Anxiety can and should be noticed early: the earlier the cause is found, the easier it is to correct. The editors have compiled a practical algorithm — from daily habits that reduce the level of anxiety, to a list of examinations that help distinguish a psychological state from a hormonal failure or a side effect of supplements, and "red flags" that should not be delayed.
Prevention: a base that works
The most effective means of preventing anxiety are no different from the basics of sports recovery. Regular sleep lasting 7–9 hours stabilizes the autonomic nervous system and reduces reactivity to stress. Consistent down and up times, a dark, cool bedroom, and no screens an hour before bed help more than any "soothing" supplement.
The second support is adequate nutrition. A long-term severe calorie deficit, especially in "weight" sports and during preparation for bodybuilding competitions, increases cortisol levels and increases the risk of mood disorders. The IOC Consensus on Relative Energy Deficiency (REDs, 2023) refers to psychological disturbances as typical consequences of insufficient energy consumption.
The third component is intelligent load planning. Periodization with unloading weeks, control of subjective well-being, resting heart rate and sleep quality allow early detection of overtraining. The consensus of the ECSS and ACSM (Meeusen et al., 2013) emphasizes that changes in mood often appear earlier than a decline in athletic performance.
Finally, psychological skills are as trainable as technique. Breathing exercises with prolonged exhalation, progressive muscle relaxation, work with a sports psychologist on pre-start rituals reduce the intensity of anxiety. The NICE guideline for generalized anxiety disorder recommends starting specifically with psychological interventions - self-help and cognitive behavioral therapy.
Revision of supplements and drugs
If the anxiety appeared recently, the first step should be an honest list of everything that a person consumes: coffee, energy drinks, pre-workout complexes, fat burners, medicines and any "course" drugs. Often the problem is the combined dose of stimulants from multiple sources that the athlete has not even thought about.
- Calculate your daily caffeine intake: coffee, tea, energy drinks, pre-workout supplements, fat burners, caffeine pills.
- Check the ingredients for synephrine, yohimbine, unspecified "extracts", DMAA and DMHA.
- Do not take stimulants after dinner if training in the evening causes insomnia.
- Choose products that have been independently tested for banned substances.
- Do not stop prescription drugs abruptly - discuss the withdrawal with your doctor.
For most healthy adults, EFSA considers up to 400 mg of caffeine per day to be safe, and a single dose of up to 200 mg usually does not cause problems. However, in people with a slow metabolism of caffeine or a tendency to anxiety, unpleasant effects are possible even with smaller amounts. Gradual reduction of the dose helps to avoid the withdrawal syndrome.
Regarding prescription hormones, steroids, clenbuterol, or thyroid drugs, the editorial does not offer advice on "regimen adjustments." If a person already uses such means and experiences anxiety, palpitations or insomnia, the right step is to tell the doctor about it frankly. The doctor is not a representative of the anti-doping agency, and concealment of information makes diagnosis difficult.
Separately, you should be careful with "natural" sedatives. Some interact with antidepressants and other medications, and the evidence base for most herbal supplements for anxiety disorders is limited. They do not replace the examination if the symptoms are pronounced.
Diagnosis: where does the doctor start
The short GAD-7 questionnaire is widely used by clinicians for initial assessment (Spitzer et al., 2006). It consists of seven questions about symptoms in the past two weeks; the sum of points 5, 10 and 15 conditionally corresponds to a light, moderate and severe level of anxiety. It is a screening tool, not a diagnosis, but it allows you to monitor the dynamics.
| Examination | What allows you to exclude or detect |
|---|---|
| TSH, free T4 (if necessary T3) | Hyperthyroidism, including iatrogenic from thyroid hormones |
| General blood test, ferritin | Anemia, iron deficiency |
| Glucose, HbA1c | Disorders of glucose metabolism, tendency to hypoglycemia |
| ECG, if necessary Holter monitoring | Arrhythmias imitating panic attacks |
| Testosterone, LH, estradiol (as indicated) | Hypogonadism, including after AAS |
| Electrolytes, blood pressure | Hypertension, violation of water-salt balance |
The doctor will also ask about the duration of the symptoms, how they relate to exercise, eating, sleeping, coffee, and about heredity and previous episodes. Panic attacks that occur during exercise, especially with chest pain or loss of consciousness, require a cardiac examination, as they may be of a cardiac nature.
If somatic causes are excluded, the doctor or psychiatrist evaluates the criteria for anxiety disorders. Treatment includes cognitive-behavioral therapy and, if necessary, medication. It is important for athletes to inform their doctor about competition: some drugs, including beta-blockers, are prohibited by WADA in certain sports and their use may require a therapeutic use permit.
When to consult a doctor urgently
Most anxiety episodes are not life-threatening, but there are situations when "nerves" hide an emergency. Chest pain or pressure, especially during exertion, fainting, severe shortness of breath, heart rate over 150 beats per minute at rest, or an irregular pulse require an emergency call.
Anxiety with a high temperature, profuse sweating and confusion after taking fat burners, especially DNP, as well as tremors, sweating and confusion on the background of insulin - possible hypoglycemia - also require immediate help. Both conditions can be fatal and do not go away on their own.
Thoughts about self-harm or suicide, a sense of hopelessness are grounds for seeking help on the same day: to a doctor, a psychological support line, or an emergency service. The IOC consensus separately emphasizes that the sports environment should provide quick access to such specialists.
You should consult a doctor as planned if the anxiety lasts for more than two weeks, disrupts sleep and work capacity, makes you avoid training or competition, or if you notice a connection between the symptoms and the intake of any substance. Early consultation shortens the time to recovery.
Editorial conclusion
Prevention of anxiety in sports is based on simple but disciplined habits: sufficient sleep, adequate nutrition, periodization of workloads and development of psychological skills.
A review of stimulants and drugs is the fastest way to find a fixable cause. A brief GAD-7 screening and a few basic tests help distinguish psychological distress from hyperthyroidism, anemia, arrhythmia, or hormonal failure.
Chest pain, fainting, fever on the background of fat burners, symptoms of hypoglycemia and thoughts of self-harm are grounds for immediate help.
The editors recommend also reading our materials on the causes of anxiety in athletes and its connection with pharmacology, on overtraining syndrome and on thyroid hormone tests.
References
- Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092â1097.
- Reardon CL, Hainline B, Aron CM, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med. 2019;53(11):667â699.
- National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113). London: NICE; 2011.
- Meeusen R, Duclos M, Foster C, et al. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the ECSS and ACSM. Med Sci Sports Exerc. 2013;45(1):186â205.
- Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073â1097.
- EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific opinion on the safety of caffeine. EFSA J. 2015;13(5):4102.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev. (DSM-5-TR). Washington, DC: APA; 2022.
