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.

All of us who have been diagnosed in late adulthood/late life experience an overwhelming amount of emotions that are very similar to the 5 stages of grief. But to explain this a little more, I wanted to share what my specific brain variant of ADHD, hypersensitivity and autism does to me and how it has changed my behavior, communication and overall life.

Let me start by debunking the most common statement, “We all have a little bit of ADHD. No, we don’t!
My brain lacks two hormones that are essential for executive functions that regulate concentration, impulse control, memory, and well-being: dopamine and epinephrine. Our brain works like a computer with 200 tabs open at the same time, which not only means that our brain jumps from one thing to the next without any rhyme or reason, but also that we are constantly at war with the environment because we are overwhelmed by sounds, smells, and sights; this is even more pronounced for me because I am also hypersensitive and on the autism spectrum. Stimuli become unbearable, I would feel like a rat in a cage, the brain starts racing and looking for an escape, resulting in me becoming agitated/aggressive when people say or do things that I feel are not right/negative, etc.
I have often compared my emotions to a freight train that, once started, could not be stopped or controlled. But how did it get to this point, why was I never diagnosed, and what were the consequences?

It is painful to read my report cards from school, apprenticeship and business school. Here are the statements, labels and judgments people have given me throughout my life:

• You are lazy. If you just tried a little harder, you could be the best/have excellent grades.
• You are combative
• You are too aggressive
• You are too loud
• You are a shit stirrer
• You have way too much empathy, which means you are neurotic
• You are disruptive
• You are intimidating/scary
• You are way too direct
• You need to learn to keep your mouth shut
• You are distracted and need to stop daydreaming
• You are not grounded in reality
• THERE IS SOMETHING WRONG WITH YOU!
• THERE IS SOMETHING WRONG WITH YOU!

I could probably go on with this list for a while, but these were the most common statements I’ve heard, the most painful ones, and also the ones that led to two hospitalizations after two complete mental breakdowns that left me unable to function and unwilling to live.

When I was a child, no one noticed that I was rarely present (in my mind) because things that really interested me would create hyper-focus, and having an endless curiosity about various topics allowed me to get really good grades in school in most subjects, which would make up for the not so good grades in subjects that couldn’t hold my attention or focus, like math, physics, and chemistry. However, I figured out “hacks” to always get by without failing classes, and I also knew that good grades would lead to success later in life.

I was also incredibly lucky to have a handful of teachers who saw my potential and recognized that I was ahead in certain subjects. But the real problems started as soon as I graduated from high school. I was 17 and starting an apprenticeship, and gradually my grades started to drop. I noticed an even bigger drop in concentration, lacked all impulse control and often “disrupted” the class with stupid remarks or singing! Too much stress and dysfunction in my personal life compounded my problems.
It all came to a head when my boss/teacher called me into her office and said that my outspokenness was refreshing but if she had 20 of me she’d shoot herself and told me to stop talking, start paying attention, work harder and stop being lazy. She also said that if I didn’t shape up, she might have to kick me out. I called my teacher and told him I didn’t know what was going on and he ended up calling her. I never really knew what he said to her, but after that she was very supportive and actively helped me graduate and get my diploma.

The thing is, having ADHD also means having RSD – Rejection Sensitive Dysphoria, a condition specifically attributed to the ADHD brain. For us, criticism and rejection cause severe emotional, mental, and sometimes even physical pain (hello, fibromyalgia). So we develop panic attacks, phobias and depression, which in turn are misinterpreted and misdiagnosed by doctors, friends, family and co-workers.

This is what it looks like. You know from a very early age that you are “not normal” and that there is something wrong with you, but you don’t know what it is. You feel that you do not fit in, so you begin to isolate yourself. Then rejection and criticism start raining down on you all the time. This not only emphasizes that something is wrong, but also that you are unlovable, that it is all your fault, that you need to try harder to fit in and behave normally because you are “just not right and other people can do it easily.

I had constant friction in my life because I had an extreme sense of right and wrong/fairness, as well as the all-or-nothing brain that would dictate either doing something or doing nothing at all. Where others were afraid to speak or do, I would fearlessly jump in front of the bus, no matter the consequences – but only for other people, not usually for myself.

By the age of 19, I had developed severe phobias and depression, attempted suicide, and engaged in self-destructive behavior. That was until I moved to the United States. There I learned to be a chameleon and began to imitate successful people, often asking them to mentor me. Every piece of advice I got, I took and applied without question. I also learned a million hacks to hide my “defective” brain.

Here are some of them:

1. Never enter a meeting on a laptop or later on a cell phone
2. When people speak to me/at me, turn away from the screen, stop what you are doing, and look only at their face
3. Make to-do lists
4. Always put things in the same place/develop designated places for everything
5. Don’t go to parties or clubs with other people so you can leave if things get too much
6. Never show sadness, anger/frustration, fear, anxiety or that you are overwhelmed
7. Pretend to be an extrovert
8. TRY TO KEEP YOUR MOUTH SHUT

My life was an endless series of rituals, rules and hacks and a constant censoring of myself while living with the fear and anxiety of making mistakes or opening my mouth inappropriately again. My life was hell, often unbearable, while I felt I was walking on the edge of an abyss and one wrong step would spell disaster. I was put on most of the antidepressants in existence, none of them worked. I was put on Alprazolam/Xanax for the constant anxiety attacks and sleeping pills for the never ending insomnia. I went to the emergency room countless times because I would break out in hives, have bizarre dizzy spells or horrible headaches and vomit until I had no choice but to go to the hospital. Nothing was ever found except a spike in blood pressure, sometimes an infection, but usually nothing that made me feel crazy. Of course, anxiety and panic attacks are not so easy to diagnose.

In 2006, the first real break came after shoulder surgery and severe stress in my personal life (again) that required hospitalization in the open ward of a psychiatric unit in the same hospital that had just repaired my shoulder. My brain was spinning, I couldn’t stop crying, I didn’t want to live anymore and all I could think was “I can’t do it anymore. I have no more strength. I’m so tired, so very tired.” I trusted my family doctor and he had the care and compassion to admit me to the hospital.
I was immediately put on a number of medications. There was Paxil for the depression, Ambien/Zolpidem for sleep, Xanax as needed for anxiety, and a drug I had never heard of, Adderall, to give me a little more energy and stop the suicidal thoughts.
When I left the hospital, for the first and only time in my life, my head was absolutely calm. I was able to listen to people, I had very little or nothing to say, and I felt at peace. Of course, when I stopped the medication, I also stopped the peace in my head.
*It is important for me to say here that I have never attempted suicide again and would never attempt it because my hypersensitivity would never allow me to hurt my loved ones by ending my life.

The next nearly two decades were filled with ups, mostly downs, and a steadily diminishing ability to self-regulate and censor. The safe haven of working for a large corporation that inadvertently used my neurodivergence to bring out the best in me was blown away by the market crash of 2008 and my forever trying to fit into the very neurotypical world of corporate America at various companies – and failing miserably. There was a steady stream of bad and impulsive decisions I made and the consequences that would eat away at my physical, mental and emotional health. And then came perimenopause! See my post about ADHD and menopause.