On a hot day in the spring of 2021, as the Columbia College Koalas softball players in South Carolina left the field at the end of an inning, athletic trainer Kenya Moore noticed a disoriented player.
The player complained of dizziness, difficulty breathing and muscle tremors. Suspecting possible heat stroke, Moore said he put her in an ice bath and called 911. As the player recovered and Moore examined the circumstances that led to the incident, one thing stood out: The athlete had just changed. your ADHD medication.
The incident has stuck with him, and Moore, now a teaching and research assistant at the University of South Carolina's athletic training program, is part of a group of sports medicine experts working to raise awareness about the elevated risk of sunstroke faced by athletes. who take medications for conditions including ADHD, anxiety and depression. Experts also call for more research, especially as mental health awareness has led more people to seek help, which often includes medication.
Federal data show that heat illness diagnoses and heat stroke deaths have increased as global temperatures rise. This summer, the hottest on record worldwide, five middle school and high school football players in the United States died from heatstroke, the most since 2011, according to the National Catastrophic Sports Injury Research Center.
“It's almost like one of those perfect storms,” said Michael Szymanski, a research associate at the University of Connecticut. UConn is home to the Korey Stringer Institute, which studies heat-related deaths in sports.
Nearly one in three college students takes some type of psychotropic medication, according to the 2023-24 Healthy Minds Study of College Student Mental Health. It is not uncommon for young adults to have multiple mental health conditions and take more than one medication. About 35% of elite athletes “suffer from eating disorders, burnout, depression, and/or anxiety,” according to a 2021 release from the American College of Sports Medicine.
Nationwide, doctors wrote 567 million prescriptions for mental health medications in 2022, according to data research company Statista, second only to prescriptions for medications to treat hypertension. That includes high school students and middle-aged weekend warriors, who are less likely than college and professional athletes to be monitored by medical personnel, but may also be at higher risk for heat illness.
Studies show that medications to treat mental health conditions can increase the risk of heat stroke by constricting blood vessels or inhibiting sweating, which prevents the body from cooling properly. They can also increase blood pressure and core temperature, decrease the body's perception of fatigue, and/or put overall pressure on the cardiovascular system.
“Blood vessels expand to allow heat to dissipate during exertion,” Szymanski said. But stimulants, for example, can hinder that mechanism because they constrict blood vessels. “You just have an improved system.”
In June, Dawn Emerson, an assistant clinical professor at the University of South Carolina, spoke to the National Athletic Trainers Association about four types of mental health medications (antipsychotics, antidepressants, anti-anxiety medications and stimulants) and their possible connection to the stroke. of heat. It found that medications with possible risk factors include popular brands such as Adderall, Ritalin, Xanax and Ambien, as well as Bupropion, a generic antidepressant often sold under the brand name Wellbutrin.
Emerson was an investigator on a 2021 study that showed higher body temperatures among marching band participants taking mental health medications.
Erin Pettinger, a Georgetown University athletic trainer who attended Emerson's presentation, said the research rang true to her. It has seen an increase in the number of athletes taking these medications and has around 40 on its current lists. Several years ago, during a particularly hot fall in Washington, D.C., about six of his athletes suffered heat illnesses in the span of a week.
“The common denominator for all of these kids was that they had all been diagnosed with ADHD and they were all on medication,” he said.
Former University of Maryland football player Jordan McNair, who died of heat stroke in 2018, had been taking prescription Vyvanse, a stimulant used to treat ADHD. The independent investigation into his death determined that the team's medical staff should have identified the medication as a risk factor. “There is general concern among the medical community about student-athletes engaging in physical activity while taking stimulant medications, although precautions are generally not listed on medication information sheets,” the report stated.
When asked if these types of drugs are tested for heat stroke risk or whether they include heat stroke as a possible risk factor, a spokeswoman for the U.S. Food and Drug Administration wrote that the approval process for Each medication is unique and could not be answered based on the four drug classes.
Last year, the FDA updated warning information on stimulants used to treat ADHD, listing Adderall, Concerta, Dexedrine and Ritalin as examples. The updated labels tell patients to watch for increased heart rate or blood pressure, but make no mention of heat stroke, exercise or exertion.
ESPN found no mention of heat in a review of several FDA medication guides. Emerson said it was unlikely that any manufacturer was testing specifically for heat-related interactions.
“They discuss all cardiac, renal and other effects, but not specifically heat,” he said. “The problem is that if something affects those systems, then it affects thermoregulation.”
Sports medicine professionals face challenges when tracking athletes' medications. Athletes may not want to disclose such information for fear of being stigmatized, and many athletes arrive at college or a new team using medications prescribed by a local doctor rather than a team or university doctor. A minor but important factor is the perception by some athletes that certain mental health medications enhance performance or act as appetite suppressants, reasons for taking them that athletes would not want to share with sports medicine personnel.
Moore, a former Columbia College athletic trainer, said the softball player who suffered heat illness had been prescribed medication by a doctor not affiliated with the team or school.
“I know we had conversations about, 'Hey, [do we] Do you need to tell the doctor again that this happened? You don't feel very well. Is there any way to alter the dosage?'” he said.
In middle and high schools, which sometimes don't have athletic trainers, parents should make sure the school is aware of any medications and the possible risks, said Tim Neal, director of athletic training education at Concordia University. of Ann Arbor.
Dr. Korin Hudson, a sports medicine physician at MedStar Health in the Washington, D.C., area, where she serves as team physician for Georgetown University and the Washington Wizards and Mystics, said she hopes athletes and staff athletes become more aware of the risks so they can continue taking their medications while finding other ways to cope with the heat.
“If someone has depression or anxiety, I never want to suggest that someone not take their depression or anxiety medications,” Hudson said.
“I think it's probably best for us to educate athletes so they don't increase their risk even more. Right? Don't have three cappuccinos and a bunch of caffeine right before the race or before a hot day of soccer.”
In most cases, Pettinger said, athletes prefer to continue taking the medication and take greater precautions with hydration, sleep and other preventative measures.
While much of the discussion centers on heatstroke (from which 72 football players have died since 1996), Neal said it's worth monitoring the potential effects of medications simply because heat risks can inhibit how well athletes practice or compete.
“Because they are tired or dehydrated, not to the point where they need attention, but it decreases their performance,” he said. “And then when their performance declines, guess what that does? It makes them anxious or depressed.”
Hudson, who volunteers with the Boston Marathon, said the elevated risk of heat illness extends beyond athletes participating in regular competition to people of all ages participating in races and other outdoor events. , which generates a greater need for awareness.
“When we think about marathons and mass events, we now look at people in their 40s and 50s who are also taking ADHD medications. So they're still taking their stimulants, like now.” We're starting to take blood pressure medication,” he said. “We just have to think about what that means for us in terms of event safety. “I think awareness comes first.”
