Navigating mental healthcare and finding a psychiatrist is challenging in many countries. It is especially tough if you are a neurodivergent person who isn't fluent in the native language and doesn't fully understand the system. It took me awhile to learn how to advocate for myself and get an ADHD evaluation in Germany. Here's the process I went through to get evaluated by an english-speaking psychiatrist and ultimately diagnosed with ADHD as an adult in Berlin. Please note that this was my personal experience and not a definitive guide.

Finding a psychiatrist and getting an appointment

If you have opted into the public healthcare system (gesetzlich versichert), it will probably feel a little bit insurmountable at the beginning to find a psychiatrist that accepts public insurance AND is accepting new patients AND can offer support in english. But it's possible! And I want to give you some insight into the process.

Before my move to Berlin, I was already dealing with anxiety and depression. I was starting to investigate what ADHD looks like in adult women (reading this book helped a lot) and questioning if all my anxieties and depression were actually symptoms of undiagnosed ADHD. But, to be honest, I didn't know any women personally that had been diagnosed with ADHD. It was only through twitter that I had begun to connect with folks with my interests that also happened to be ADHD or neurodivergent.

So, since I was already dealing with anxiety and depression at the time, I knew that I was probably going to need to find a psychiatrist in Berlin once I got settled. I also knew it was going to take months for me to actually follow through and do it. Even though it was an important task on my to-do list, it was going to be hard to actually get started and "do the thing". It was going to take me a lot of effort and motivation to research and find an english-speaking psychiatrist, and I knew that because of this effort needed, I was definitely going to avoid doing it (and also have anxiety because I wasn't doing it).

I had made some connections in Berlin through twitter, so my low effort approach was to casually start asking them if they knew of anyone that knew of any english-speaking psychiatrists that took public insurance and were accepting new patients. This is how I was lucky and got the contact info for my psychiatrist (whom I am still a patient of).

If you have private health insurance (privat versichert), it will be way easier to find a psychiatrist that accepts private insurance and is accepting new patients. It is likely that a google search will provide several options for psychiatrists with appointments available.

If you have public health insurance (gesetzlich versichert) but are willing to pay out of pocket to see a psychiatrist that only accepts private health insurance, I would strongly consider going this route and just pay the costs yourself. To get an ADHD evaluation will probably take 2-3 visits with a psychiatrist which would likely cost a couple hundred euros.

Though I had the contact info of a psychiatrist, I sat with this info for months. I basically let my mental health deteriorate immensely to the point where I was barely coping with my anxiety and negative self-talk. This is when I knew I couldn't avoid this task any longer and urgently emailed for appointment. I was lucky they were still accepting new patients and could offer me an appointment.

What to expect at the appointment

Psychiatrists are overbooked and overworked. Expect the appointment to be short and to the point. The advice I wished someone had given me before I went to my first appointment here is to be prepared to assertively and clearly ask for what you want from them. If you are struggling with anxiety and/or depression but think ADHD might be the root cause, and want to be evaluated for ADHD, succinctly express the desire to be evaluated for ADHD.

I most definitely delayed my ADHD diagnosis by discussing a lot at that first appointment about I was struggling with anxiety and depression and my feelings and questioning that maybe it was linked to undiagnosed ADHD, but I didn't assertively request an evaluation for ADHD. I was emotional and coupled with the fact I had previously been diagnosed with depression, I was again diagnosed with depression. Anxiety and depression often also occur with ADHD, so it's not uncommon to be misdiagnosed initially.

Writing yourself notes or talking points to have handy is a great strategy that I would recommend. I used this strategy the next time I asked for a ADHD evaluation.

Dealing with not getting an ADHD evaluation initially

The doctor wanted to prescribe a SSRI for the depression. However, I did not want to take a SSRI because of the possible side effects (weight gain and loss of libido). So I was offered a SSNRI (Milnaneurax) instead. I accepted my diagnosis and decided to take the SSNRI after I researched and found that the medication is a non-stimulant option for ADHD. I felt that maybe it was the best I could do for myself at the time and at least I would be on some medication that could offer me some benefits if my struggles were related to ADHD.

I was on this medication for over 2 years. It did help boost my motivation and energy levels. I felt like myself on the meds. It made my emotional meltdowns somewhat less frequent and intense, but I still struggled with them. And I still struggled with getting overwhelmed and the self-deprecating negative thoughts when I couldn't focus or find motivation.

I continued to look out for other women in Berlin sharing stories of getting diagnosed with ADHD to try to find out which doctors might be empathetic to an adult woman seeking an ADHD evaluation, but I kind of gave up on the likelihood of getting diagnosed at this point. On the rare occasions that I would discuss my suspicions of ADHD in myself with folks, I would get discouraging advice that it was going to be an uphill battle to get a diagnosis since I am successful in my career and can keep a job. This was so frustrating to hear! I feel I'm successful in spite of my ADHD and the challenges it presents me.

Asking for the ADHD evaluation (again)

It was only after I started dating my partner last year that I decided to try again asking for an ADHD evaluation. He was diagnosed with ADHD when he was 7. He later told me that on our first date, he was already convinced I too had ADHD based on my lack of eye contact (was it really that bad?), my interests in niche hobbies and topics and the style in which I approached conversations.

With his support, I came up with a plan to ask again for the evaluation. I wrote the following script before my appointment so that I could stay focused and clearly express my arguments for why I should be evaluated for ADHD:

I started dating someone that was diagnosed with ADHD at age 7 and he has brought to my attention that we have a lot of similarities in how we act and talk and our coping mechanisms and we've discussed ADHD a lot.

