Sydney Pickrem says depression and anxiety will be her constant companions, but she's able to navigate them by thinking of herself as a human first and a swimmer second.

Pickrem, who won a pair of Pan American Games gold medals in Santiago, Chile, withdrew from July's world championship in Fukuoka, Japan with what she'd called "crippling anxiety and depression."

"I've been in these positions before," Pickrem said Wednesday night at Santiago's Centre Acuatico. "I definitely had bad years and bad days and struggle with my mental health throughout the years. I don't think this was necessarily the first time. Sometimes I almost forget, once I'm doing well, to still check in and take care of myself.

"Someone asked me 'is that all behind you?' and I'm like depression and anxiety will never be behind me. It's going to be something I always have for the rest of my life, but I embrace it and I want to tackle it and be the best me I can be."

Pickrem is a dual Canadian-American citizen who was born in Florida and whose family is from Halifax. She's a two-time Olympian who helped Canada's women win a medley relay bronze in Tokyo's Olympic Games two years ago.

She graduated from Texas A&M in 2019, but continues to train there with the men's swim team.

"I swim with 30 guys. I don't swim with any girls. At first, it was really hard for me to open up with my struggles," Pickrem said. "I think it caught them off guard when I wasn't going to worlds because of where I was at in training and my physical ability.

"They were like 'but you're going to crush it.' I was like 'it's not worth it to me to just stick [it] through and not be a happy human being.' Having to be vulnerable with 30 college guys is not easy, but it's really pushed me to be in this position now."

Aggies associate coach Jason Calanog helped Pickrem reframe how she saw herself.

"I had to lean on people for support," Pickrem said. "This sport sometimes is so individualized and you forget that you train with a team every day. It's really only those two minutes you're doing it yourself.

"My biggest thing that me and my coach worked on, let's be the best me that I can be, and whatever swimmer that is, that's what's meant to be.

"Sometimes we forget, and we try and make ourselves just the best swimmer and we forget to even think of ourselves as a person. I just was thinking about what was the outcome for Sydney the swimmer, not Sydney the person."

The 26-year-old capped her Pan Am Games by winning the women's 200-metre individual medley in a Games record time of two minutes 9.04 seconds. Pickrem was also a gold medallist in the 200 breaststroke.

Five days out from Santiago's opening ceremonies, Pickrem won the women's 200 IM at a World Cup meet in Athens, Greece.

Her previous Pan Am appearance was in 2015 in Toronto.

"I was basically a baby," Pickrem recalled. "I realize how special it is. It's not an opportunity you get for the rest of your life to represent on this kind of stage, so I think it means a lot.

"It means more to me that I actually get to almost step back and enjoy it a bit and then I kind of see better swims. It's been 10 years almost on the national team. It feels good to kind of soak it in a little bit more."