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Editor,—Professor Schwenk makes the important point that elite athletes are not immune to serious mental illness and that many of the symptoms of overtraining may, in another context, be considered diagnostic of depression.1
I have usually considered the following to be a helpful differentiator between the two conditions. Patients with depression will almost always resist any suggestion that they may be more physically active. In contrast, the complaint of the athlete with what has been termed either overtraining or the chronic fatigue syndrome will usually be that they desperately wish to exercise. However, whenever they do exercise, they become profoundly fatigued such that the exercise is not pleasant and further compounds their state of chronic fatigue.
However, after reading Professor Schwenk's article, it struck me that, as fatigue is a symptom that is perceived centrally in the brain, it may be that this distinction is not as clear cut as one may conclude. Could exercise intolerance, as opposed to exercise avoidance, be a symptom of depression in elite athletes?
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