Do Endurance Athletes Ignore Signs of Burnout?

By Heather Markham, PMHNP at Axis Integrated Mental Health

Endurance sports are often praised for their ability to boost mood, build resilience, and improve mental clarity.

For many of us, the long hours of training offer a sense of purpose and a powerful way to manage stress.

However, new research highlights a more complicated picture, particularly for ultra-endurance athletes.

A 2023 review published in Sports underscores that despite the well-documented mental health benefits of exercise, ultra-endurance athletes are at increased risk for a range of psychiatric disorders, including depression, anxiety, eating disorders, and exercise dependence. 

Intensity + Isolation = Psychological Overload

Ultra-endurance training often happens in solitude, with athletes balancing demanding schedules, recovery needs, and social lives.

With high training volumes come biological risks: the overtraining syndrome and relative energy deficiency (RED-S) can disrupt hormones, sleep, and mood, intensifying emotional strain .

Let's take a step back and understand both these clinical terms: 

Imagine you're driving a sports car every day, pushing it to its limit. You're always in the fastest gear, rarely braking.

You never give it an oil change or let the engine cool down. Eventually, it overheats, burns out, and stops performing. Even if it looks okay from the outside.

That’s Overtraining Syndrome.

• You’re training intensely, but instead of getting fitter, you get slower, moodier, and more exhausted.
• Your body stops responding positively to workouts.
• You might feel physically drained, emotionally flat, and even sicker more often.

Your “engine” (nervous system + hormones) is burned out, and the usual fix, which is assumed to be more training, makes it worse.

If we talk about RED-S, let’s say your phone is on 5% battery, but you're trying to stream HD video, navigate with GPS, and message your friends, all at once.

It starts glitching, slowing down, and eventually shuts off.

That’s RED-S.

• You’re not eating enough to meet the demands of your training.
• Your body starts shutting down non-essential systems: mood regulation, hormones, digestion, and even fertility.
• You might lose your period, feel chronically cold, tired, or emotionally unstable, not because of burnout, but because your “fuel tank” is empty.

Your body is running a high-performance sport without the calories (energy) to sustain it.

Simply put, Overtraining Syndrome is doing too much, and RED-S is not eating enough. Both deeply affect emotional and physical health.

Rob Krar’s Never-Ending Race Against Depression

Rob Krar, a Canadian ultrarunning legend and two-time Western States and Leadville 100 champion, has long grappled with depression, even at the height of his athletic prowess.

“When I get injured, I’m more likely to go into it. But they’re not joined at the hip.”
Even when his physical performance soared, depression could still tug him into a hole."

By July 2017, after a devastating knee injury, he reached what he called “one of the darkest moments of my life,” contemplating suicide. He revealed:

“I was silent for too long, cycling through denial, anger, and shame.” 

But speaking out made all the difference.

Rob shared that opening up to his wife, Christina, allowed him to coincide the blessing of vulnerability with his life in the wilderness.

Their deep emotional bond, forged through trail highs and mental lows, became his lifeline. 

What Does Depression Look Like in Athletes?

Depression isn’t just sadness. It’s a complex medical condition with:

• Persistent low mood
• Loss of interest in training or daily life
• Sleep and appetite disruption
• Deep fatigue
• Centralized feelings of worthlessness

If you're an athlete or have a loved one who is training for the Ironman or triathlons, support them through their burnout or depression.  

How to Support a Loved One Who Isn’t Okay?

• Start with curiosity, not accusation:
  
  “I read an article about ultra-endurance athletes facing depression…and thought of your intense training. How are you feeling lately?”

• Reference relatable themes:
  
  “They discuss how stepping back affects identity—that made me reflect on what you might be going through.”

• Frame help as strength:

  “The athletes I admire most are those who sought mental health care. That takes courage.”

• Offer non-pressured support:

  “If you ever want to talk or explore options, I’m here. Always in your corner.”

What to Do When You Need Help?

At Axis Integrated Mental Health, we craft tailored care for Colorado’s endurance athletes. Whether you're training in Boulder, Westminster, or the Crested Butte backcountry. Our integrated programs address:

• Exercise dependence, depression, and anxiety
• RED-S and hormonal imbalance
• Identity stress and life transitions through therapy
• Trauma-informed care and performance-life balance

Your strength on the course is powerful, but your emotional well-being matters even more. 

Additional Resources

• How to Recognize Signs of Hidden Depression in Your Loved Ones?
• What Stops People from Seeking Mental Health Treatment?
• How to Support Someone with Depression?
• 13 Ways to Help Decrease Anxiety

Frequently Asked Questions

1. What strategies can help when you feel mentally fatigued before physical fatigue?
2. Do some runners have mental illness, or does ultrarunning attract people struggling with depression or SUD?
3. Is there a link between isolation in ultrarunning and mental health issues, like depression or anxiety?
4. What mental strategies do endurance athletes use to cope with boredom or distraction during long training sessions?