Hey loves.

You start a psychiatric medication and suddenly the workout that used to feel normal feels different. Maybe you’re sleepier.

Maybe you’re hungrier. Maybe your heart rate behaves differently. Maybe the weights feel inexplicably heavier. Or perhaps you feel exactly the same.

Psychiatric medication does not automatically mean training less. It means understanding what variables may have changed.

Here are the five things we can use as a framework to understand psychiatric medication:

Energy

Cardiovascular response

Coordination

Thermoregulation

Body composition/recovery.

I would also like to make an important distinction: a medication side effect is not the same thing as a loss of fitness. 

Someone can feel more fatigued without having suddenly lost muscle or cardiovascular capacity.

The research itself supports being cautious about sweeping statements: antidepressant findings on physical performance have been inconsistent; antipsychotics have more often impaired performance in the small studies available; stimulants tend to enhance certain performance measures; and sedatives can produce residual or “hangover” effects. (PubMed Central (PMC))

The Rule Before We Discuss Any Drug

Your medication is prescribed for a reason. Do not skip, reduce, delay or rearrange psychiatric medication simply to improve a workout unless the prescriber specifically tells you to.

Instead, manipulate the variables that actually belong to training:

volume
intensity
rest periods
exercise selection
workout timing
hydration
temperature
nutrition
expectations

Adjust the program around the medication and not the medication around the program.

Someone accustomed to squatting 80 kg doesn’t necessarily need to abandon 80 kg because she started medication. But if 80 kg normally feels like RPE 7 and suddenly feels like RPE 9, that information matters.

RPE simply means your rate of perceived exertion. It’s a subjective measure of force ranging from 0-10.

ANTIDEPRESSANTS

SSRIs

Examples of antidepressants: sertraline/Zoloft, escitalopram/Lexapro, fluoxetine/Prozac, paroxetine/Paxil, citalopram.

Serotonin is a feel good hormone responsible for those feelings of warmth and happiness. 85% of our serotonin is stored in our gut so our diet plays a huge part in producing this hormone.

Potential training-relevant effects can include:

fatigue or sleepiness
GI symptoms
changes in sleep
changes in appetite/weight
dizziness in some people
sexual side effects that aren’t directly fitness-related but affect quality of life

Research examining SSRIs and exercise performance has produced mixed results. Studies of paroxetine, for example, haven’t consistently shown the same performance effect. (PubMed Central (PMC))

How I’d train

Don’t automatically reduce your program.

For the first few weeks or after a dose change, use RPE rather than chasing previous numbers at all costs.

Strength:
2–4 sessions/week, normal progressive overload if tolerated.

Cardio:
Begin with moderate steady-state cardio if intense sessions suddenly feel disproportionately difficult.

Key lesson:

Temporary fatigue during medication adjustment should not automatically be interpreted as lost fitness.

Keep going at your normal rate and simply track your difficulty levels for improving your performance.

SNRIs

Examples: venlafaxine/Effexor, duloxetine/Cymbalta, desvenlafaxine.

Serotonin helps regulate your mood, sleep, appetite and emotional balance. Norepinephrine is more about energy, focus, alertness and your response to stress.

Because norepinephrine is involved, cardiovascular responses deserve a little more attention than with a generic “antidepressants make you tired” discussion.

We also have to understand factors that are being affected such as:

blood pressure
heart rate
sweating
dizziness
perceived exertion

Training advice:

Use long warm-ups.

Avoid immediately jumping from sitting/lying exercises into maximal standing movements if prone to dizziness.

Use RPE alongside heart-rate data rather than treating smartwatch zones as absolute truth.

And if resting HR or BP changes substantially after starting medication, discuss it with the prescriber rather than trying to “cardio your way through it.”

Bupropion / Wellbutrin

I am giving Wellbutrin its own section because pharmacologically it doesn’t behave like an SSRI.

Wellbutrin (bupropion) mainly increases norepinephrine and dopamine activity, which are involved in energy, motivation, focus and reward.

