Why Are Ultra Athletes Suffering from Anxiety and Depression?

Communication, Flexibility, and Being Realistic - The Real Keys to Happiness in Sport?

By Carrie Barrett (with additional contributions by Pat Spencer, LCSW)

Exercise is good for your mental health. Running, biking, and regularly engaging in physical activity have been proven to reduce anxiety and depression. That’s why movement is often prescribed to alleviate mood disorders. But there may be a tipping point.

Research has emerged that indicates that, while moderate amounts of exercise and training are good for our heads, ultra-endurance training may pose some mental health risks and has been linked to an increase in psychiatric disorders, including anxiety and depression. 

Little is understood at this point, and it’s important to remember there may be a chicken and egg effect here–people who have mental health struggles are often drawn to ultra-endurance sports as a way to manage their mental health–but, as athletes who like to push our limits, we should take stock of what the results of these studies may mean for us, and how we ourselves may be at risk. 

Training at the Expense of Family and Social Life

Because ultra-endurance athletes often train like elite athletes, they also place high expectations on themselves and those around them when it comes to the frequency, intensity, and duration of their training. 

Many age group athletes fantasize about living the “pro athlete’s life,” but few can do it successfully with competing priorities, including full-time (non-athletic) jobs and families. These unrealistically high self-expectations on performance and time demands lead to inflexibility and an inability to adjust the schedule as needed, and this inability to adjust can then lead to feelings of disappointment, self-flagellation, and an irrational desire to outperform or over-achieve on expectations. It’s a vicious cycle.

Case in point: In May 2013, I was training for IRONMAN Lake Placid and for our wedding anniversary, my husband planned a weekend trip to Asheville, North Carolina for some quality running and riding (Yeah, we’re that couple). He had rented bikes for the weekend and even mapped out a century ride as he knew it was “on my plan.” Lo and behold, it rained non-stop all weekend, like a torrential “don’t leave the house” sort of rain. Here we were in this gorgeous cabin in the mountains and all I could think about was, “I not going to get my training done this weekend. What a f*cking disaster!” This concrete, all-or-nothing thinking made it impossible for me to see any of the beauty of the area, the romance of the trip, or any of the reasons to celebrate our anniversary.  I was miserable, threw a tantrum or two, and proceeded to make it the worse anniversary weekend ever. Why? I was caught in the trap of training and couldn’t see my way out. I was a bucket of stress and cemented in my head that I had to train or I wouldn’t even finish the race (that was still two months away). Needless to say, my husband didn’t plan any more of those trips!

Solution: Work with a reputable coach who you trust and will actually listen to. Together, set realistic expectations for both performance and time allowance. Communicate alternate plans for holidays and weather contingencies. Also, when appropriate, involve family in your training expectations and develop a schedule that complements and doesn’t always compete with obligations. 

As Licensed Clinical Social Worker Pat Spencer suggests, “When experiencing such rigid thinking (I must get this workout in!), we can also tap into what is actually happening. We can Recognize what we are feeling physically and emotionally, Understand where those feelings come from, Name what we are feeling, Explore possible responses, and choose which Response we want (RUNER). This is easier said than done, but with practice we can build those skills. 

Can’t Keep Up with the Fueling Demands/ Low-Energy Availability (LEA)

Training for ultra-endurance events like IRONMAN distance races or ultra-marathons requires caloric consumption well above and beyond a “normal” day of fueling. Athletes, unfortunately, have a tendency to under-consume calories (intentionally and unintentionally), thereby putting themselves into a low-energy availability, or LEA state. According to this study, LEA represents a state in which the body does not have enough energy left to support all physiological functions needed to maintain optimal health.

A chronic state of LEA can lead to myriad physical and emotional repercussions including “increased risk of menstrual dysfunction, poor bone health, metabolic issues, haematological detriments, psychological disorders, cardiovascular impairment and gastrointestinal dysfunction than those with adequate EA. Performance variables associated with low EA included decreased training response, impaired judgment, decreased coordination, decreased concentration, irritability, depression, and decreased endurance performance.”

Solution: Training for ultra races isn’t a “weight loss strategy.” In conjunction with your coach, consider hiring a reputable registered dietitian or qualified sports nutritionist to dial in caloric and macronutrient needs, especially during peak training. 

Trying to Race Goals That Aren’t Feasible

I have a friend who desperately wants to earn her pro triathlon card. She is buried in the sport from morning to night. Weekends are spent logging hour upon hour of training, working for her dream, and yet, she’s miserable. Why? She’s not ready. She’s finishing up a Master's program and working full-time in a non-flexible corporate environment. She has set goals that aren’t yet attainable and the stress of hitting these goals is wreaking havoc on every area of her life. 

Even if you’re not chasing a pro card, it’s not uncommon to fall into the trap of setting unrealistic goals like setting a personal best every time you race, trying to qualify for World Championships, or nabbing an FKT (Fastest Known Time) on a difficult course. 

There is nothing wrong with setting goals; quite the opposite, actually. Goal setting is a trait of successful people, but so is a realistic and incremental roadmap of how to get there. Your one-year plan may turn out to be three years, but if you’re happier and more fulfilled, you’ll enjoy the journey AND the goal even more. 

