I go to bed. I close my eyes. And my brain, apparently unbothered by the concept of rest, continues doing exactly what it does all day, thinking, connecting, processing, sensing. The lights go out, but the engine keeps running.

For most of my life I assumed this was just how sleep worked. It is not.

The State Between

There is a neurological phenomenon called hypnagogia, the transitional state between wakefulness and sleep where the brain is technically no longer conscious but hasn’t quite stopped thinking either. It produces thoughts and experiences so vivid and coherent that they feel completely real, because the content isn’t fantastical. You’re not flying or talking to cartoon animals. You’re lying in bed, thinking. Which is exactly what you’d be doing if you were actually awake.

For people with ADHD, this state is particularly pronounced. The ADHD brain has difficulty fully powering down. Even in sleep it keeps processing, planning, making unexpected connections, because that’s what it does, and no one told it to stop just because the body is horizontal.

I used to find this disorienting. I now find it useful. Some of my best ideas don’t come in the shower or on a walk. They come at 3am when my brain thinks I’m asleep but forgot to tell the rest of me.

The most vivid example I can give: I had been wrestling with a difficult professional situation for months. Should I address it directly? Stay quiet? The conscious, awake version of me kept circling the same options and finding none of them satisfying.

Then one Saturday morning, in that half-in, half-out state, my brain handed me something I hadn’t considered. Not a solution to the problem, a way around it entirely. An email that had nothing to do with the problem at all, that simply reconnected me with someone important, with no agenda, no complaint, no direct confrontation. My brain had quietly concluded that the problem didn’t need solving head-on. It needed patience, and a different kind of connection that might, in time, create its own resolution.

My fully awake, fully filtered brain would have kept circling. My hypnagogic brain cut the knot. I sent the email before I was even fully conscious. The outcome exceeded anything I could have engineered deliberately.

This is also, I believe, where my fraud instinct lives. The pattern recognition that fires before I can explain it. The knowing that arrives before the evidence. The prefrontal cortex, the part that edits, doubts, and overrides, is offline. What’s left is pure signal.

Forget Everything You Just Learned

During a stay at a clinic, I attended a sleep hygiene class. You know the drill: no blue light, no screens, no stimulation before bed, dark room, quiet environment. All the standard advice.

When the class ended, I walked up to the doctor and said: “I know all of this. But it doesn’t work for me. I fall asleep like a champion within five minutes of watching TV.”

He looked at me with a completely straight face and said: “Do you have ADHD?”

He had the look of a man quietly reassessing everything he thought he knew about sleep.

I said yes. He said: “Then forget everything I just taught in there. None of it applies to you. Your brain needs stimulation in order to power down. Complete silence will keep you awake.”

I have never felt more seen by a medical professional in my life! And the kicker? This was a clinic that treated many ADHD patients. Nobody thought to mention this in the class. To the room with numerous people it applied to most.

This is why my evening routine involves the TV, a game on my tablet, and often a conversation with my AI collaborator, simultaneously. Not because I can’t focus. Because I focus better with all three running at once. The ADHD brain doesn’t power down through silence. It powers down by getting just enough input to stop generating its own. Give it nothing and it will create something. Give it something manageable and it will finally, eventually, let go.

The Dreams That Aren’t Quite Dreams

Then there are the other ones. The dreams I am less sure how to explain.

In early 1994, Los Angeles was hit by the Northridge earthquake, one of the most destructive in the city’s history. I had arrived from Germany barely a year earlier and had never experienced an earthquake. In the two nights before it struck, I dreamt about it. The first night: the damage to buildings and infrastructure. The second night: the ocean, with waves rising high. People being scared, but there weren’t any real casualties. On the third night, somewhere around 4 or 5am, the ground moved.

I had been telling my then-husband about the dreams. He was baffled. I was too, honestly. But it wasn’t the first time something like that had happened, and it hasn’t been the last.

I learned to read Tarot in my 20s. Not because I believed the cards held the answers, but because having a tool made things easier to explain. When you know something you shouldn’t be able to know, people find it less unsettling if there’s a prop involved.

I want to be careful here, because I am not claiming supernatural powers. What I believe, and what science increasingly supports in interesting ways, is that the AuDHD brain processes an extraordinary volume of information below the level of conscious awareness. Pattern recognition operating at a depth the thinking mind never sees. Micro-signals absorbed and synthesized before they ever surface as a thought. What feels like knowing is often the brain finishing a calculation it started long before you were paying attention.

