Fueling the Athletic Mind: Supplements in Athletics

Mental health concerns are increasingly recognized in competitive sport. Studies suggest that up to half of elite athletes experience clinically significant symptoms of anxiety, depression, or psychological distress during their careers. At the same time, interest in nutritional supplements that support mental well-being has expanded rapidly across athletic populations. Clinicians working with athletes can therefore be asked about products such as creatine, omega-3 fatty acids, or adaptogenic herbs. Despite widespread use, the evidence supporting these interventions varies widely in quality and magnitude.

For clinicians, it is important to frame supplements as adjuncts rather than replacements for evidence-based care. Adequate sleep, nutrition, injury recovery, psychological support, and appropriate psychiatric treatment remain foundational for mental health in athletes. Supplements may have a role in specific contexts, particularly when addressing nutritional deficiencies or physiologic stress associated with intensive training. The following sections summarize several commonly used supplements and the current evidence relevant to mental health in athletic populations.

Creatine

Creatine is widely used in sports to enhance strength and power, but it also plays an important role in cerebral energy metabolism. Through the creatine–phosphocreatine system, creatine supports rapid adenosine triphosphate regeneration in neurons, which may help buffer the cognitive fatigue associated with sleep deprivation, psychological stress, and heavy training loads. Interest has therefore grown in its potential psychiatric and cognitive effects.

Clinical evidence suggests that creatine may have modest antidepressant properties.¹ Small trials examining creatine as an adjunctive treatment for depression have demonstrated reductions in depressive symptoms compared with placebo, though the magnitude of benefit is generally small and the certainty of evidence remains limited due to small sample sizes and methodological concerns. Experimental studies also suggest improvements in cognitive performance during physiologic stress, including sleep deprivation, which may be relevant to athletes undergoing intense training cycles or travel schedules.²

In practice, many athletes already take creatine monohydrate for performance purposes at doses of approximately 3 to 5 g daily. For these individuals, any cognitive or mood benefits should be viewed as potential secondary effects rather than primary indications. Creatine is generally well tolerated, with mild weight gain from water retention being the most common adverse effect. Contrary to persistent misconceptions, current evidence does not demonstrate kidney toxicity in healthy individuals using recommended doses, although caution remains appropriate in those with pre-existing renal disease.

Omega-3 Fatty Acids

Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), play essential roles in neuronal membrane function and neuroinflammatory regulation. These properties have prompted extensive investigation into their effects on mood disorders. For athletes, omega-3 supplementation is already common for its potential benefits in recovery and inflammation, which makes its mental health effects clinically relevant.

Meta-analyses of randomized trials demonstrate a modest antidepressant effect of omega-3 supplementation, particularly in individuals with established depressive disorders. A recent systematic review reported that increasing omega-3 intake was associated with small but statistically significant improvements in depressive symptoms, with optimal effects occurring around 1 to 2 g per day of combined EPA and DHA.³ Evidence for anxiety reduction is more heterogeneous, although some studies suggest clinically meaningful improvements in individuals with anxiety disorders.

From a clinical perspective, omega-3 supplementation may be most useful for athletes with low dietary intake of fatty fish or those experiencing mood disturbances during periods of injury, overtraining, or career transition. Supplements are generally well tolerated, though clinicians should monitor total dosage, as intake above approximately 3 g daily may increase the risk of bleeding.

Vitamin D

Vitamin D deficiency is common among athletes, particularly those who train indoors, live at northern latitudes, or have limited sun exposure. Beyond their established roles in bone health and immune function, vitamin D receptors are widely expressed in brain tissue, raising interest in their potential role in mood regulation.

Observational studies consistently show an association between low vitamin D levels and increased risk of depression. Randomized trials suggest that supplementation produces small improvements in depressive symptoms, particularly in individuals who are deficient at baseline.⁴ A recent meta-analysis reported modest reductions in depression scores with daily supplementation, although benefits appear to plateau at higher doses. Evidence for anxiety reduction remains inconsistent.

