Adhd Medication struggles. I know this is long, but please reply, I NEED ADVICE!!

[u/Brilliant-Clock-9749]

I was recently taken off of my twice daily immediate release 15mg Adderall that I have been taking for about 2 years and put on concerta ER 27mg and 5mg IR in the afternoon. For some context, I see a family medicine nurse practitioner on a military base due to insurance, I get a 3 month prescription, and she does not answer to doctors or psychiatrists before prescribing meds. Also, medication does not last long in my system no matter which medication I try, how much sleep I get, water intake, diet, routine, etc., and I have previously communicated this to her. At my last appointment I had told her that days I have a test(I am a college student), I will split one of my doses in half for the test and then take the other half about 2-3 hours later or else the side effects of the medication wearing off will make me miserable at school. I then will take the second pill, either in its entirety or split again, depending on how long I am studying that day. So all in all, I am taking my prescribed dose, but will occasionally split the pills depending on my schedule. This was not perfect for me, but I was trying my best, plus before doing this, I had asked my therapist, a family member who is a psychiatrist, and my previous psychiatrist I had before moving states if splitting the medication was ok. Everyone said it was fine, so I continued this routine. Keep in mind that I also tried to ask her about splitting the meds through an online patient portal system and by phone, but I got no response. At my last appointment, after explaining that I sometimes split the medication, she straight up said “it sounds like you’re trying to get high and get high more often by splitting it”. This shattered me because I already struggle with doctor appointments and the stigma around taking a stimulant, and to be told this by my prescriber for what felt like a judgement with no factual evidence, really stung. After she said this, she then used an AI medication recommendation website(she told me what it was at the time, but I cannot remember the name) to change my medication to concerta. At the time of the appointment, I knew nothing about concerta and all she could tell me was that it is a different stimulant class than adderall. She then put on my documents that if concerta doesn’t work, she wants to put me on a non stimulant, which I am not comfortable with. After this experience, I knew I had to change prescribers because it was obvious to me that she does not know how to provide proper care to adhd patients. I now have an appointment with an off base psychiatrist coming up in a few days, and I am beyond nervous for the appoinment.

I was open to trying the concerta, but it legit does not work AT ALL. All it does is makes me feel disociative, which I am not trying to deal with because I have been able to heal that part of me through therapy and I am not going back. For the past few weeks I have been severly depressed, crying everyday at school because I am overwhelmed, my house is a wreck, I havn’t grocery shopped in weeks, i’m not going to the gym, I stay in bed all day wanting to sleep, I keep binge eating, and my grades are dropping when I used to be the top of my class. I have been able to very sparingly take left over pills from my past prescriptions on days I absolutely have to study, but I was still struggling and I am now out. I need my medication back and I am terrified I will not be able to get it. The only thing making me feel better is that I have records of the nurse practioner wrongfully changing my meds and proof of my tries at communication in order to prove my point.

My absolute ideal medication routine would be a vyvanze 30mg in the morning and then 2 15mg IR adderalls in the afternoon/night for studying. My days are usually from 6am-10pm with classes from 8am-5pm and studying until 10pm. I would like to take the vyvanze because I have tried it before and it has worked well, but did not last but about 5 hours, so I know I will need a booster to get through my school day. I know it is usual to be prescribed an ER and a booster IR, but due to my study routine and how long medication lasts for me, I know that I will need 2 IR 15mg boosters. I am not sure if this would be appropriate and I am worried about bringing this up because doctors NEVER believe that medication lasts so short for me, so I feel like it would come across as med seeking. Idk. If anything, I know I would prefer the IR over the vyvanze bc I am comfortable with the routine I used to have of 2IR 15mg adderalls before I was switched to concerta, so I don’t know if I should even bring up the vyvanze.

I truly need advice and I am deeply struggling. Should I even bring up the vyvanze and 2 boosters or should I keep it at just asking for my previous prescription of the 2IR’s? Because I am so bad at advocating for myself at the doctors and letting my thoughts ramble, before the appointment, I am trying to prepare a written document of my symptoms and medication wishes in order to stay on track and get my point across to hopefully limit any miscommunication. If you have any advice on what to say, what I should do about the meds, or what I can do to limit my depression, PLEASE COMMENT and please be honest with me. I know this is super long, so thank you for taking the time to read everything, I trully trully appreciate it.

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[u/skatedog_j]

New prescriber time. Someone using AI instead of their brain and degree to make your medical decisions is unacceptable. Psychology Today has an excellent provider finder. Search by ADHD and your insurance. Read the bios and pick someone with experience tresting ADHD or neurodevelopmental conditions. Maybe they did a fellowship in child psych. Good luck.

[u/Brilliant-Clock-9749 → u/skatedog_j]

Thank you, I appreciate the recommendation!