Whether that fully explains what I’ve experienced across my life, I honestly don’t know. Quantum physics has demonstrated that reality operates by rules far stranger than our daily experience suggests. I find it less unsettling to sit with the mystery than to pretend it doesn’t exist.

What I do know is that this same mechanism, whatever it is, shows up in how I detect fraud, how I read people, how I know within minutes whether someone is dishonest or truthful, being genuine or performing. It’s not intuition in the vague, hand-wavy sense. It’s information processing happening below the conscious surface, arriving as certainty before it arrives as explanation.

The Brain That Lives in Two Places

All of this connects to something I wrote about in my last post – the parallel universe, the camera feeling, the sense of existing slightly outside ordinary reality. Sleep is where that experience is most concentrated and most undeniable.

The vivid dreams that feel more real than waking life. The hypnagogic state where thought and dream are indistinguishable. The precognitive quality of certain dreams that I can’t explain away. The concept of astral travel, the idea, supported by quantum physics or Einstein’s theory of relativity, that consciousness might not be as firmly located in one place and time as we generally assume, doesn’t feel abstract to me. It feels descriptive.

I’m aware that this is the point where some readers will edge toward the door. That’s okay. I spent decades not talking about any of this for exactly that reason, the fear of sounding unhinged, of being dismissed, of losing credibility I’d worked hard to build.

But here’s what I’ve come to: a brain that has never fully powered down, that processes reality on multiple levels simultaneously, that generates its best thinking in the space between sleeping and waking, that brain is going to have experiences that don’t fit neatly into standard descriptions of consciousness. That’s not a malfunction. That’s the logical consequence of being wired this way.

What This Means for Sleep

Practically speaking, AuDHD and sleep have a complicated relationship. The brain resists shutdown. It generates vivid, sometimes startlingly real experiences in the transition states. It makes connections and solves problems overnight that the waking mind couldn’t crack. It occasionally knows things it shouldn’t.

What’s helped me most is accepting that my sleep will never look like the textbook version, and that this isn’t entirely a loss. The email that changed my year came from that half-awake state. So have ideas, insights, and moments of clarity I couldn’t have manufactured consciously.

The brain that never powers down is exhausting to live in sometimes. But it is also, quietly and consistently, doing work I didn’t ask it to do,  and occasionally the results are extraordinary.

I’ve learned to keep a notebook nearby. Just in case.

I am sitting in a meeting. Someone is talking. To all external appearances, I am present – eye contact, appropriate nodding, the occasional thoughtful expression. And then someone notices my eyes have gone glassy, that I am looking directly through them rather than at them, and they say, with increasing alarm: “STOP STARING AT ME!”

I am not staring at them. I am not even there. I left about two minutes ago and forgot to take my body with me.

Welcome to Part 2 of my relationship with time, which is less about efficiency and more about the fact that I have never been entirely sure which universe I actually live in.

The Parallel Universe

Long before I had any diagnosis, long before anyone had words for what was happening in my brain, I built myself another world.

It had different parents. In this world, I was loved without condition, I had friends, I was popular, I had everything I had wanted and I was happy. It was vivid and detailed and completely real to me, not a daydream exactly, but a place I could go. And I went there often. During school especially. Teachers would call on me and get no response, not because I was being difficult, but because I was genuinely elsewhere.

This got particularly noticeable around 4th grade and into the first half of 5th grade. Teachers scolded me for not paying attention. What they didn’t know, what I couldn’t have explained, was that I was managing two parallel lives simultaneously, and the other one was considerably more pleasant than this one.

Then, somewhere in the second half of 4th grade, I made a decision. I chose to stop going there.

Three different therapists, across different periods of my life, have independently landed on the same response when I told them this story: that I had made a conscious choice between sanity and insanity. That given everything I had experienced, I could have ended up completely lost in that other world, catatonic, unreachable, and that people had arrived at that place with far less reason than I had. They were also unanimous in their bewilderment at how I had done it, given that the cognitive ability to make that kind of decision shouldn’t have existed in a child that age.

What I told them was simple: I knew that if I kept going back, there would come a point where I couldn’t return. And as much as I loved that other world, I chose this one.

