OVERTRAINING SYNDROME AND MENTAL HEALTH IN ATHLETES - A LITERATURE REVIEW

Abstract

Overtraining Syndrome (OTS) is a complex biopsychosocial condition arising from a chronic imbalance between training load and recovery. OTS produces numerous psychiatric symptoms that remain systematically underrecognized in clinical practice. This review examines the neurobiological mechanisms linking OTS to mental health disorders, characterizes its psychiatric symptomatology, clarifies differential diagnosis with primary psychiatric conditions, and synthesizes current evidence on monitoring, prevention, and management. OTS affects numerous elite athletes during their careers, with a relapse rate of 80–90% within three years of recovery. Its neurobiological mechanisms — HPA axis exhaustion, serotonergic receptor dysregulation, neuroinflammatory activation, and autonomic nervous system dysfunction — overlap substantially with those of major depressive disorder, providing a mechanistic basis for the extensive psychiatric comorbidity observed clinically. OTS presents across three dimensions: affective and anxiety symptoms, neurocognitive and somatic impairment, and burnout. Differential diagnosis requires systematic exclusion of primary psychiatric disorders, Relative Energy Deficiency in Sport (RED-S), and organic pathology. Prevention and management form a continuum encompassing psychological monitoring, primary prevention strategies, and — in established OTS — multidisciplinary treatment including psychiatric and psychological interventions. OTS is a biopsychosocial condition whose psychiatric dimension is clinically substantial yet underdiagnosed. Its neurobiological overlap with major depressive disorder warrants integration of psychiatric expertise into the routine evaluation and management of overtrained athletes. The field remains constrained by the absence of validated diagnostic criteria and evidence-based psychological interventions — gaps that sports psychiatry is well-positioned to address.