Interesting that modafinil shows no clear dose-effect pattern. When I tried it, I took 1/4 of a pill, and that was always enough. The nice thing about it is that it’s easier to get than stims in many countries. I used the effect of mine to set up diagnostic and prescription of something better in the first place.
A big risk is being cut off from a drug that works, but the dosage is wrong, just because the doctor doesn’t understand how differently people react to these drugs. For me at least it has taken a long time to find out what dose works for me, how and when I should take it, because I’ve had to find out without professional support. GPs don’t have enough understanding about the issue and complexity to actually give any advice or suggest options, and psychiatrists are really difficult to get to (especially ones that are specialized in neurodivergence).
I’m on Elvanse/Vyvanse and on a regular day I take 25mg, but if I leave home and know the day will be stressful I’ll take 40-50mg (25-30mg in the morning and the rest in a few hours). But if I’m really overwhelmed it may be too little or way too much. The small dose helps significantly with my mood and impulsivity etc but there are some unpleasant side-effects as well as potential risks I wish would be addressed by the doctor - but then again I’ll rather take this suboptimal solution than risk losing the prescription altogether, because at least this works somewhat.
My experience is that the psychiatrist initially prescribed me way too large doses even though I mentioned I’m sensitive to drugs, they just went on with the “regular titration plan”, and I believe that intensified my burnout. Another thing in here is that they’ll basically try 3 individual drugs (with maybe 3 different doses) and that’s it. If there are any issues you’ll easily get cut off the meds, there isn’t much consideration for alternatives. You’ll be lucky to try the actual ADHD meds, especially if you rely on public health care, as many are refused neurological evaluations and are stuck with SSRI’s or similar.
Exactly this. It can be so frustrating and exhausting for nds. GPs don’t understand so they dismiss you as normal or a problem other GPs should avoid or be cautious with
My experience is that the psychiatrist initially prescribed me way too large doses even though I mentioned I’m sensitive to drugs, they just went on with the “regular titration plan”, and I believe that intensified my burnout. Another thing in here is that they’ll basically try 3 individual drugs (with maybe 3 different doses) and that’s it. If there are any issues you’ll easily get cut off the meds, there isn’t much consideration for alternatives. You’ll be lucky to try the actual ADHD meds, especially if you rely on public health care, as many are refused neurological evaluations and are stuck with SSRI’s or similar.
Thank you for your thoughtful response and funnily enough it makes me think of surfing.
The hardest part to surfing by far is dropping in on the wave, it is a dynamic motion that is unlike what happens once you get to a standing position and have fully caught the wave. You have to experience it as a reactive process that you fling yourself into and if you have ever watched surfing videos it is obvious it can easily go haywire if just a couple of motions are off or are timed incorrectly. If surfers only judged waves by how they felt initially to catch and not what riding the wave actually felt like after would that make sense?
Yet this is how we treat ADHD people beginning drugs. Catching a wave is inherently a moment of chaos that has to be framed in that way, but why do we frame beginning an ADHD drug and adjusting dosages like it could be something you could schedule like a timetable of train arrivals? Everything is stilted about ADHD treatment including medication and the sloshing wavelike nature of adjusting to a new drug makes a rigid attempt at navigating it almost feel meaningless sometimes. Maybe it will work maybe it won’t but can I even know if I am am even gathering data about what works and what doesn’t given how unresponsive and rigid the methods available to me are?
Well said! I love your metaphor! Surfing is an interesting way to describe the process, and they do bear similarities! Also for both, I suppose, it’s crucial to “read” the environment and weather correctly - or the physical and mental circumstances. If you are already used to it things probably go a lot smoother than if you have to learn it while doing.
I don’t know what would be an equivalent in surfing, but something I’ve also learned the hard way is that the stimulants can also help focus on those unpleasant side-effects or get stuck on thoughts etc, especially when learning to navigate the effects of the drug - like when you are bicycling and there’s an icy road ahead: staring at the road, thinking about losing control and crashing instead of looking forward will most likely end up in you crashing (that’s me at least 😹).
Did anyone else think an LLM wrote that?
Feel free to link to an equivalent better article you think was written by a human.
No. I made an observation. Your value judgment on it is a you problem.
AI doesn’t put spaces around em dashes… No one should do that.
It did, yes.
Intensive dose management sounds like a great solution to the issues mentioned in the article - only problem is that requires more regular visits and reviews by doctors. That’s both financially impossible for most patients, and frankly impossible to achieve widely with specialist shortages.
Yes and if I understand it correctly a point made in the arcticle is that studies often evaluate either on too rigid of a dosing management schedule or the dosing adjustment is unrealistically responsive to real world experience for people seeking ADHD medication.