I never fully understood why I was able to make that choice. What I know now is that I was never really a child in the way the world expects children to be. I was an adult trapped in a child’s body, giving my mother relationship advice before I had even started school, sorting my toys by height on a shelf rather than playing with them, navigating adult emotional landscapes before I had the vocabulary for any of it. The cognitive ability the therapists said shouldn’t have been there, it was there, because it had to be.

The Camera

Here is something I have never talked about before.

For as long as I can remember, I have had the persistent feeling of being watched. Not in a paranoid way. I know, intellectually, that there is no camera. But I move through life with a background awareness of being observed, as if I am a character in a film and somewhere, in some other universe, an audience is watching.

I think of it as the Truman Show feeling. And like Truman, I sometimes find myself wondering: what if none of this is real? What if I actually live in that other universe, and this one is the constructed one?

This feeling has not always been unwelcome. In many ways, it kept me safe. When I was on the verge of a decision that could have gone badly, something would pull me back – the awareness of the camera, the sense that I was accountable to something larger than the moment. It kept me out of a lot of trouble. It made me follow rules even when I disagreed with them, because some part of me felt that how I behaved mattered beyond the immediate situation.

What I have since learned is that this experience has names. What I was describing, observing my own life from the outside, the feeling of existing in a kind of waking dream, the blurring of boundaries between states, is known as depersonalization and derealization. And it is significantly more common in neurodivergent people than most realize. The parallel universe I built as a child, the camera feeling, the vivid dreams that feel more real than waking life and sometimes recur across years, these are not signs of psychosis. They are signs of a brain that experiences the boundaries between inner and outer reality differently than most.

I was always too ashamed to speak about this. It felt too strange, too close to something I was afraid of being labeled as. But it is not hearing voices. It is not hallucinating. It is a brain that built extraordinary coping mechanisms in extraordinary circumstances, and then never quite dismantled them, because they were useful.

The Disappearing Act

Which brings me to dissociation — or as I prefer to call it, my emergency exit.

I can step away entirely and most people will never notice. Not in a dramatic way, not with any visible sign. I am simply there, and then I am not, while my body stays behind and does a passable impression of paying attention. I learned in a clinic that this is common in people with AuDHD, that the brain, when overwhelmed by sensory overload beyond a certain threshold, simply… steps out for a moment. Hits pause. Goes somewhere quieter.

The only time it becomes visible is what I now know to call a freeze response. My eyes go unfocused, I look through whoever is in front of me rather than at them, and I am simply gone. It’s the situation I’ve described in the beginning of this post. It tends to make people uncomfortable. It also, on more than one occasion, made people angry, particularly men who interpreted my vacant stare as aggression or a challenge and responded accordingly. Being shouted at for staring when you are not even present is a special kind of surreal experience.

What nobody ever stopped to consider was that I was not staring. I was coping.

300 Years Old and 30 at the Same Time

There is one more way that time works differently for me, and it is harder to explain than all the others.

I feel ancient and young simultaneously. When I turned 40 and caught my reflection and suddenly noticed I was aging, it was not the aging itself that unsettled me; I have always looked considerably younger than I am, and that has not changed. What unsettled me was the awareness of limitation. Of a world that looks at a woman who is, on paper, in her 40s or 50s, and makes decisions accordingly – about what she is capable of, what she should be offered, what chapter of life she must be in. From the inside, I have always been able to reinvent myself entirely, to start over, to become something new regardless of how many years had technically passed. Age never felt real to me in a linear way. It still doesn’t.

And yet. I am also acutely, painfully aware of time passing. When it is June, the year already feels almost over. Entire periods of my past feel genuinely inaccessible, not forgotten exactly, but sealed off, as if they happened to someone else in another timeline. Which, in a way, they did.

The Lightbulb

The last piece of this is perhaps the most AuDHD thing about me.

I do not evolve gradually. I do not inch forward through slow, incremental change. I try and try and try to shift a pattern, to understand something, to break through a wall I can feel but cannot see, and nothing happens. And then one day, without warning, a lightbulb turns on. The puzzle unfolds in my mind’s eye, complete and fully formed. I see it. All of it. And I cannot understand how I didn’t see it before.

Once something clicks, I do not forget it. I do not slip back. I simply become different, immediately and permanently, in a way that apparently unnerves people who were not expecting it. It is one of the reasons a clinic once declared me ready to leave ahead of schedule. Not because the work was easy, but because when it landed, it landed completely.

