MEDICATIONS: Side effects, worries, and what are Pre-Workout meds?

We live in a culture where people will swallow, snort, inject, or chug just about anything if it promises to make them happier, sharper, or stronger. Some of it works, some of it doesn’t, and some of it lands you in a congressional hearing.

SSRIs

SSRIs are the antidepressants like fluoxetine, sertraline, escitalopram. They’ve been around long enough to be studied to death¹. The verdict is that they’re safe long-term². Your brain isn’t going to melt, and there’s no hidden timer where they suddenly stop working and ruin your life.

The catch is side effects. Sexual side effects are common³, and in some unlucky cases they linger even after stopping. This is officially called Post-SSRI Sexual Dysfunction⁴, which sounds like the name of the worst punk band in history. And if you quit SSRIs too fast, your nervous system throws a party you didn’t ask for: dizziness, brain zaps, flu-like misery. Usually temporary, but enough to convince you that tapering is not optional⁵.

Amphetamines

Amphetamines are the ADHD meds with names like Adderall, Vyvanse, Dexedrine. They jack up dopamine and norepinephrine so your brain can focus for longer than ten seconds⁶. People always worry that long-term use will fry your dopamine system like meth. Spoiler: it doesn’t. Decades of research show that therapeutic doses don’t cause brain rot or permanent depletion⁷.

In fact, kids with ADHD who take stimulants are less likely to abuse drugs later⁸, probably because they’re not busy self-medicating with weed and Monster Energy. Stimulants can slow growth in kids by maybe an inch, but most catch up⁹. When you stop them, you might feel tired or flat for a while, but that fades. It’s more like a long Red Bull crash than a permanent state of doom¹⁰. As the I’ve Had It podcast would say, “I’ve had it with people acting like Adderall is meth with a prescription label.”

Caffeine: The OG Pre-Workout

Caffeine is the original performance enhancer. People have been chasing that buzz forever. In the 1904 Olympics, marathon runners were literally dosed with brandy mixed with strychnine¹¹. By the 1930s, caffeine pills were everywhere¹². Weightlifters in the 70s swore by black coffee before training, and in the 80s we got Ultimate Orange, a pre-workout that mixed caffeine with ephedra and hit like a freight train¹³. It worked, until people started having heart attacks, and the FDA banned ephedra¹⁴.

Modern pre-workout powders are basically caffeine in a neon tub, sometimes spiced up with beta-alanine (the tingle stuff) and creatine. Is it necessary? Absolutely not. Caffeine does improve performance¹⁵, but you can get the same boost from a cup of coffee. The difference is whether you want your caffeine with marketing or not. Pre-workout is psychological as much as physiological. If you believe the scoop will turn you into The Rock, you’ll probably lift harder. If you’re anxious, it’ll just make your heart race faster and convince you you’re dying.

Testosterone, Steroids, and HGH: Bigger Biceps, Smaller Testicles

Synthetic testosterone was first isolated in the 1930s¹⁶, and by the 1950s weightlifters and bodybuilders were already injecting it¹⁷. Testosterone itself is the natural hormone that makes muscles grow, voices drop, and teenagers unbearable.

When people talk about “anabolic steroids,” they’re usually talking about synthetic derivatives of testosterone that crank up the muscle-building (anabolic) effects while trying to minimize the androgenic ones¹⁸. Human growth hormone, or HGH, is in a different category. It was discovered in the mid-20th century¹⁹ and originally used for kids with stunted growth²⁰. In adults, HGH increases muscle mass, reduces fat, and makes celebrities claim they’re aging in reverse²¹.

So what’s the difference? Testosterone is the natural hormone that men and women both make. Anabolic steroids are its lab-designed cousins, tweaked for maximum gains, often at the cost of your liver and your mood²². HGH isn’t testosterone at all. It’s a separate hormone that tells your body to grow everything, not just muscles, which is why too much of it can make your jaw, hands, and heart enlarge²³. People use all three because humans love shortcuts, but the risks range from “annoying acne” to an enlarged heart.

The Real Risk

So what happens long-term? With SSRIs, the worry is lingering sexual dysfunction, but that’s rare. With amphetamines, the worry is dopamine burnout, but the research says it doesn’t happen at prescribed doses. With caffeine, the worry is mostly that you’ll become the guy at the gym who spends $60 on a tub of pink powder when a double espresso would have done the same thing. With testosterone, steroids, and HGH, the worry is that your shortcut to bigger biceps will also give you shrunken testicles, mood swings, heart problems, and a lifetime membership in the “why did I do this to my liver?” club²⁴.

The real danger isn’t these substances destroying you later, but untreated depression, untreated ADHD, untreated exhaustion, and untreated insecurity wrecking you right now. Or, as George Carlin would put it: “It’s never just about the medicine. It’s about the culture, the fear, and the bullshit we build around it.”²⁵ If you have a comment, or want to continue this conversation, please contact me through my website: www.boulderpsychiatryassociates.com.