List of healthy coping mechanisms:

• coffee
• therapy
• jogs
• routines/rituals

When I originally came for my first appointment, I wanted to discuss an ADHD evaluation and instead I was treated for depression. I have tried this anti-depressant and other medications for anxiety and insomnia and also healthy coping mechanisms. Despite these things, I'm still struggling with focus, ignoring distractions and not getting overwhelmed.

I don't think I'm in the box I'm supposed to be in. I would like to ask again for an evaluation for ADHD.

This was a successful strategy and I received a separate appointment for the ADHD evaluation!

Preparation for the ADHD evaluation

I was given a questionnaire (see below) to fill out and instructed to remember examples from my childhood of things I struggled with or that were easy. I also needed to get an EKG (to check my heart function) from my Hausarzt in the case I would be prescribed ADHD medication.

ADHD Evaluation

I was nervous for the appointment because I worried I would need to bring up a lot of specific memories from my childhood as evidence of my ADHD. I could remember a few examples from my childhood, but for the most part I have a poor memory of my childhood. However, the evaluation was straight-forward. My psychiatrist went through the take-home worksheet and scored it based on my answers and also asked questions from other diagnostic worksheets that evaluated my struggles with ADHD as an adult and calculated an overall score. For the adult ADHD evaluation, it was necessary to answer the questions without considering the coping skills I have built up over many years as an adult and this was difficult! I was diagnosed with ADHD and immediately offered medication.

Medication

I was expecting to only be offered Medikinet, as it is the ADHD medication most folks take in Germany. However, I was offered my choice of 3 stimulant-based medications: Medikinet (methylphenidate), extended-release Ritalin (methylphenidate), and Elvanse (lisdexamfetamine). My doctor went through how each worked, how they were released differently over time and how often during the day I would need to take it. They also offered to go through the non-stimulant options if I wasn't interested in any of the stimulant meds. Honestly, it was information overload and was completely overwhelming to make a decision at that moment. I opted to start with Medikinet. I would start with the lowest dose, 5mg, and take it twice a day for a couple weeks to see how I adjusted.

When I started taking Medikinet, I would feel a bit spacey and sluggish immediately. And if I drank a coffee too soon after taking it, I would feel even more spaced out. I definitely had unreasonable expectations that I would immediately get laser focus and it would immediately and drastically improve my productivity, especially for tasks I avoid. You may read about others' experiences and may feel like it's not working for you if you don't see immediate improvements.

It takes time for your body and brain to adjust to the meds, so it may take some weeks before you see sizable improvements. I didn't feel bad on Medikinet and I could start to see some small improvements in my focus and self-assurance, but Medikinet is a short release medication (~4 hours). So for a full workday, I needed to remember to take my second dose at lunch. I was struggling to do this and it made me feel really up and down during the day.

I decided I wanted to try an extended-release medication instead. I took time to research all of the stimulant options I was offered and decided to speak again to my psychiatrist and switched to Elvanse. Since it works for 10-14 hours, I'd only have to remember to take it first thing in the morning. Again, I started on the lowest dose of Elvanse (30mg) for a week and if it was going ok, I'd double my dose to 60mg and see how I felt. My doctor expected I'd land on either a 50mg or 70mg Elvanse dose long-term. After this titration, I have stuck with 50mg of Elvanse daily. I also consulted with my psychiatrist and if I need an extra focus boost in the evenings, or if I'm feel extremely overwhelmed or having an emotional meltdown, I'll take 5mg of Medikinet as well in these situations.

How I feel when I take my ADHD meds

I take my meds first thing after waking up. I take an Elvanse and drink a glass of water. I walk the dog, prepare a tea and breakfast bowl. I work from home, so I move to my desk and start working while I eat my breakfast. I feel my meds kick in fully 1.5 - 2 hours after I take them. This "kick in" feels like the desire to get stuff done and the confidence that I can "do the thing". The meds give me an oomph to get going and give me a bit more resiliency during the day.

I work as a software engineer and have struggled with imposter syndrome and overwhelming anxiety that I will be found out as an intellectual fraud. On my meds, I don't feel this imposter syndrome as much. I have more confidence in myself to be able to do hard tasks. I rarely cry at my desk now, don't get stuck in negative self-deprecation cycles and have considerably less emotional meltdowns. I feel confident and capable of figuring out any task. I get completely immersed in my work tasks. The downside is that I find it harder to take regular breaks or to eat lunch at a reasonable time and it's been harder to pull myself away from my desk to take lunchtime jogs.

On weekends or holidays, I still take my meds regularly. The only times I skip my medication is if I have traveled outside of Germany and lacked the planning necessary to get the appropriate documents issued from my psychiatrist and signed by the Gesundheitsamt in time to take my meds with me (yes, you are supposed to have a very specific signed form to travel with stimulant medication, even within the EU, since stimulant meds are considered narcotics. I wrote about the process here).

I still enjoy drinking coffee on my meds but I generally wait at least 2 hours after I wake up to make a coffee. I also switched to eating a high protein breakfast and try to eat more protein than carbs at lunch, as I felt a full-body tiredness and less alert if I carb load while on meds. I drink alcohol less frequently- I have more headaches and struggle with falling asleep if I do.

The greatest benefits for me is my improved mental resiliency and the decreased likelihood that I'll feel emotionally overwhelmed and have a meltdown. I show more kindness and forgiveness to myself. I still have times I struggle with low energy and ADHD paralysis, especially during the gray and gloomy Berlin winters, but I always feel like myself.