This is not patience or discipline. It is just how my brain processes things – in the dark, and then all at once, in the light.

What It All Means

I have spent a lot of time in this post describing things I have rarely or never said out loud. The parallel universe. The camera. The disappearing. The strange relationship with age and years and the passage of time.

What I want you to take from this, if you recognize any of it, is that none of it makes you broken. It makes you someone whose brain found extraordinary ways to survive an ordinary world that wasn’t built for it. The parallel universe was not madness. It was creativity in the service of survival. The camera was not delusion. It was accountability without external structure. The dissociation was not weakness. It was your nervous system doing exactly what it was supposed to do.

You built what you needed, with what you had, before anyone gave you a name for any of it.

That is not a disorder. That is resilience.

There is a particular kind of loneliness that comes not from being alone, but from being consistently misread by the people around you. From trying your hardest to connect, and watching it land wrong. From caring deeply, sometimes too deeply, and being told you are cold, arrogant, aggressive, or self-absorbed.

This is a story I know well. It is the story of most of my life.

“You always make everything about yourself”

One of the things I heard most often in relationships and friendships was that I made everything about me. Someone would share an experience, and I would immediately jump in: “Oh my God, that happened to me too!” or “I know exactly what you mean, once I…”

What I was trying to do was make them feel heard. Safe. Less alone in their experience. In my mind, sharing a similar story was the highest form of empathy, proof that I genuinely understood, that their experience resonated so deeply it triggered my own memory.

What they heard was: here she goes again.

It took me a long time to understand that for most people, empathy looks like silence and nodding, not enthusiastic parallel storytelling. And it took even longer to stop feeling hurt by that, because my intention was always the opposite of selfishness. I was relating. I just didn’t know that my way of relating looked, from the outside, like hijacking.

This is one of the cruelest paradoxes of AuDHD: I feel everything. Other people’s pain, joy, discomfort, excitement, I absorb it all like a sponge. And yet the very intensity of that feeling causes me to respond in ways that get misread as oblivious or egotistical.

Too Much, and Never Enough

I am animated. When I am excited, I get loud. When I am angry, I get louder. When I am passionate about something, I talk faster, my hands move, my whole body gets involved. I have been told I am aggressive, combative, threatening, intimidating, and half the time I didn’t even realize my volume had climbed.

I would walk away from conversations genuinely confused. Was I angry just now? I didn’t feel angry. I was passionate. I was engaged. I was, in my own internal experience, enthusiastic, and what landed on the other person was a wall of intensity they didn’t know how to handle.

So I learned to censor. To monitor my own volume in real time, to modulate my tone, to consciously soften edges that felt sharp to others but completely normal to me. It was exhausting. And it was yet another layer of masking – performing “calm” and “reasonable” while internally running at full speed.

At the same time, I somehow also managed to miss obvious signals. Hints. Subtext. The thing someone is really saying when they say something else. I can walk into a room and feel the tension before anyone has spoken a word, and yet completely miss that someone has been trying to tell me something for weeks because they never said it directly. If you don’t tell me clearly, there is a good chance I won’t pick it up. Not because I don’t care, but because my brain is wired for directness and tends to take things at face value.

So I was simultaneously too much and not enough. Too intense, too loud, too honest,  and also somehow oblivious to the obvious. Another name for me „Captain Obvioius.“

The “Defect” Problem

I have spent my entire life learning everything I could about whatever captured my attention. When I was finally diagnosed with AuDHD, I did what I always do: I researched obsessively. I read everything. I learned about rejection sensitive dysphoria, about sensory processing, about the specific ways autism and ADHD interact and contradict each other in the same brain.

So when I was at a clinic and the therapists kept referring to AuDHD as a defect, a mental disability, and framing it as a psychological illness, I could not stay quiet. They had never heard of rejection sensitive dysphoria. They were telling patients that something was fundamentally wrong with them.

I argued. I corrected. I explained. AuDHD is a neurotype, not a disease. It is a different operating system, not a broken one. A neurodivergent brain is not defective, it is merely differently wired. There is a significant difference, and the language we use to describe it matters enormously, especially to the people sitting in that room trying to make sense of their own minds.

To their credit, they listened. “We didn’t know that,” they said. And that was that.

