Trends in Antidepressant, Anxiolytic, and Cannabinoid Use Among Italian Elite Athletes (2011–2023): A Longitudinal Anti-Doping Analysis

Mental health disorders, particularly depression and anxiety, have become increasinglyprevalent among elite athletes, exacerbated by factors such as competitive pressureand the Coronavirus Disease 19 (COVID-19) pandemic. This study analyzes trends inthe use of antidepressants, anxiolytics, and cannabinoids (delta-9-tetrahydrocannabinol(THC)/cannabidiol (CBD)) among Italian athletes from 2011 to the first half of 2023(FH2023), referring to anti-doping reports published by the Italian Ministry of Health.Data from 13,079 athletes were examined, with a focus on non-prohibited medications,banned substances, and regulatory impacts, including threshold adjustments for THCsince 2013 and the legalization of CBD. The results show fluctuating use of antidepressants/anxiolytics, with peaks in 2021 and the FH2023, coinciding with post-pandemicawareness. Positive THC cases rose following regulatory changes, reflecting socio-culturaltrends. Gender disparities emerged, with THC use predominantly among males (e.g., ninemales vs. one female in 2013), though female athletes were underrepresented in testing.This study highlights the need for personalized, evidence-based strategies that balancetherapeutic efficacy and anti-doping compliance. Clinicians should carefully considerprescribing selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines to addressdepression and anxiety and should monitor the risks of CBD contamination. Future researchshould adopt longitudinal, gender-sensitive approaches to refining guidelines andcombating stigma in professional sports.