Why I ask CEOs what drugs they are taking

Exceptional leaders have “own-the-room” qualities we call “executive presence”. These traits are prized because they inspire trust, confer power and get things done. One reason this flavour of authority is rare is that the psychology and physiology of this generation of high performers is under the influence of prescription medication.

Think of the people around you at work – reports, colleagues, superiors, leadership. Next to their toothbrush, I’ll bet almost everyone has at least one pill bottle (and maybe a dozen). Statins for cholesterol, sleeping pills for after a stressful day, Ozempic for weight loss, beta-blockers for anxiety, SSRIs for depression, stimulants for ADHD.

The executive generation is medicated. Half of UK adults in their 40s and 50s take at least one regular prescription medication. Drugs are prescribed for good reasons, but many fix one problem at the expense of another. Executive presence side-effects are not listed on the label – they should include: “may cause career glass ceiling”.

The side-effect I’m talking about is the ability to drop into a state of quietly energised and emotionally attuned presence.

I started asking my executive coaching clients what medications they used after a lightbulb crossover moment from my psychotherapeutic work. In most developed countries at least 10% of adults take antidepressants; in the UK it's 20%, and prescriptions have doubled in the last decade. SSRIs and SNRIs (Prozac, Zoloft, Citalopram, Seroxat, Cymbalta etc.) mitigate emotional negativity in a way that helps people function better and suffer less. But many people also find them emotionally flattening — they blunt the highs as well as the lows. The world gets greyer. Joy and wonder and awe drift slightly further out of reach.

For what it’s worth, this was also my experience: years ago, SSRIs kept me functioning through burnout. When I stopped, and my emotional world returned from black and white into colour again, my clients noticed the quality and depth of my coaching. I could better feel what they were going through and what they needed.

Executive presence requires emotional agility. This means leading with and through our raw authentic emotions, rather than despite them. It’s hard to speak and lead from the heart when our own emotional range is blunted. I never saw an exec on SSRIs who could infect a room with positivity.

ADHD in its true and debilitating form responds well to stimulant medications such as Adderall, Concerta, Ritalin, Vyvanse and Modafinil. It is also very broadly diagnosed (UK adult ADHD prescriptions tripled over the last decade and jumped 24% last year). It is no coincidence that many people find these drugs helpful for focus, flow, wakefulness and concentration.

If you studied at a pressure-cooker university or took a competitive corporate track (especially tech, finance and law), you’ll know how easily stimulant pills get prescribed and used as “study drugs” or to get an edge at work. This supercaffeinated executive generation is smart, competent, productive, hardworking – and bemused as to why it doesn’t have a corner office.

Stimulants bias towards dopamine-driven task focus and set the autonomic nervous system towards go-do-fight-flight. You might have seen it in the eyes of crypto or AI mid-managers: energised, sharp, speaking with something like charisma and passion – but not quite. They are missing that quality of dignity that emerges in the pauses, the spaces between – because there are no spaces. Firehose mode is a liability in the arena of leadership communication. You pay attention to facts and ideas, but are less able to read the room. People hear you, but they can’t feel you.

I became interested in this phenomenon several years back in a group-coaching session which I was leading together with a colleague. Partway through, I decided to switch in a new exercise that would better fit the group dynamic. The other coach resisted the change, and was quite fixated on sticking with the plan. It looked to me like decision-making tunnel vision of the kind we’re working to eliminate. He was taking Concerta for ADHD.

Side note: it is impossible to meditate on Ritalin. That tells us something about presence. But before we point any fingers at study-drug junkies, put down that second cup of coffee. Stimulants of all kinds reduce embodied stillness and parasympathetic settling. My most frequent feedback to clients on speaking delivery is, slow down. I can’t remember the last time I said, speed up. “Pause tolerance” is the scientific term for this. It drops measurably under influence of stimulants, even caffeine.

Stimulants are also a problem for people suffering from anxiety: they worsen fear of public speaking. That said, many medical solutions for anxiety cause an opposite problem. Beta blockers are among the most commonly prescribed drugs in the UK — over 50 million prescriptions a year – for blood pressure and anxiety. Executives taking beta-blockers to calm their nerves and reduce vocal tremor under pressure are also lowering their energy and flattening out the passion in their delivery. Medicating to improve performance by reducing anxiety comes at the cost of presence.

That’s the paradox of executive presence in the most medicated generation in history: medications that help us function are blocking intangible qualities that we need at the top. Medications that boost one component of performance also undermine another. When I ask a CEO what’s in the bottle on the bathroom shelf, it’s not with a view to changing what they take. That’s a conversation for them and their doctor. It’s for insight into why they lead and perform how they do. That informs where and how we need to work.

See ISOC Executive Communication Coaching for details