But that reaction was the exception, not the rule. More often, at work, in friendships, in countless conversations where someone asked for my opinion or advice, the pattern looked very different. I would research deeply, form a well-grounded view, and share it honestly. And I would be told I was arrogant. Lecturing. Too serious. Sitting on a high horse. The cruelest version of this was when someone specifically asked for my input, didn’t like the answer, and then made me the problem for giving it.

I have a sense of humor, by the way. A very good one. I can sit in a corner laughing at something ridiculous I said or did, completely entertained by my own brain. It is just that my humor tends to be dry, or specific, or internally referenced in a way that not everyone follows. I spent years thinking something was wrong with my sense of humor too. Turns out, I was just funny in a room that wasn’t tuned to my frequency.

The Honesty Problem

I still don’t fully understand why honesty is treated as a character flaw.

I don’t understand the social contract that says you should soften the truth to the point of unrecognizability, or stay silent about something that matters, in order to keep the peace. I find dishonesty, even the polite, well-intentioned kind, genuinely confusing. Why say you’re fine when you’re not? Why agree when you disagree? Why not just say the thing?

The answer, I now understand intellectually, is that most people are managing a complex web of social relationships where directness can cause damage and ambiguity preserves harmony. I understand this. I just cannot always execute it.

What I struggle with most is knowing when it is safe to speak. I book a seat in the quiet section of the train specifically because I cannot manage the sensory overload of noise and chaos. When someone sits down next to me and proceeds to have a loud phone conversation, I am faced with an impossible choice: say something and risk being attacked for it, or say nothing and sit in sensory distress for the next few hours.

I have tried both. Neither works consistently. When I speak up calmly, politely, I am mostly still met with rudeness or hostility that I did not expect and cannot regulate my response to. When I say nothing, I spend the journey white-knuckling it through the noise, blood pressure rising and desperately trying to control my anxiety.

The result is that I often feel voiceless. Not because I have nothing to say, but because how I say it tends to land wrong, and when I am already emotionally activated by someone being rude or unkind, my ability to regulate my tone collapses entirely. I become the problem, even when I wasn’t the one who created it.

What I Wish People Understood

For most of my life, I was made to feel stupid. By teachers who called me lazy. By people who didn’t understand me and assumed the fault was mine. By systems that mistook my intensity for aggression and my honesty for arrogance. That feeling never fully went away, even after I had every reason to know better.

The truth is that being misunderstood this consistently and this chronically does something to a person. It makes you doubt yourself. It makes you wonder if the problem really is you, if you are too much, or not enough, or simply wired wrong.

What I know now is that I was never too much. I was just in the wrong rooms, with people who didn’t have the tools to understand me, and sometimes, frankly, didn’t have the desire to try.

There were always people who got it. Who found my honesty refreshing instead of offensive. Who laughed at the same things I did. Who didn’t need me to perform a quieter, softer, more palatable version of myself. They were, unfortunately, in the minority.

But they were enough to remind me that the problem was never me.

It was the frequency.

I recently attended a sales training. Not exactly my natural habitat, I am not a salesperson, I am a fraud prevention consultant, but it turned into one of the most unexpectedly validating experiences I’ve had in a long time.

The trainer had spent quite some time working for tech companies in the US and Israel before returning to Germany. He also knew various cultural differences, communication styles and worlds, which turned out to be relevant.

First, a detour: Active Listening

Early in the training, the topic of active listening came up. The trainer quickly realized that this wasn’t a new concept for me and that I had been applying it for years. He asked me to explain what active listening actually looks like in practice.

Here’s the irony: active listening does not come naturally to me at all.

One of the hallmarks of ADHD is that we relate to people by sharing our own experiences. Someone tells you about their difficult day, and your brain immediately fires back with a similar story of your own, not out of selfishness, but because that’s how we connect. The problem is that it looks like interrupting. It looks like making everything about yourself. I spent years being perceived as rude or self-centered for something that was simply how my brain was wired to show empathy. I needed to make sure that people felt safe and in my head, they’d definitely feel safe if they know that I had experienced a similar situation or  challenge.

Active listening taught me to do something genuinely difficult for my ADHD brain: to be fully present in what someone else is saying without simultaneously preparing what I will say next. To listen without an agenda. To hear not just the words, but the tone, the hesitation, the thing behind the thing and then simply sit with it rather than immediately responding. I had to learn to be comfortable with silence and also potentially not having a solution or a response.

