Trastornos de bipolares y comorbilidades – consideraciones éticas en deportes

Translated title of the contribution: Bipolar disorders and comorbid conditions – Ethical considerations in sports

Kenneth R. Kaufman, Miriam Campeas, Melissa Coluccio, Ronke Babalola, Anthony Tobia

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Introduction: The goal of pharmacologic intervention is therapeutic outcome – maximal efficacy with minimal adverse effects. In treating bipolar disorder, this may be complicated by comorbidities and/or adjunctive medications required to address adverse effects. Optimal rational polypharmacy may maximize therapeutic outcome yet could create ethical issues in competitive sports. The World Anti-Doping Code (WADC) and yearly published World Anti-Doping Agency Prohibited List are intended to deter and sanction athletes using performance-enhancing agents while promoting an even playing field for all competitors. This paper presents three hypothetical examples (ADHD/lithium-tremor/pain) wherein unintended Prohibited List contravention would result in doping violation disqualifications without approved Therapeutic Use Exemptions (TUEs). Method: Hypothetical case analyses with literature review. Results: Comorbid ADHD – the Prohibited List precludes psychostimulants (methylphenidate/amphetamines) in competition (S6) but permits guanfacine/atomoxetine. When psychostimulants effectively treat ADHD in athletes with bipolar disorder but guanfacine/atomoxetine do not, these patient-athletes, with clinician's certification and supportive documentation, should file TUEs. Lithium-tremor – beta-blockers are frequently prescribed to control lithium-tremor but are not permitted for specific sports (P2). If alternatives (primidone) are ineffective, TUEs are indicated. Pain – chronic pain management is difficult in athletes as narcotic analgesics (S7) and cannabinoids (S8) are prohibited in competition. When comorbid pain is not controlled with approved medications, TUEs are required. Conclusion: Patient-athletes with bipolar disorder and comorbidities require holistic approaches with appreciation of both the WADC and Prohibited List. Athletes should list all medications with diagnoses/obtain TUEs/verify proposed medication status (banned/restricted/permitted) with appropriate International Federations and/or Olympic organizations. Clinicians should be cognizant of these issues when treating patient-athletes.

Translated title of the contributionBipolar disorders and comorbid conditions – Ethical considerations in sports
Original languageSpanish
Pages (from-to)55-61
Number of pages7
JournalApunts Medicina de l'Esport
Issue number198
StatePublished - Apr 1 2018

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


  • Bipolar disorder
  • Clinical care
  • Comorbidities
  • Doping violation
  • Education
  • Ethics
  • Hypothetical cases
  • Psychopharmacology
  • Sports
  • World Anti-Doping Code, prohibited list, and therapeutic use exemptions


Dive into the research topics of 'Bipolar disorders and comorbid conditions – Ethical considerations in sports'. Together they form a unique fingerprint.

Cite this