Elite athletes suffer many mental health symptoms and disorders at rates equivalent to or exceeding those of the general population.  The novel coronavirus disease 2019 (COVID-19) has created new strains on elite athletes, thus potentially increasing their vulnerability to mental health symptoms.  This manuscript serves as a review of the impact of the pandemic on management of those symptoms in athletes.  It specifically addresses psychotherapy, pharmacotherapy, and higher levels of care.  Within the realm of psychotherapy, crisis counseling might be indicated.  Individual, couple/family, and group psychotherapy modalities all may be helpful during the pandemic, with novel content and means of delivery.  Regarding pharmacotherapy for mental health symptoms and disorders, some important aspects of management have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants, and medications for substance use disorders.  Providers must consider when in-person management (e.g., for physical examination, laboratory testing) or higher levels of care (e.g., for crisis stabilization) is necessary, despite potential risk of viral exposure during the pandemic. Management ultimately should continue to follow general principles of quality health care with some flexibility.  Finally, the current pandemic provides an important opportunity for research on new methods of providing mental health care for athletes, and consideration for whether these new methods should extend beyond the pandemic.