I had to consciously learn and practice this, and I developed hacks to make it work. I stopped bringing my phone or laptop into meetings and one-on-ones. Not as a courtesy gesture, but as a hard rule for my own brain. Because I will get distracted by anything and everything if given the chance. If the devices aren’t there, they can’t compete for my attention. For the same reason, I always sit in the front row when someone is presenting, and I keep my camera on in remote meetings. It forced me to be fully present with the person in front of me, and over time it became one of the most powerful tools in my management and communication toolkit.

And apparently, I had gotten good enough at it that a trainer with decades of experience thought it was innate.

Then Came the Cold Call Email

The main exercise of the day: write a cold call email that would actually get read and get a response. The trainer told us that most cold emails are deleted without a second thought. Our job was to write one that wouldn’t be.

Here’s what we knew about him: he is an avid sailor who also teaches others how to sail. That was our hook, if we chose to use it.

The brief: Pitch something in a way that would make him read the email and consider responding.

For me, the answer was immediate. I have organized fundraisers and roundtables for most of my career. I know how to ask people for things. And the one thing I have always known is that the fastest way to get someone’s attention is not to pretend you want nothing from them, but to be completely honest about what you need and why you think they specifically can help.

So I wrote this:

Subject: I could use your help and expertise!

Dear [name],

I have learned that you are an avid sailor, and not only sail to various locations, but also teach others how to sail. Based on your extensive background in coaching, training and teaching, I thought you to be the perfect person to help me with a project.

I am a consultant in fraud and risk prevention and I’m currently in the process of starting a new roundtable that would enable eCommerce companies to share their pain points, knowledge, as well as potential solutions. Unfortunately, it is difficult for me to get people to join my roundtable, since I am working for a fraud solution provider, and in the global fraud world they are usually banned from these conversations.

I am well known in the international fraud world, but not as much in the DACH region. Do you have any idea how I could engage people who do not know me yet and build this roundtable?

Please let me know if you’d have a few minutes to discuss and give me some insight.

Warmest wishes, Carmen

He read it out loud to the group. Then he went through it, line by line.

“Let’s start with the subject line. See how she is asking for help and expertise? It instantly got my curiosity, because here is someone who doesn’t seem to want to sell me anything.”

He walked through how I had connected his sailing background not as a gimmick, but as a genuine reason why his specific experience made him the right person to ask. He pointed out that I had named my own obstacle openly – that working for a solution provider typically gets you excluded from exactly the conversations you need to have. He called the tone personal, humble, and authentic. Not salesy, not demanding.

He said it could have been a little shorter, but that even that wasn’t really an issue.

“This,” he said, “is an email that gets a response.”

What He Didn’t Know

He doesn’t know I’m neurodivergent.

He had no idea that the instincts he was praising, the active listening, the radical honesty, the ability to make someone feel seen rather than targeted, weren’t things I learned in a sales course. They were things I developed over decades of having to figure out how people work, because my brain processes the world differently and I had to compensate.

AuDHD means I have spent my entire life reading rooms. Masking. Adapting. Learning to communicate across different “operating systems,” different cultures, different communication styles, different expectations of who I was supposed to be. In the US, we did the Insight Discovery test, where personalities are differentiated by colors. Colleagues read me as Red -direct, driving, assertive. In Germany, people saw the Green-Yellow immediately – empathetic, positive, people-focused. Neither was wrong. Both were true. I had simply learned to present differently depending on where I was. In Germany I present much more authentic: Green, Yellow, Blue, Red.

What looks like a communication superpower from the outside is, from the inside, the result of a lifetime of work. Work that neurotypical people never had to do, because the standard social manual worked just fine for them.

The Bigger Point

We talk a lot in neurodivergent spaces about the deficits. The things we can’t do, the ways we struggle, the systems that weren’t built for us. And those things are real and worth talking about.

But there is a flip side. The same brain that makes a crowded conference overwhelming, that replays conversations for days, that masks so thoroughly that even a trained professional reads you as an extrovert, that brain also notices everything. It listens deeply. It connects dots others miss. It leads with honesty because performance has always been exhausting, and somewhere along the way it learned that authenticity is simply more efficient.

I didn’t write the best sales email in the room because I’m a natural salesperson. I wrote it because I have spent my whole life learning how to be genuinely heard and it turns out, that’s the only sales skill that actually matters.

