Warning: This article discusses sensitive material which may be triggering to some.

Brian Johnson is on the mound and he's locked in. It takes a tremendous amount of mental energy to throw in the majors. Who's at the plate? What's the count? Which pitch should he throw? When Johnson is locked in, he's in attack mode. Each ball he throws is done with confidence and conviction.

Behind Johnson, just a shade to the right on the mound and playing second base, is Brock Holt. Holt is a ball of boundless energy. The charismatic Red Sox infielder always seems to be smiling or cracking a joke.

Which is why it may be impossible for the average fan to recognize that Holt suffers from an anxiety disorder and Johnson has suffered through bouts of anxiety and depression.

Anxiety disorders are the most common mental-health issues and, according to Dr. Nicole Danforth of Newton-Wellesley Hospital, anxiety disorder is seen in up to 25 percent of the general population.

Depression is also more prevalent than people may realize. Dr. Danforth estimates that 6-8 percent of American adults have a depressive disorder in a given two-week period.

Athletes are just as likely to suffer as the rest of us.

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Johnson now realizes everyone battles something. But, looking back, he sees that the pressure to perform was like a snowball gaining momentum down a steep hill.

At first, he found himself experiencing panic attacks.

“Very hard to catch my breath,” Johnson said, “Hard for me to have a train of thought.”

Johnson was able to keep things under control early. But as the pressure mounted to perform, the anxiety continued to build.

“You start to let the outside things bother you,” Johnson said, “You start thinking about the future. It was one thing after another.”

Soon it wasn’t just anxiety for Johnson. The left-hander was also experiencing a depressive episode.

“I would wake up at noon after going to bed at 10, exhausted, tired. Waking up in cold sweats. Not sleeping," Johnson said. “I would not eat for half day and then basically shove food down my face. My appetite was all messed up. I’d be shaking on the mound because I didn’t eat all day.”

Johnson quickly learned a lesson. “You just didn’t realize how one thing could play dominoes with everything else.”

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It's normal to experience some anxiety and sadness. Emotions are a part of life. However, there's a significant difference between experiencing anxiety or feeling sad and having anxiety or a depressive disorder.

Dr. Danforth stressed that a diagnosis isn’t made by symptoms alone, but more by the level of distress and impairment a patient is feeling.

She explained that anxiety disorder includes feelings of worry, fear, or anxiety that are strong enough to interfere with a person’s daily activities.

A depressive episode “is very different than feeling sad,” Dr. Danforth said.

She went on to define a depressed person as someone who will feel a wide range of symptoms “which last beyond a two-week period.”

(Those symptoms include: a pervasive sense of sadness or depression, excessive crying or tearfulness, a loss of interest in activities, social isolation, difficulty falling asleep or waking very early in the morning and not being able to fall back asleep, a lack of energy or motivation, difficulty feeling joy or pleasure, feelings of worthlessness or guilt, difficulty concentrating or making decisions, a change in weight or appetite [can be a loss of appetite or excessive eating], agitation or restlessness or even slowed thinking or speaking, and recurrent thoughts of death or suicidal ideation.)

“Sometimes,” Dr. Danforth said, “a depressed person may feel ‘numb’ and will talk about feeling nothing at all.”

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Brock Holt now admits he’s always had a little bit of anxiety.

But the Red Sox utility player says he didn’t recognize or give it a name until a trifecta of life-altering events: The birth in December 2016 of his son Griffin, who spent the early hours of his life in the NICU; the sudden death of his uncle, and a concussion which cost him most of the 2016 and 2017 seasons.

Holt coped with his anxiety by making jokes and trying to let things go because he didn’t want to cause any problems. But on the inside, he was reeling.

Holt worried about his future on the field.

“I was wondering if I was going to be able to play, continue to play,” he said. “Wondering if I was ever going to get better.”

He was also consumed with thoughts about the meaning of life and his greater purpose.

“I was looking at my uncle’s passing and thinking, ‘Why should I get excited about this if tomorrow . . . I could get a phone call and my dad could pass away,” he said. “Or I could pass. So why am I getting excited about this stuff if it can all be taken away like that?

"I put on a front, that’s how I realized these things have really affected me and I just haven’t talked about it. I haven’t admitted to myself that something is going on and that these things that have happened in my life have really affected me.”

An explanation like this doesn’t surprise Dr. Danforth, who has worked with athletes.

“Athletes often have a negative perception of help-seeking and are often trained to accept pain,” she said.

“Professional and elite athletes are trained from an early age to focus on the positive, to minimize self-doubt or negative thoughts, and to move forward. So often issues around stress or anxiety or depression are pushed to the back of their minds.”

For Holt, what Dr. Danforth describes was all-too familiar.

“[I was] thinking the negative always,” he said. “Which would turn good moments, happy moments, into things I wasn’t happy about or proud of.”

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Both Johnson and Holt finally reached out for help and both players now take medication to minimize their symptoms.

This may not seem like a big deal, but for many people suffering from a mental health issue taking medication is a scary step. People worry about the stigma of “being medicated” and the side effects.

But for Holt, taking medicine was necessary.

“I needed something," he said. "I was in a bad place and I didn’t know it and I needed something to help calm me down. I feel like what I’m taking now. I take it every night before bed. It helps.”

It also helped both players to know they weren’t alone. Both have family members who had also dealt with mental-health issues and used medication. Johnson lost a relative to suicide, but also saw the successful treatment of others in his family.

“I saw it work for them, so why wouldn’t it work for me?” Johnson said. “And if it didn’t work, then at least I can say I tried.”

Dr. Danforth is quick to point out that while medication is an option, it is only part of an important overall treatment plan.

“Such an intervention is just part of the solution,” Dr. Danforth said. “And talk therapy is an important part of recovery.”

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It's one thing to talk to a therapist in the privacy of their office. It's entirely different to go public with such a personal battle. Yet both Johnson and Holt do so willingly.

“I know that talking about it and talking to people about what I was feeling and what the issues were that were bothering me, it helped me,” Holt said. “It helped me get from the point where I was holding everything in.”

Johnson agrees that being open about the subject helps him as much as it helps others. It has also allowed the pitcher to be true to himself.

“If someone wants to judge me for having depression and anxiety, you can do that,” Johnson said. “I’m going to go out there and do what I can do every five days or out of the bullpen and I’m going to get dinner with my family. If you want to judge me for that, I don’t care.”

Johnson’s advice for someone who is living in silence? Break it.

“The moment you do, you’ll question why you took so long.”

If you, or someone you know, is experiencing suicidal thoughts or depression, call 911 or the National Suicide Prevention Hotline at 1-800-273-8255. You can access the National Alliance on Mental Illness here.

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