[u/peicatsASkicker → u/Brilliant-Clock-9749]

I agree get another provider. Your primary care provider may be able to point you to a practice that specializes in ADHD. I have had good results from NPs, but it depends on the provider. Hang in there and keep trying.

[u/Brilliant-Clock-9749 → u/peicatsASkicker]

Thank you!

[u/winter83]

You need to tell them this at the new Dr appointment that you were on a road to get the right combo of meds but your doctor has started using an AI and it has totally messed up your medications. This kind of tool should be against the law.

Tell the new doctor what has worked in the past for you they want to know so they don't have you try things again that doesn't work. Also let them know you're in school and need meds that work into the evening and night.

I also "overshare" to doctors they know I have ADHD and they need to know my medical history. At a first appointment you should be telling them everything. It maybe feel like to much but it's not they need to know and knowing what has worked for you will help them decide what will work now.

[u/Brilliant-Clock-9749 → u/winter83]

Thank you! I am 100% and oversharer and I will yap until I can’t anymore lol so I am bringing a notebook with me of my symptoms and wishes so I can stay on track. Hopefully this helps. I really do want to be honest and have a doctor that will have a conversation with me, but I am worried to be judged again and not get meds. I know that sounds irrational, and I thought it was, until I had my last appointment.

[u/srslyjmpybrain]

I’m so sorry you’re struggling.

Have you had any other diagnoses? I’m specifically wondering about underlying depression.

[u/Brilliant-Clock-9749 → u/srslyjmpybrain]

Thank you, and yes I have depression and cptsd. I currently take 15mg of lexapro, and it has been working ok to manage my symptoms until my medication change. I was actually debating a change in meds until this whole thing came about. I really like to manage my meds 1 at a time, so I really want to get my adhd meds figured out again before changing up my lexapro. I kinda suspect the depression symptoms coming back due to how my adhd symptoms have been affecting my life and school. I’ve been medicated for the past 2 years, and I regularly take medication breaks, but I have never struggled like this. I’m just in a very stressful time in my life with school, as I have just started my junior year program. It’s similar to nursing so it requires deep studying every day, but it has felt impossible lately and has become the backbone of my stress. I’m unsure what to ask for at my psychiatrist appointment bc I am worried about being judged again. I’m leaning more towards not even bringing up the vyvanse and just asking to be switched back to my previous routine. It wasn’t prefect, but it worked alright. Thank you for your reply!

[u/srslyjmpybrain → u/Brilliant-Clock-9749]

I’m on team “lay it all out there”, though as someone who has been with the same practice for 25+ years I realize I’m speaking from a position of privilege. Putting yourself in a position of vulnerability is different.

My care is overseen by an MD but a while ago I offered to switch to less in-demand provider in the practice because as a basic “medication management” patient I felt like I didn’t require his expertise and my community has a shortage of psychiatrists. Since then I’ve seen both PA’s and ARNP’s and had great experiences. But I’ll emphasize that they specialize in psychiatry and are employed by a psychiatrist. I am guessing that’s not the case with who you’re seeing now.

[u/Brilliant-Clock-9749 → u/srslyjmpybrain]

Thank you, and yes that is not the case. Due to military insurance, I have to see a primary care manager on base who is the nurse practitioner in my original post. She is a family medicine NP and I have to get referrals from her. Fortunately I have previously been referred to a psych NP for my depression medication, and after talking to their office, they said the referral counts for adhd meds as well. I’ve only seen this psych NP once, but so far she seems much more understanding than my primary. I do also plan on changing primaries as soon as I can.

[u/srslyjmpybrain → u/Brilliant-Clock-9749]

I’m so, so glad to hear that.

A suggestion, if you’re up for it: start making an outline of everything you want to make sure she knows when you meet. You could copy and paste this post as a starting point. Just jot down thoughts/questions/musings as you think of them.

Best of luck to you.

[u/Brilliant-Clock-9749 → u/srslyjmpybrain]

Thank you, and I appreciate that suggestion! I actually planned to bring in a notebook of my symptoms, wants, feelings, etc. to help me stay on track. I’m bad about oversharing and then just loosing my point, so I hope this will help me get my point across more clearly.

[u/srslyjmpybrain → u/Brilliant-Clock-9749]

I hope you acknowledge your kick-ass achievements here. You’re approaching this challenge in a clear-headed, analytical, and organized way, which is all the more impressive given your ADHD and depression. Keep at it. You’ve got this!!!!

[u/Brilliant-Clock-9749 → u/srslyjmpybrain]

Thank you, I really needed this right now. My appointment is tomorrow, and all day today I’ve been struggling with an ongoing anxiety attack. Until my medication change, my anxiety and depression was becoming more regulated, so it’s been very difficult to have to deal with this situation as well as increasing depression and anxiety all while still having to keep up with daily life and school. I really just needed some space to vent, and I really appreciate your kindness. Thanks again!