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.

ADHD and hypersensitivity often occur together, especially in women. Research shows there’s a reason for this. The dopamine receptor gene DRD4 is associated with higher cognitive empathy in women, and certain dopamine gene variants are associated with the personality variant of hypersensitive people. Yes, we are literally wired differently.

ADHD people have an endless thirst for knowledge and wisdom, and it is also proven that the ability to recognize patterns is more pronounced in an ADHD brain. Not only are we more empathetic, but we also pick up on behavioral patterns more quickly and sense what people feel and need more accurately. But why is this? It is because of the three types of empathy that are wired differently in our brains.

1. Cognitive Empathy
   Allows us to mentally understand and put ourselves in another person’s situation and understand their thoughts and intentions.
2. Emotional Empathy
   Allows us to not only put ourselves in someone else’s shoes, but to actively feel their emotions in our bodies. Unfortunately, this also means that we can take on the moods of those around us, which can be detrimental in toxic environments.
3. Social Empathy
   Is derived from both cognitive and emotional empathy and allows us to understand people of different races, cultures, backgrounds, ages, personalities, etc.

We have a higher emotional reactivity, which leads to stronger emotions and increased emotional empathy. All of these traits are perfect when working in a social field, such as being a nurse, doctor, teacher, etc. Outside of these fields, however, these abilities are often detrimental and result in more judgment, friction, and trauma for us.

Our ability to feel and read other people’s intentions is also one of the reasons why we are often marginalized and targets of bullying and retaliation. We often forget, at least I always do, that other people rarely see the true intentions of others, so if a person is acting and behaving in a way that is detrimental to the team/others, or is deliberately trying to deceive, we will usually call it out; and pay a heavy price for it.

Because we are blamed, labeled, insulted, and attacked for our abilities for most of our lives, we begin to doubt ourselves and our self-esteem shatters over time. This is especially true for those of us who were diagnosed later in life. When 10 people tell you that you are wrong, a troublemaker, a liar, a shit stirrer, and a problem, while no one else around you acts the same way, sees the same things, and speaks the same language, you come to the conclusion that they are right. You begin to believe that there is something seriously wrong with you, that you are crazy, neurotic, emotionally unstable, and stupid.

The damage done to us by others, as well as a lifetime of masking, trying to fit in, hiding our true thoughts and feelings, while constantly censoring our words and actions, is exhausting and often leads to severe depression, anxiety, and burnout. Doctors will then mislabel us as suffering from clinical depression and anxiety disorders and prescribe antidepressants, which of course never work.

This world is not built for people like me. From huge, open-plan offices, to managers who not only know nothing or very little about psychology and especially neurodiversity, to performance measures that are not designed to reward or include individuality, we are simply doomed to fail from the time we leave kindergarten until the time we retire. Unless, of course, you are lucky like me and end up in a company and position that celebrates my neurodiversity and recognizes my special abilities rather than punishing me for my shortcomings.

I feel and suffer with all my friends and those who have not yet had the courage to be tested. I hope they find help and understanding so they can thrive before they break.

What do they do, and why is an amphetamine prescribed for people whose brains run too fast? The short answer is that they have the opposite effect on us than they do on a neurotypical person. All of these drugs increase the levels of chemicals/neurotransmitters that we do not naturally produce enough of. These neurotransmitters include dopamine and norepinephrine, which are basically responsible for concentration, i.e. the executive function of the brain, as well as feelings of well-being. So these chemicals actually slow our brains down!

How does that feel or look? Well, the first time I took Ritalin, I felt a little euphoric at first. But as the medication was slowly released into my bloodstream, I actually felt relaxed and almost sleepy, and my brain started to get a lot quieter. I was able to focus and concentrate. I was also able to have “normal” conversations, meaning that a) I was present instead of missing what was being said because I was somewhere else, and b) I didn’t interrupt anymore because the urge to interrupt because I wasn’t sure I would remember what I wanted to say was gone. In other words, I had impulse control. Believe me, this was very obvious to the people around me!

How do I take the medication? Well, the proper dosing and finding the right medication takes quite a while. I am on a medication called Medikinet, which is a newer version of Ritalin. It is slowly released into the bloodstream, but still has to be taken twice a day. Dosing is rather rough and I have been trying to find the right dose since May (2024). In addition, Medikinet cannot be taken on an empty stomach and I used to eat breakfast rather late, which meant that I couldn’t take the second dose, which brings me to the side effects.