That’s why some people experience it as more activating or energizing, rather than calming or sedating.

Bupropion has actually produced performance-enhancing effects under certain experimental conditions, particularly involving heat, although this does not mean it should be regarded as a performance drug. (PubMed)

Training implication:

Watch out for the combination of an activating medication + hard training + lots of caffeine/pre-workout + heat.

More stimulation isn’t necessarily more performance.

Older Antidepressants: TCAs & MAOIs

TCAs: amitriptyline, nortriptyline, clomipramine.

Some medications can cause sedation, making you feel more tired or less alert, while anticholinergic effects may contribute to dry mouth, blurred vision, constipation or a faster heart rate.

Others can lower blood pressure and cause dizziness when standing or changing positions quickly. Certain medications can also affect heart rate, rhythm or longer-term cardiovascular health, so if you experience unusual dizziness, fainting, chest pain or significant shortness of breath during training, don’t simply push through it.

MAOIs: phenelzine, tranylcypromine etc.

If you’re training while taking an MAOI, pay extra attention to dizziness and blood-pressure changes, especially when standing up quickly after floor exercises or heavy sets.

Hydrate properly, build intensity gradually and give yourself longer rest periods if needed. Be careful with pre-workouts, stimulants and certain supplements because MAOIs can have serious interactions with ingredients that increase blood pressure or neurotransmitter activity.

Also remember that MAOIs require specific food and medication precautions, so never assume a supplement is safe just because it’s marketed for fitness.

ANTIPSYCHOTICS

Antipsychotics and Training

Examples:

aripiprazole/Abilify
olanzapine/Zyprexa
quetiapine/Seroquel
risperidone/Risperdal
paliperidone/Invega
clozapine
lurasidone/Latuda

Taking an antipsychotic does not mean you cannot build muscle, it also doesn’t mean you can’t lose weight or stay slim.

Biology is biology and your body responds to hyper trophy regardless of pharmaceutical variables.

Muscular hypertrophy still responds to mechanical tension, adequate protein, training volume and recovery.

Some antipsychotics can create additional obstacles and make it harder to enjoy your training session.

Antipsychotics can affect training in several ways depending on the medication and the individual. Sedation and fatigue can make workouts feel harder, while orthostatic hypotension may cause dizziness when standing or changing positions quickly. 

Movement-related side effects can include stiffness, tremor, restlessness or akathisia, which may affect exercise comfort and coordination. Some antipsychotics can also increase appetite and weight, while metabolic effects may influence blood sugar and cholesterol.

They can also affect thermoregulation, meaning your body may have more difficulty regulating temperature during intense exercise or hot weather: making hydration, recovery and paying attention to overheating especially important.

Antipsychotics have generally shown more performance-impairing effects than stimulants in the limited experimental literature. (PubMed)

Thermoregulation is something to look out for when it comes to training on antipsychotics.

Some antipsychotic prescribing information specifically warns that the body’s ability to reduce core temperature may be disrupted, particularly with strenuous exercise, extreme heat and dehydration. (FDA Access Data)

That matters enormously for someone doing HIIT outdoors in Beirut or Barcelona in August.

Training strategy

Strength training can remain the foundation. You want to favor predictable progression rather than constantly testing maxes.

Allow longer rests if HR or perceived exertion requires you to do so. Also, train in cooler environments when heat tolerance is impaired.

Hydrate appropriately. Don’t treat severe dizziness, confusion or overheating as something to “push through.”

Orthostatic hypotension is also a possibility: antipsychotics vary in risk, but dizziness or faintness when standing can occur. (PubMed Central (PMC))

Akathisia Is NOT “Extra Cardio”

I really wanted to write this section because almost no mainstream fitness article would include it.

What is akathasia? It’s an intense inner restlessness that may produce pacing, rocking, shifting or an inability to remain still.

Movement caused by akathisia should not be treated as bonus NEAT or a reason to train harder.

