In my last medication post, I wrote about finally finding some relief with Lisdexamphetamine (Elvanse) and Bupropion. If you read that post, you’ll remember that I ended on a cautiously hopeful note “an almost normal life again.” Well, this is the update.
It didn’t stay that way.
I stopped taking Bupropion after taking it for almost two years. What I hadn’t realized at the time was that it was the Bupropion causing my face to turn bright red at the slightest emotional trigger, good or bad, happy or stressed, it didn’t matter. My face would flush visibly, which is manageable in my personal life but a real problem in business meetings. Once I made the connection and stopped taking it, the flushing stopped. But so did the extra dopamine support it had been providing.
The challenge with Lisdexamphetamine is that it wears off in the afternoon. A dopamine booster that stays in the system longer had been filling that gap. Without it, the afternoons were rough again.
And then work became extremely stressful, the kind of stress that doesn’t stay at the office. It triggered something I hadn’t experienced at that level in a while: constant anxiety and daily panic attacks. Every meeting, especially certain ones, would set it off. I was living in a state of permanent fight-or-flight. Sleeplessness. Heart racing and irregular beats. Blood pressure spiking every afternoon, sometimes as high as 165/110. Trouble breathing. It was, to put it plainly, not sustainable.
Enter Venlafaxine
In February, I had an appointment with my psychiatrist and told her what was happening. She suggested Venlafaxine. She explained that it works particularly well alongside ADHD because, unlike a standard antidepressant, it targets both noradrenaline and dopamine and is specifically designed to help with panic and anxiety disorders. I had never heard of it. When I looked it up, I found that it’s sold in the US under the brand name Effexor.
Because Venlafaxine needs to build up gradually in the system, she started me on a very low dose:
- 37.5 mg for two weeks
- 75 mg for two weeks
- 112.5 mg for two weeks
- 150 mg where I am now, for about three weeks
What Changed
The first thing I noticed was that the panic attacks simply stopped. Not gradually faded, but stopped. The constant background hum of anxiety went quiet.
Then something else started happening. After a while, I began experiencing something I hadn’t felt in a long time: genuine happiness. Not a medicated high, but something much more familiar – my old self. I sing again. I laugh a lot. I don’t get worked up as easily, and when I do (because that fiery, passionate side of me isn’t going anywhere), I come back down quickly, the way I imagine most “normal” people do.
But the thing that surprised me most was this: I had been meditating consistently for almost a year, and while I knew intellectually that it was good for me, I wasn’t sure how much it was actually landing. Venlafaxine seems to have been the missing piece. It’s as if my brain could finally hear the meditation, actually observe thoughts and emotions instead of being swept away by them. That shift has been profound.
People started noticing too. Comments about a glow, looking well, seeming different and at peace, or “having a great energy.” That kind of external confirmation is something I don’t take lightly, because it means the change isn’t just in my head.
The Side Effects
In the spirit of full honesty, which is why I write this blog in the first place, here’s what I’m still navigating.
On weekdays, when I take Lisdexamphetamine, I still experience blood pressure spikes and headaches around 3 pm, namely when the amphetamine starts wearing off. On weekends without it, this doesn’t happen, which tells me the interaction between the two medications is likely the culprit rather than Venlafaxine alone. I’ve also noticed an increase in appetite and some weight gain, so I’m keeping an eye on that. Luckily, the appetite gets suppressed by the amphetamine so it’s easier to balance.
Then there’s the one I find almost amusing: the dreams. Vivid, strange, and often completely nonsensical, but not nightmares. Sometimes they’re oddly therapeutic. A couple of times I’ve actually worked out real-life conflicts in my sleep and woken up laughing. What makes it even more interesting is that I almost always remember them, which is not something I could say before.
The other side effect, shaking hands, can be contributed both medications rather than Venlafaxine alone, but worth mentioning for the full picture. It’s been part of my life since I’ve been taking amphetamines, so I’m used to it.
I’ve tried stopping the Lisdexamphetamine entirely, but within a couple of weeks, the focus, concentration, and memory issues return. So for now, I need it, I just need to manage the combination better.
I’m currently experimenting with timing: taking my blood pressure medication and Lisdexamphetamine first thing in the morning, then waiting two hours before taking the Venlafaxine. I only just started this approach, so the data isn’t in yet.
The dosage question is its own saga. I’ve been on 30 mg of Elvanse for over a year and a half. In Germany, adult dosing guidelines are limited, and the guidance isn’t always clear. My doctor suggested opening the capsules and weighing micro-doses, which I tried and gave up quickly. 60 mg is too high and simply unbearable and measuring out of a capsule to add to your daily dose was messy and highly inaccurate. Whether I’m currently under- or overdosed at 30 mg is genuinely unclear to me. It’s one of those frustrating grey areas that I suspect many of you living with ADHD in Europe will recognize. However, my glass is half full, because in certain countries ADHD meds aren’t even available for adults.
The Bigger Picture
What I can say with confidence is that Venlafaxine has changed my life when I added it to the Lisdexamphetamine. The stimulant gave me back my focus and the ability to do my job. Venlafaxine gave me back myself.
If you’re neurodivergent, struggling with anxiety or panic attacks, and feel like something is still missing from your medication picture, it might be worth asking your doctor about SNRIs, and specifically about Venlafaxine.
As always, none of this is medical advice. I’m just someone with a noisy brain, sharing what’s worked and what hasn’t, in the hope that it saves someone else a few years of trial and error.