Clinically, the most appropriate approach is to assess serum vitamin D levels and correct deficiencies. Maintenance doses typically range from 1000 to 2000 IU daily, with higher doses reserved for deficiency under medical supervision. For athletes with adequate vitamin D status, additional supplementation is unlikely to meaningfully affect mood.

Magnesium

Magnesium plays a central role in neuromuscular function and neurotransmitter regulation and has long been associated with stress modulation and sleep regulation. Athletes may be at risk for suboptimal magnesium intake due to dietary patterns and increased losses through sweat during intensive training.

Emerging evidence suggests that magnesium supplementation may reduce symptoms of depression and anxiety, particularly among individuals with low baseline magnesium levels. A recent meta-analysis reported moderate improvements in depressive symptoms with supplementation, though most studies remain small and heterogeneous. Magnesium may also support sleep quality and relaxation, factors that are particularly relevant in high-performance sport.^5,6

Supplementation is generally safe at doses of 200 to 400 mg daily. Magnesium glycinate is often favored for its calming properties and improved gastrointestinal tolerability, whereas magnesium citrate is more likely to produce gastrointestinal effects. Clinicians should exercise caution in individuals with significant renal impairment.

Adaptogens: Ashwagandha and Rhodiola

Adaptogenic herbs such as ashwagandha (Withania somnifera) and rhodiola (Rhodiola rosea) are increasingly used in sport for stress resilience and mental recovery. Although historically rooted in traditional medicine, modern clinical trials have begun to examine their effects on psychological stress and fatigue.

Randomized trials of ashwagandha have demonstrated reductions in perceived stress, anxiety symptoms, and cortisol levels, suggesting potential benefits in individuals experiencing chronic stress. Rhodiola has been studied primarily for mental fatigue and cognitive performance under stress, with some evidence supporting improvements in alertness and resilience during periods of psychological or physical strain.^7,8

While these supplements are generally well tolerated, clinicians should remain mindful that herbal preparations vary widely in quality and standardization. When used, products should be sourced from manufacturers with reliable third-party testing. As with other supplements, they should be considered adjunctive tools rather than primary treatments for mental health conditions.

Concluding Thoughts

Nutritional supplements occupy an increasingly visible role in conversations about athletes' mental health. Current evidence suggests that certain supplements, particularly omega-3 fatty acids, magnesium, and vitamin D in deficient individuals, may provide modest benefits for mood or stress resilience. Others, such as creatine and adaptogenic herbs, show emerging but less definitive evidence.

For clinicians working with athletes, the key challenge is balancing openness to these interventions with careful evaluation of the evidence base. Supplements may be reasonable adjuncts when used thoughtfully, but they should be integrated into a broader framework that prioritizes nutrition, sleep, psychological support, and evidence-based medical care.

Mr Singh is a research fellow at Montefiore Medical Center, with a clinical and academic interest in athletics, mental health, and well-being. He is also part of the Athletes for Hope Athlete Research Fellowship.

Dr Mirhom is past president of the New York County Psychiatric Society, an assistant professor of Psychiatry at Columbia University, a Forbes contributor, and Chief Wellbeing Officer at Athletes for Hope.

References

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4. Ghaemi S, Zeraattalab-Motlagh S, Jayedi A, Shab-Bidar S. The effect of vitamin D supplementation on depression: a systematic review and dose–response meta-analysis of randomized controlled trials.Psychol Med. 2024;54(15):3999-4008.

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7. Anghelescu IG, Edwards D, Seifritz E, Kasper S. Stress management and the role of Rhodiola rosea: a review.Int J Psychiatry Clin Pract. 2018;22(4):242-252.

8. Wang X, Yang X, Gao Z, et al. The effect of Rhodiola rosea supplementation on endurance performance and related biomarkers: a systematic review and meta-analysis.Front Nutr. 2025;12:1645346.