Michael Phelps, Serena Williams, Jerry West, Theo Fleury, David Freese, Terry Bradshaw — they’ve won Olympic gold medals, Wimbledon crowns, NBA Championships, Stanley Cups, Cy Young Awards and Super Bowls. Along with achieving their sport’s ultimate success, these professional athletes also share something else: depression.

Depression knows no boundaries. It can afflict anyone — even those who seem to be, quite literally, at the top of their game. Professional and top-level amateur athletes face the same risk factors for depression as everyone else. But they also face stressors that mere athletic mortals don’t experience. “There are factors in an athlete’s life that are not in the everyday person’s life that would make them more prone [to depression],” says Dr. Ronald L. Kamm, a psychiatrist who subspecializes in sport psychiatry and is the director of Sport Psychiatry Associates in Oakhurst, New Jersey.

[Read: Is Depression a Disease?]

At the top of that list: “They are under pressure to win, which you and I don’t have,” says Kamm, who works with local amateur and pro athletes and is a past president of the International Society for Sport Psychiatry. And that pressure is magnified by the spotlight that shines on athletes. “No one is watching you do your job, but when [athletes] are performing at a high level, all the cameras are on you,” says Dr. Eric Morse, a sports psychiatrist with Carolina Performance in Raleigh, North Carolina and the sports psychiatrist for North Carolina State University. “Especially in the day of social media, everything is so accessible. It has changed in the past decade, where anyone can criticize you on social media. That is a unique challenge as well,” says Morse, who is also a past president of the International Society for Sport Psychiatry and previously worked with the University of North Carolina, University of Maryland and the Baltimore Orioles.

A Long List of Risk Factors

The irony with athletes is that exercise is one of the best ways to stave off depression. And that may help some, Kamm says. But the added risks may also outweigh the benefit. The list of those risks is long — including the risks that their sports impose on their body. “Athletes are willing to take [physical] risks the average person doesn’t,” Kamm says. “My subspecialty is boxing, and they are putting their life on the line. They face bodily injury when they go to work. You and I don’t.”

Injuries from that risk also present a huge problem. A serious injury can mean the difference between playing or being benched. “If they don’t return to their previous level, that is depressing,” Kamm says. So is the fact that athletes retire at a very young age, whether from injury, being cut or simply being considered “old” at age 30. Unexpected or unplanned retirement is a known risk factor for depression.

Concussions also are linked to depression, both as a cause and as a risk factor. “There is no question that concussion often leads to depression, and there are also some studies showing that depression is a risk to developing concussions,” Morse says. Athletes with depression may not protect themselves as well, he says. “It also may be that if have depression and then get concussed, you are more likely to feel the effects of concussion, though that is still not clear.”

[Read: How Do I Know If I Have Depression?]

Other common stressors include social isolation, especially for nonteam athletes like boxers, tennis players and others; language and cultural isolation for foreign-born athletes; and an athlete’s demanding schedule during the season, which often preclude family and relaxation time. Exposure to drugs and alcohol, especially at a young age, can exacerbate mood disorders. Then there are the sadly common traumatic realities of sexual or mental abuse from coaches and eating disorders while trying to reach weight limits.

Now add athletes’ belief in appearing invincible, lest they give an opponent an edge. “Mardy Fish, the tennis player, said his anxiety was equated with weakness,” Kamm says. “He was afraid his opponent would see him as weak, and to show weakness is to deserve shame.” That stigma, Kamm says, may be why depression is underreported among athletes.

The Stigma Is Lessening

But thanks to the stars listed above, and many more like them, the stigma of seeking help is slowly diminishing among athletes. “Athletes come for help more, and having a sports psychologist or psychiatrist [on a team] is less taboo,” Morse says.

Because many athletes have built-in protective factors such as exercise and team-based social networks, Morse believes that they often need medication to address biologically based causes. “Most athletes are pretty insightful about depression and medication,” he says. “Because they are healthy and have healthy livers, we may be more aggressive in medication dosages, because they are rapid metabolizers in my experience.” Fortunately, today’s antidepressants have very few side effects. “Many athletes are worried [the drugs] will impair performance, but many tell me they perform as well or better on antidepressants,” Kamm says.

[See: Am I Just Sad — or Actually Depressed?]

Famous athletes may also need or want more privacy. Kamm says he has a private entrance to his office or tries to schedule appointments when the waiting room is less likely to be filled. On the other hand, “I have also had huge football players come in and not worry about it,” he says.

That’s exactly what sports psychiatrists hope for: that athletes don’t worry about seeking help. “It is not a sign of weakness,” Morse says. “It is a medical illness, requiring medical treatment, and it is extremely treatable. I would say athletes respond to medical treatment better than nonathletes, because at that point it is so biological.”

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What Can — or Should — Be Done to Help Pro Athletes With Depression? originally appeared on usnews.com