deny them. Indeed, every situation is unique, and every athlete falls on different parts of the mental health spectrum. For example, many athletes perform better when they start a family and have children. Likewise, some athletes perform better when they have overcome their addictions to drugs and alcohol; some do not. On paper, it seems like Naomi Osaka performed better when dealing with her depression versus when she started getting help and took time off the sport. In the case of motocross champion Zach Osborne, a sure sign that he was going to do well was when he was nervous and throwing up just before the gate dropped at the starting line.

Dr. Michael Miletic is a renowned psychiatrist and former Olympic athlete in weightlifting. He specializes in ketamine IV-assisted psychotherapy for athletes. As a former professional athlete, he understands the nuance that perseverance is often born out of trauma. He says that most athletes are unaware of their traumas or the need to adapt to them. In his experience, ketamine has the power to safely open up traumas that would be otherwise too painful to face and helps to begin a new life, free from all the constraints of the built-up unconscious traumas. With so much trauma fueling athletic performance and bringing untold suffering and emotional struggle, he looks forward to the day when professional sports not only allow but support ketamine and other psychedelic treatments for athletes.

He tells the story of a 24-year-old NFL player who significantly benefited from ketamine IV-assisted psychotherapy. The ketamine sessions were initially challenging, but he ultimately returned to how he once felt as a young boy before his mother’s death and how he once felt on the football field before becoming injured. Dr. Miletic says that the athlete is doing well today and still playing in the NFL. The complete story can be found on Dr. Miletic’s blog at https://themileticcenter.com/ketamine-and-the-elite-athlete/

Depression and suicide in athletes

The story of professional cyclist, Jonathan Cantwell, tells it succinctly. Jonathan Cantwell, an Australian professional cyclist, was born in 1982 in Brisbane, Australia. Cantwell reached the highest level of cycling during a career spanning over ten years. A loving and outgoing individual, he lived to race his bike, socialize, and meet people. Near the end of his career, Cantwell experienced many difficulties - Jonathan’s brother committed suicide, he divorced his wife, and was fighting a legal battle with his cycling team. His brother’s suicide was deeply traumatic. After his brother’s death, he exclaimed on social media that he would take care of his kids. Jonathan’s father also ostensibly killed himself when Jonathan was young. Shortly after his career finished, he successfully battled testicular cancer and was cured. Like many ex-professional athletes, finding his new purpose in life proved difficult. He became CEO of a bike brand, hoping to make a name selling bikes, and he also started competing in triathlons.

In November 2018, Jonathan killed himself with a noose in his native Australia. In retrospect all the signs were there. Was his suicide due to genetics or specific life events? He certainly had a strong family history of suicide. Indeed studies show that first-degree relatives of individuals who have committed suicide have more than twice the probability of killing themselves than the general population (McGuffin).

Some scientists believe that suicidality is approximately forty percent heritable, and the role of the environment makes up the rest. A closer examination of Johnathan’s environmental factors would suggest that he was coming off a successful career and faced many legal and marital difficulties. For Jonathan, like so many ex-professional athletes, it was hard not knowing what to do next to get that next dopamine hit. It’s not likely Jonathan took his life because he had a genetic predisposition. Instead, everything culminated around him to satisfy his conditions for suicide at a dark, vulnerable moment. Once again, we have to consider that if Jonathan could have received the proper treatment with ketamine and psychotherapy, he would still be here, laughing and joking non-stop like he always did. Unfortunately, the world will never know.

Today, more athletes are taking a stance on mental health, highlighting the need to optimize their views on life. Athletes often have multiple coaches: strength, conditioning, nutrition, physical therapy, and sports psychology. Athletes are speaking openly about using therapy, psychedelics, and medications to treat mental health conditions such as depression, anxiety, PTSD, addiction, and traumatic brain injury.

Chronic traumatic encephalopathy, or CTE, is a brain condition associated with repeated impacts on the head. A definitive diagnosis can only be made in an autopsy, but a 2017 study showed that 99 percent of former NFL players and 91 percent of college football players have CTE. Depression and suicidality are central symptoms of CTE; others include memory loss, confusion, personality changes, and erratic behavior. Athletes who have had CTE and committed suicide - Junior Seau, Mike Webster, Aaron Hernandez, and Shane Dronett- are just a few.

