What I didn’t mention is what it did to my sleep.

The Unexpected Side Effect

I started Venlafaxine in January of this year, building up slowly from 37.5mg to the target dose of 150mg. By the time I arrived at the full dose, something had shifted. I was falling asleep without any problem, but I was waking constantly throughout the night. Fragmented, unrestorative sleep that left me exhausted regardless of how many hours I spent in bed.

Over eight months, I also gained 10 kilos. For a medication that is actually known to cause weight loss in many people, this was baffling.

More on that in a moment, because what my psychiatrist told me this week turned out to be one of the most fascinating pieces of pharmacological information I’ve come across in my entire medication journey.

The Medication Parade

First, let me walk you through what the past few months have looked like, because I think it’s important for people to know that finding the right sleep solution is rarely straightforward, and that trying and failing medications is not failure. It’s information.

I had been taking Lunivia for about three years. It worked well, until Venlafaxine entered the picture. After starting Venlafaxine, Lunivia stopped doing its job properly. It would knock me out, but it couldn’t keep me asleep. I would wake constantly throughout the night, unable to get the restorative sleep I needed. So my GP and I began the search for something that would work alongside Venlafaxine.

Quviviq (Daridorexant) – a newer sleep medication that works by blocking orexin, the chemical that keeps you awake. It is supposed to restore the natural sleep cycle. The plan was to cross-taper: take Quviviq alongside Lunivia while gradually reducing the Lunivia dose. The first week I took the full 3mg of Lunivia with Quviviq, then dropped to 2mg, then 1mg. Here’s what I noticed: the further I tapered down from Lunivia, the less the Quviviq seemed to be doing. By the time I was completely off Lunivia, Quviviq stopped working altogether. It turned out Quviviq hadn’t really been carrying the sleep on its own, Lunivia had been doing most of the heavy lifting underneath it the whole time.

There was also one alarming episode during this period: I was fully awake, about to get up to go to bed, and when I tried to say something to my husband, nothing came out but gibberish. I tried three times. No coherent sentence. It only happened once, but it was unsettling enough to report to my GP immediately. He attributed it to the complex interaction of multiple medications during the taper period.

Promethazin – this was the worst. Promethazin is an antihistamine with strong sedative properties, and antihistamines and I simply do not get along. I cannot take NyQuil or any medication like it. Medical marijuana affects me badly because of the combination of THC and antihistamine properties – both give me a deeply unpleasant “speediness,” an uncomfortable restless uneasiness that borders on anxiety. Promethazin did exactly the same thing, amplified. I took it for five nights at various doses. Every single night, the same result: hours of an unpleasant twilight state where I was neither properly awake nor asleep. I couldn’t fall asleep, and in the morning I woke up with a horrible headache and a hangover so heavy I literally could not open my eyes properly or drag myself into consciousness. Exhausted despite having been in bed all night. Five nights of this was enough. I went back to my previous medication while we figured out the next step.

In hindsight, if someone had asked me about antihistamine sensitivity before prescribing it, we could have skipped this chapter entirely. Which brings me to something worth mentioning: always tell your doctor about reactions to over-the-counter medications and supplements, not just prescription ones. Those reactions are data.

Amitriptyline – a tricyclic antidepressant sometimes prescribed at low doses for sleep. I tried it one night. My sleep tracker told me everything I needed to know: REM sleep of just 16 minutes, core sleep of 3 hours 36 minutes. Amitriptyline and I were not going to work together.

The Psychiatrist Appointment – The Plot Twist

Yesterday I saw my psychiatrist and discussed both the sleep problems and the weight gain. She said something that stopped me in my tracks.

She raised my Venlafaxine dose from 150mg to 187.5mg, and explained why in terms I hadn’t heard before.

Venlafaxine below 150mg works primarily on serotonin. Above 150mg, it shifts mechanism, what she described as going onto “two tracks” – producing mainly noradrenaline and dopamine instead. This shift does two important things: it makes the medication work more in alignment with how it helps ADHD brains, and it significantly reduces the risk of serotonin-related side effects.

Including, potentially, weight gain.

Here is where it gets interesting: Venlafaxine is actually known to cause weight loss in many patients. But at lower, serotonin-dominant doses, some people experience the opposite, increased appetite and weight gain, because serotonin affects hunger regulation. I may have been sitting at exactly the dose where serotonin dominates, experiencing the serotonin side effects, without getting the full noradrenaline and dopamine benefits.

Raising the dose slightly may shift that balance entirely.

She also prescribed Trimipramin in drop form, a tricyclic antidepressant with sedative properties that she has had good results with in patients also taking Venlafaxine, partly because the reduced serotonin interaction risk at the higher dose makes the combination safer.

Last night was my first night on Trimipramin. 8 drops at 9pm.

Sleep score: 76. REM sleep: 1 hour 44 minutes. Core sleep: 6 hours 11 minutes.

Compare that to Amitriptyline’s 16 minutes of REM.

This morning I woke up slightly tired, but after months of genuinely poor sleep, that’s hardly surprising. The moment I got out of bed, something felt different. I was happy. Full of energy. I did a full hour of yoga without any issues, no pain, no fatigue, no dragging myself through it. The contrast with the Promethazin mornings, where I couldn’t open my eyes and felt like I’d been hit by a bus, could not have been more stark.

It’s one night. I never draw conclusions from one night. But it’s a very promising start.

What I Want You to Take Away

This is the third medication post I’ve written, and I keep coming back to the same theme: the medication landscape for neurodivergent people is complex, under-researched, and deeply individual. What works brilliantly for one person does nothing for another. What causes weight loss in most people caused weight gain in me, because of a dose-dependent mechanism shift that most people are never told about.

The questions worth asking your doctor:

• At what dose does your antidepressant shift its primary mechanism?
• What are the serotonin-specific side effects vs. the noradrenaline/dopamine ones?
• Are your sleep problems potentially related to the serotonin dominance of your current dose?

I am not a doctor and none of this is medical advice. I am someone with a complicated brain and a complicated medication history, sharing what I’ve learned in the hope that someone else’s journey becomes slightly less bewildering.

The sleep chapter isn’t over yet. But for the first time in eight months, last night I got nearly two hours of REM sleep.

I’ll take it.

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.