If someone is already physically distressed, piling exhaustive training on top may simply increase the burden.

Exercise can still be used if comfortable but training should not become an attempt to exhaust the restlessness out of yourself.

Persistent or severe symptoms belong with the treating clinician.

PART III: MOOD STABILIZERS

Lithium: The Medication Every Serious Trainer Needs to Understand

This section deserves special treatment. The issue isn’t that people taking lithium can’t train, it’s that fluid and sodium balance can influence lithium levels.

Training on Lithium can lead to:

higher alertness
potential HR/BP changes
reduced appetite
sleep disruption
heat considerations
perceived energy

NHS guidance specifically advises drinking plenty of fluids during intense exercise or hot weather because increased sweating and dehydration can increase lithium concentrations. Sudden reductions in dietary sodium can also matter. (nhs.uk)

This creates a fascinating collision between wellness culture and medicine. Influencers or trainers often advise us to cut out sodium, to sweat everything out, to train faster or to dry out before a photoshoot.

All of these are inappropriate for some key taking Lithium.

Training approach

If you are on Lithium, hydration has to become part of your program. Furthermore, one must be cautious about extreme heat.

Avoid deliberately dehydrating yourself for the sake of your appearance. Don’t suddenly make dramatic sodium changes without medical guidance.

Also make sure to keep scheduled lithium monitoring. Finally, you want to know what the toxicity warning signs are:

The NHS lists symptoms including significant shaking, muscle weakness, twitching/jerking and difficulty speaking among signs requiring emergency assessment. (nhs.uk)

Valproate, Lamotrigine & Carbamazepine

These medications can lead to the following:

fatigue
dizziness
coordination issues
weight/appetite effects depending on drug
drug-specific medical monitoring

Technique deteriorates before ambition does. If coordination or dizziness is affected, that’s not the day for a PR deadlift.

Machines, supported movements and familiar exercises can temporarily be excellent choices while adapting.

ANXIETY & SLEEP MEDICATION

Benzodiazepines

Examples: alprazolam/Xanax, clonazepam/Klonopin, lorazepam/Ativan, diazepam/Valium.

Potential issues on these drugs are:

sedation
slower reaction time
impaired coordination
balance
residual next-day effects

The psychotropic-performance review found sedatives can produce residual/hangover effects, while observational evidence has also associated regular benzodiazepine use with poorer measures such as balance and walking speed in older adults. (PubMed Central (PMC))

What that basically means, unfortunately is that utilizing heavy barbell compounds and being under significant sedation creates an unnecessary risk.

If clearly impaired, choose walking or another low-risk activity rather than forcing a heavy session.

Please don’t skip your prescribed benzodiazepine for the sake of training. You can elicit a hypertrophic response training in the rep range of 3-4 sets of 8-12 repetitions.

Just don’t go for those 3×3 sets, especially not in a lift like the squat, for instance.

Beta Blockers Used for Anxiety

Example: propranolol.

Beta blockers like Propranolol can blunt heart-rate response. This means that your smartwatch might tell you you’re not working very hard while your legs strongly disagree.

This is where RPE and the talk test become useful. Don’t chase your old heart-rate zones blindly.

For resistance training, heart rate matters considerably less than technique, load, repetitions and proximity to failure anyway.

ADHD MEDICATION

Stimulants

Examples: methylphenidate/Ritalin/Concerta and amphetamine-based medications.

The research review found stimulants were the one psychotropic category with relatively consistent performance-enhancing findings—although the available studies were limited and shouldn’t be extrapolated into using medication as a sports enhancer. (PubMed)

However, your brain may feel ready before your body is recovered.

Stimulation can also alter perceived energy. Feeling switched-on doesn’t guarantee muscles, connective tissue and sleep have recovered.

What about pre-workouts?

Prescription stimulant combined with 300 mg of caffeine and an energy drink isn’t automatically a better training environment.

