Int J Sports Med 2004; 25(2): 150-153
DOI: 10.1055/s-2004-819952
Physiology & Biochemistry

© Georg Thieme Verlag Stuttgart · New York

Abnormal Serotonin Reuptake in an Overtrained, Insomnic and Depressed Team Athlete

A. L. T.  Uusitalo1 , M.  Valkonen-Korhonen2 , P.  Helenius3 , E.  Vanninen1 , K. A.  Bergström1 , J. T.  Kuikka1, 4
  • 1Kuopio University Hospital, Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Kuopio, Finland
  • 2Department of Psychiatry and Department of Clinical Neurophysiology, Kuopio University Hospital and University of Kuopio, Finland
  • 3Unit for Sports and Exercise Medicine, University of Helsinki, Finland
  • 4Niuvanniemi Hospital, Kuopio, Finland
Further Information

Publication History

Accepted after revision: May 30, 2003

Publication Date:
26 February 2004 (online)


The purpose of this report is to study serotonin reuptake of the brain in a severely overtrained athlete by using single-photon emission computed tomography (SPECT). A 26-year-old team athlete increased his training volume (by 200 %) and intensity markedly in a new high-level team. After two months, he started to feel continuous fatigue. He had tinnitus in his left ear, he felt disturbing palpitation and had pollacisuria. After four months, he started to suffer from insomnia. He still continued to play for another three months, after which he was unable to play. He could only sleep for 3 to 4 hours per night. Only minor abnormalities could be found in extensive physical and laboratory examinations. The athlete had a severe overtraining state. In the brain SPECT scans, using the specific radioligand for serotonin transporter imaging (123I labelled 2β-carbomethoxy-3β-[4-iodophenyl]-nortropane), low activity areas were detected in the midbrain, anterior gingulus, and left frontal and temporo-occipital lobes. In a psychiatric examination, the patient was found to have signs of major depression, which he hardly recognized himself. We conclude, that that the severe overtraining state could have been related to decreased serotonin reuptake in the brain and signs of major depression.


  • 1 Barron J L, Noakes TD, Levy W, Smith C, Millar RP. Hypothalamic dysfunction in overtrained athletes.  J Clin Endicrinol Metab. 1985;  60 803-806
  • 2 Beck A T, Steer R A, Garbin M G. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation.  Clin Psychol Rev. 1988;  100 77-100
  • 3 Bergström K, Halldin C, Hall H, Lundkvist C, Ginovart N, Swahn C G, Farde L. In vitro and in vivo characterization of nor- β- CIT: a potential radioligand for visualization of the serotonin transporter in the brain.  Eur J Nucl Med. 1997;  24 596-601
  • 4 Booij J, Knol R, Reneman L, Bruin K, Janssen A G, van Royen E A. Iodine-123 labelled nor- β- CIT binds to the serotonin transporter in vivo as assessed by biodistribution studies in rats.  Eur J Nucl Med. 1998;  25 1666-1669
  • 5 Charney D. Monoamine dysfunction and the pathophysiology and treatment of depression.   J Clin Psychiatry. 1998;  59 (Suppl 14) 1-14
  • 6 Donnan G A, Kaczmarczyk S J, Paxinos G, Chilco P J, Kalnins R M, Woodhouse D G, Mendelsohn F A. Distribution of catecholamine uptake sites in human brain as determined by quantitative [3H]mazindol autoradiography.  J Com Neurol. 1991;  304 419-434
  • 7 Drevets W C. Functional anatomical abnormalities in limbic and prefrontal cortical structures in major depression.  Prog Brain Res. 2000;  126 413-431
  • 8 Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatry. 1960;  23 56-62
  • 9 Hiltunen J, Åkerman K, Kuikka J, Bergström KA, Halldin C, Nikula T, Räsänen P, Tiihonen J, Vauhkonen M, Karhu J, Kupila J, Länsimies E, Farde L. Iodine-123 labelled nor- β- CIT as a potential tracer for serotonin transporter imaging in the human brain with single-photon emission tomography.  Eur J Nucl Med. 1998;  25 19-23.
  • 10 Kuikka J T, Tammela L, Bergström K A, Karhunen L, Uusitupa M, Tiihonen J. Effects of ageing on serotonin transporters in healthy males.  Eur J Nucl Med. 2001;  28 911-913
  • 11 Malison R, Price L, Berman R. Reduced brain serotonin transporter availability in major depression as measured by [I123]2 β-carbomethoxy-3 β-(4-iodophenyl)-tropane and single photon emission computed tomography.  Biol Psychiatry. 1998;  44 090-1098.
  • 12 Weicker H, Struder H. Influence of exercise on serotoninergic neurotransmission in the brain.  Amino Acids. 2001;  20 35-47
  • 13 Uusitalo A. Overtraining. Making a difficult diagnosis and implementing targeted treatment.  Physician Sportsmed. 2001;  29 35-50
  • 14 Zhou D, Huether G, Wilfang J, Hajak G, Rüther E. Serotonin transporters in the rat frontal cortex: lack of circadian rhythmicity but down-regulation by food restriction.  J Neurochem. 1996;  67 656-661.

MD A. Uusitalo PhD

Kuopio University Hospital, Department of Clinical Physiology and Nuclear Medicine

P.O. Box 1777, 70211 Kuopio, Finland ·

Phone: +358 17 173281

Fax: +358 17 173244