Solution: This, again, is where a trusted team of experts and coaches can help you, but it also requires self-discipline and pragmatism. There are a few key components of goal setting: Is it realistic? Does the system around you support this? Is it something I really want? Goals are not set in stone. They can, and should be re-evaluated, changed, and adjusted. 

Treating Every Workout as a Pass/Fail

We’ve all been there. Every week you open your training plan document, turn on your watch, or you fire up the bike trainer. You’re staring at the training session with every intention to complete it as written. Why? It means success. You get to “check the box green” and any other outcome is deemed a complete failure. 

Approaching every training session or every week as pass/fail doesn’t lend itself to a growth mindset. Rather, it creates an additional stress burden instead of approaching the session with a sense of freedom and a “how do I feel today,” attitude. If you check the box green, you feel like a rockstar. If you can’t complete it, you feel like an utter failure and every hope or goal you had is instantly out the window. 

This is common in high-achieving ultra-endurance athletes and, yes, wanting to complete the workout as intended is a trait of a highly successful athlete. However, when that completion comes “at all costs no matter what,” the results can lead to injury, extreme fatigue, burnout, stress, and negative psychological effects. 

Remember - a successful training season and race outcomes aren’t determined in one workout. They come with consistency and healthy habits in and around your daily training sessions. 

Solution: Have honest self-dialogue and conversations with your coach about how you are feeling week on week and approaching each day’s session. Allow them to make adjustments as necessary. A good training plan should be fluid and malleable. Also, make sure you understand the intention behind every workout, as they are not all intended to be pass/fail sessions. As an example, try aiming for 80% compliance. This allows for success, creates opportunities for more flexible thinking, and for working athletes, it allows for other aspects of life to come into play. 

Going Too Hard on the Easy Days

There is a tendency of age group athletes to go too hard on the easy days. Why? Much of it comes back to setting incredibly high (and perhaps unrealistic goals). Or, you may be trying to keep up with someone who is going faster, so you push harder than prescribed.  You perceive it as an extra deposit in the training bank or a feather in your fitness cap…perhaps even a little extra credit to your coach to let them (and you) know you’re feeling good. 

The inherent problem with this approach? You never recover and allow your body to rest, adapt, and adequately prepare for the next HARD session. So, when you struggle on those hard days, the cycle of self-sabotage starts all over again. 

Solution: Communicate with your coach and employ self-discipline. Yes, it feels wonderful to knock a training session out of the ballpark but know when to back off the intensity. If you don’t fully understand the intention behind your training block and workout, ask for clarification. A zone 1-2 easy session does not mean, “A hard hilly bike with the gang.” 

The easy days are essential. They allow our bodies to adapt to the hard training and allow for days of less physical stress, which means less pressure on our sympathetic nervous system. If we overload our sympathetic nervous system, we increase our feelings of stress and anxiety and it can lead to these physical and emotional complications. 

Training Alone

Training with a group has myriad benefits from accountability to community, but it can also tip athletes down a dangerous path of overextending and pushing too hard (see above). However, training solo can be just as dangerous for athletes who log all of their miles and sessions alone. 

Endurance sports can be a social outlet and training in isolation can lead to mood disorders, especially if you’re not working with a coach or team. Know yourself and figure out if some workouts are better done with a group than others. Are you a lone ranger? That’s great, but know when to reach out if you’re starting to feel lonely or depressed. 

Solution: If possible, find a social network (either in-person or online) for community and connection. Groups are great for social runs or rides, and can also be a positive motivator to get out the door on those tough days. Your job, though, is to know what is best for you in group situations. 

Training Becomes a Job and Loses Its Joy

Many age group athletes come to sport as adults as a way to find a new challenge and personal accomplishment. Sure, there are some of us who were born and bred athletes who’ve been there for a long time, but the majority started their athletic journey as a way to gain fitness, try something new, and “do something that scares you.”

Remember when you crossed the finish line of your first race as an adult? You were giddy, proud, thrilled. Every workout was a celebration of new milestones and achievements. Even learning about the equipment was a victory as you navigated the confusing waters of shoes, bikes, clothing, power meters, wheelsets, and every other hurdle thrown your way. 

But, sadly, if you stay in it long enough, there is a point where that joy and wonder can give way to obsession and relentless pursuit of “the next best thing.” Gone are the days of the simple joy of being on your bike because they’re replaced by power data, miles per hour, and grams of carbohydrates consumed. Training and racing used to be an escape, but now you need an escape from the escape. 

If this is you (hi, mirror), you may be feeling the emotional effects of this decision fatigue and data overwhelm. If you’re feeling like training and racing has become a second full-time job, it may be time to take a break and search, once again, for the fun that brought you to sport in the first place. 

Solution: Take a break from your main sport and explore alternative activities. “Getting out of your head” is a great remedy to re-discover the joy and beginner mindset you once had. 

While questions remain as to why ultra-endurance athletes may be more prone to depression and anxiety, it stands to reason that with more stress (training, racing, and some of the factors mentioned above), the endocrine system will be negatively impacted, especially with the increased levels of cortisol and lack of recovery and adaptation. 

If you are experiencing increased levels of stress, depressive thoughts, or suicide ideation,  please seek assistance from a medical professional, an experienced coach, a teammate, or call your country’s suicide prevention hotline. In the United States, that number is 988.