Anyone experiencing palpitations, chest symptoms or concerning cardiovascular effects should stop exercising and seek appropriate medical assessment.

Non-Stimulant ADHD Medications

Atomoxetine, guanfacine, clonidine.

“Non-stimulant” doesn’t mean “irrelevant to training.” Blood pressure, HR, fatigue, sleepiness and dizziness may still matter depending on the medication.

Train according to the effect you’re experiencing, not merely the drug category printed on the box.

PART VI: BUILD THE ACTUAL PROGRAM

The Medication-Aware Training System

Here is a Green / Yellow / Red Workout System.

GREEN DAY

Normal energy.
No unusual dizziness.
Normal coordination.
Normal temperature tolerance.

Follow your program normally on this day.

YELLOW DAY

Unusual fatigue.
Mild dizziness.
Poor sleep.
Medication adjustment period.
Noticeably elevated RPE.

Keep the habit of training going but reduce the demand. Go at maybe 70–80% of normal volume.

Use machines instead of technically demanding free-weight exercises. Perform moderate cardio instead of HIIT.

Stop 2–3 reps from failure.

RED DAY

Fainting or near-fainting.
Chest pain.
Severe confusion.
Severe overheating.
Major coordination impairment.
Symptoms suggestive of lithium toxicity.
Severe medication reaction.

Do not treat training as a “discipline” day. Stop training and seek appropriate medical care.

Weight Gain on Medication: What Training Can and Cannot Do

Medication-related weight change is not at all: “You just weren’t disciplined.”

Some medications can affect appetite, energy expenditure/activity, glucose/lipid metabolism and other pathways relevant to body composition.

But also make sure not to swing into fatalism. Medication-related weight gain does not mean fat loss or physique improvement is impossible.

Focus on what you can control:

progressive resistance training
protein
fiber-rich meals
steps/NEAT
sleep
appropriate calorie intake
monitoring trends rather than daily scale fluctuations

Your body isn’t failing because the variables changed. The strategy simply needs to account for the new variables.

The Four-Week Adjustment Rule

When beginning or changing medication, think of training as an observation period rather than immediately judging your new baseline.

Track:

workout RPE
loads/reps
sleep
resting HR if useful
energy
appetite
body weight trend
dizziness
heat tolerance

After several weeks you’ll have data. One terrible workout tells you very little however a repeated pattern tells you much more.

What Your Trainer Needs to Know

A trainer doesn’t necessarily need your complete psychiatric history. They do need relevant safety information.

For example:

“I take medication that can make me dizzy when standing.”

“My heart rate is blunted by a beta blocker.”

“I need to be careful about dehydration.”

“I sometimes experience medication-related movement symptoms.”

A trainer modifies exercise. A prescriber modifies medication.

Fitness Isn’t Reserved for the Unmedicated

There is a strange assumption buried inside fitness culture. That the ideal body is built by an ideal body: perfect hormones, perfect energy, perfect sleep, perfect mental health and no medication bottles sitting beside the toothbrush.

Real people do not live like that.

They train through demanding jobs, insomnia, anxiety, depression, chronic illness, medication changes and bodies that do not behave exactly as textbooks predict.

The goal is not to pretend medication has no effect on training. Some medications can change appetite. Some can change heart rate. Some can make you tired, dizzy or restless. Some require genuine precautions around hydration and heat.

The goal is to understand those effects well enough that you stop confusing adaptation with failure.

You may need longer rests. You may need to train earlier. You may need to stop judging cardio by your old heart-rate zones.

You may occasionally need 40 kilograms to be enough on a day when 60 kilograms normally isn’t.

None of those things make the workout meaningless.

Fitness isn’t the ability to execute the perfect program under perfect physiological conditions.

It is the ability to keep intelligently working with the body you actually have.

Medication may change some of the variables. It does not automatically cancel the goal.

I hope that you enjoyed this blog post on Lifting on Medication: The Guide Nobody Gave You, please let me know what you thought about it in the comments section below!