Former athletes former heavyweight champion Mike Tyson (Boxing), Daniel Carcillo (NHL), Kerry Rhodes (NFL), Lamar Odum (NBA), and UFC fighters Ian McCall and Dean Lister are part of a growing movement of people using ketamine, plant medicines like ayahuasca and psychedelic mushrooms to help heal PTSD and the symptoms of brain trauma. In November 2020, Bryant Gumbel began HBO’s Real Sports segment with former NHL player Daniel Carcillo describing his suicide plan after retiring from hockey and his journey into psychedelics. Diagnosed with seven concussions throughout his 12-year professional hockey career, Carcillo says he likely experienced “hundreds more” and explored numerous avenues to address his mental health issues. After trying psychotherapy and antidepressants, he opted for something outside Western medicine’s realm of treatment: ayahuasca, a South American brew revered by indigenous cultures as a powerful medicine containing the psychedelic compound N, N-Dimethyltryptamine, or DMT. “I’m just trying to look for more peace of mind, less suffering,” he says to the cameras from the Peruvian jungle before attending the ceremony. Four hours later, he emerges feeling changed and calls it “the most amazing experience” of his life. Months later, when HBO’s production team visits Carcillo, he says he’s experiencing “little to no depression and anxiety.” His symptoms included slurred speech, headaches, head pressure, memory issues, concentration, and insomnia—they are all completely gone. His wife exclaimed, “I didn’t see him smile for years.” With her husband still symptom-free after five months, she asks, “how can you not believe this stuff works?”

Another segment of The Real Sports takes viewers inside a private ceremony where a group of fighters, including grappler and former UFC star Dean Lister and Ian McCall, are guided through a psilocybin experience by a shaman. Ian McCall fought in the UFC and other professional MMA leagues for 15 years before finally tapping out. Multiple injuries left him taking daily opiate painkillers, including fentanyl, turning him into a self-described “monster.” Experimenting with psychedelics helped cure him of his addiction and suicidal thoughts. Today, he is committed to helping improve the mental health of other former fighters by showing them how beneficial life-altering group experiences with psychedelic medicines can be. “Fighters are good people,” McCall says, “but they’re tormented.”

Dean Lister has experienced his fair share of head traumas, like any longtime mixed martial artist. He describes the symptoms associated with repeated concussions as being “stuck in a prison cell in your mind.” Before taking five grams of psilocybin mushrooms, Lister struggled with alcoholism, drinking up to 20 beers daily and taking Xanax every night. During the deep journey (the only kind afforded to anyone who consumes five grams, aka a hero’s dose), Lister experiences the kind of near-death hallucination only psychedelic users will be familiar with and says to himself, “If I wake up, I’m going to do things differently.” Since the experience, he’s steered clear of all drugs and alcohol.

Undoubtedly, psychedelics like ketamine can save lives for those ex-professional athletes who are severely depressed and have suicidal ideations. Indeed, as more research is published on psychedelics over the coming years, a clearer picture of these drugs’ overall effects will emerge. Mike Tyson purports psychedelics saved his life. He was suicidal and depressed as his life was riddled with emotional instability, drug addiction, and legal troubles. After his psychedelic experiences, he exclaims, “He will never be the same again. Fight your fears, and don’t be afraid to try them. You can’t be free unless you free yourself from fear.”

Since then, the number of athletes emerging from the psychedelic closet has grown. NFL quarterback Aaron Rodgers spoke openly about his ayahuasca experience on the Joe Rogan Experience. Motocross racer Adam Cianciarulo described his ayahuasca retreat on the Pulp MX show. They both describe the retreat as challenging but did it for spiritual and emotional reasons and to help with life and professional aspirations. Both depicted it as a remarkable experience and a restorative reset. Athletes who have healed using ketamine therapy include NBA player Lamar Odum and NFL player Kenny Stills. In addition to psychotherapy, many of these players report increased empathy and love for others, self-joy, and life from a different perspective. Stills says, “What ketamine does is it kind of takes away these extra levels of anxiety and the different processes happening in the brain so that we can be our true selves.” An Australian research paper says that there is evidence that psychedelic-assisted psychotherapy appears to be capable of safe, long-lasting, and meaningful changes under certain conditions. And as sport reaches higher levels of precision, athletes will undoubtedly look for any advantage, including taking psychedelics for sports performing enhancement. Currently, the World-Anti Doping Agency (WADA) does not explicitly prohibit the use of psychedelics in sports, as they do not assume these substances are performance-enhancing. Time will tell.

Johnathan Edwards MD Substack

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