If I take too little of the medication, my brain is still racing and it is hard for me to concentrate and get things done. My impulse to start 50 things and not finish any of them is strong, so I have to fight myself, make lists, and set timers to keep from going crazy. But when I take a higher dose, the rebound effect, when I come off the meds, is almost unbearable.
I get terrible headaches, especially in the morning when I wake up, but mostly in the evening when there’s little medication left in my system. The insomnia is real, so I cannot take the second dose too late; sometimes not at all. Other very unpleasant side effects include hot flashes, dry mouth, sweaty hands, palpitations, shortness of breath, and anxiety. The latter causes me to clench my jaw so hard that I get tension headaches from my neck down. The anxiety can also get so high that I feel almost paralyzed and don’t want to leave the house or just move from where I am sitting because I’m trying not to feel my body and have to distract myself. It almost feels like I am trapped in my body.
And with all this comes aggression. I am so tense that I am hyper-focused on my surroundings. For example, being in the car makes me want to cry because my depth perception seems to be off, so I am constantly aware that we are too close to another car. Any suggestion or “feedback” sounds like criticism and makes me angry. The rebound effects are greatly minimized by being distracted, so when I am out with people or attending a work function.

People may wonder why I would take something with such side effects. The truth is, the world is a million times worse without them. People at work have noticed that I feel calmer, happier, more focused and present, and overall “better”. It’s this feedback that makes me keep trying, and honestly, I couldn’t do my job, clean my house, or function at all without them. However, I will be asking my doctor at my next visit to possibly prescribe another medication that may work better for me. As I said, the initial dosing and trials to find the right medication take quite a while.

In the end, I’m doing better on medication. I check my blood pressure to make sure it stays normal, and at the hospital they did two EKGs to make sure my heart was okay. The statements that ADHD will eventually go away or can be controlled with vitamins/minerals and behavioral therapy are false and do more harm than good. This is the brain I have and if I want to have a decent life I need to regulate my brain chemistry with medication.

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.

Although impulse control disorder exists, it is also one of the most difficult symptoms of ADHD. A lack of impulse control means that you have trouble controlling your emotions or behavior; and this was by far the most devastating symptom.

I have lost count of the number of people who have lashed out at me because I “can’t keep my mouth shut. There are also those who have never said anything to my face, but just retaliated because I either said something I shouldn’t have or said something no one else had the guts to say to them. I have a tendency to not only call out dishonesty, unfairness, or hypocrisy, but to tell people to their face; and in professional situations, that will cost you your job, because your boss will not thank you for being honest, but will undermine you and find ways to get rid of you.

There are other things I’ve done that seem completely crazy to people, like traveling long distances and to places I’ve never been for jobs I should have researched better. Taking my car in for an inspection and deciding to trade it in for a newer model while at the dealership. Deciding that I don’t like any of my clothes anymore and need a whole new wardrobe. Shopping is something I have to be very mindful of because I can get lost in just buying things I will never use or wear.
While these are the “tame” examples, in hindsight there are hundreds of situations that could have gotten me into serious trouble or even killed me.

But why am I doing or saying these things? All I can say is that there is a strange thing going on in my brain that I am aware of, but I am unable to stop or control, much like one would be unable to stop a freight train. This behavior is particularly noticeable when it comes to my “speaking. In almost all situations, I have spoken up about behaviors that violate the rights of others or conflict with societal norms. I feel the words coming up in my head, I know they will get me in trouble or possibly destroy my career or relationship, but I am unable to stop them from coming out of my mouth. There’s a twisted part of me that believes that people can be reasoned with, regardless of their ideology or “opinions,” because mine can be changed if someone provides me with evidence to the contrary of what I believe. Maybe they didn’t know they were being unfair or biased or otherwise a jerk?

As I said in the beginning, this is the most heartbreaking and destructive part of my being – and it is the best weapon for narcissists and sociopaths to manipulate me. They quickly figure out that I am easily baited and upset, and then do or say things that elicit a reaction that they can and will immediately use against me. From convincing others that I’m crazy, lying, or harassing them, to making sure my credibility and reputation are destroyed, they watch gleefully – and while I saw it coming, I just couldn’t stop myself from reacting.

If I could make one thing go away, it would be this. I wish I was wired differently.