I'm on 20mg XR Adderall daily. My insurance won't cover Vyvanse which seems to be vastly more popular and well tolerated these days (the patent expires next year though, so we'll see what happens).
I'm also on Vyvanse, 60mg in the morning and 100mg of Wellbutrin which is an anti depressant, that targets the same brain chemicals as Vyvanse.
Vyvanse, helped but my depression often cancelled out the med, and SSRIs didn't help at all just made me have erectile issues which really didn't help my depression.
I brought up Wellbutrin with my doctor after reading about others with ADHD being successful with it...
I found out I had ADHD 4 years ago when I was 38, I'm almost certain I also have autism, as 3 people with ASD have flat out told me I did, and they listed a bunch of reasons and I passed a few online tests...I also over share a lot as you can see from this post.
Before getting on stimulants, I too have taken Wellbutrin/Bupropion and found it somewhat helpful. SSRIs made it worse for me.
I am quite surprised to be honest that you are taking Wellbutrin and Vyvanse at the same time. While not dangerous in terms of possible serotonin syndrome, this combination is a little bit concerning as Wellbutrin can raise the blood levels of amphetamines and lower seizure threshold.
20mg Vyvanse at 8am + 20mg at 1pm is the bee's knees for me, lasts until 7pm, not too strong, pretty much no side effects and doesn't disrupt my sleep. In fact, the PM naps when I'm on it and sleep deprived are godly.
I have a mixture of instant-release and extended-release standard methylphenidate/Ritalin.
Adderall works well too, but I find it a little bit too "drug-like" and euphoric, so I settled on regular methylphenidate which has almost zero euphoria.
For myself, it was immediate. There seems to be a certain kind of intuitive understanding that becomes obvious after the first doses of a medication.
It is quite hard to explain, but it seems like the brain knows exactly what it needs. Unless you have uncontrollable addictive tendencies, you will automatically gravitate towards the dosage necessary to restore chemical balance. You will redose when it is needed, and you will notice quickly if a medication is not the right choice for you.
I was and still am very happy with the initial methylphenidate IR and Concerta (same compound but XR). I have tried different options over time, but they did not work as well or had side effects that I was not comfortable with. For example, I noticed that contrary to MPH, Adderall is destabilizing to my emotional state and thus was definitely not suitable for productivity, and the crash mainly consists of horrible mood swings and apathy, which is not the case for me on methylphenidate. On Vyvanse this was better, but the effects themselves still somewhat comparable to those of Adderall. I have not tried Strattera yet, but I do not really see a reason to these days.
On this note, I've talked with a lot of those affected by now, and choice and benefit of medications appears highly subjective. It seems like there is no way of knowing without trying it out.
To clarify, my current dose is 20mg XR daily. I have raised with my doctor that this dose is completely spent (I have other [diagnosed] issues that lead to an overly acidic stomach) long before the end of the work day, and thus I don't have medicinal help when I turn to my personal life.
As yet she seems quite unwilling to adjust the dose or add an IR (anecdotally adding an IR seems very common), and I was wondering what the timeline was between starting medication and landing on a sufficient dose of XR+IR between you and your doctor.
Personally, I found the promise of XR's delayed-duration to be massively overstated. I like the IR's better, because you can figure out when to re-dose through experimentation (which my doc encouraged.)
I was also motivated to change to IRs, and mentioned to my doc, that the generic IRs can be had for less than half what generic XRs cost, with GoodRx. I have insurance, but GoodRx is cheaper, and insurance gives me runarounds with 'prior auth' nonsense.
My timeline was a month before switching meds/doses. Obviously, you want to give it an honest shot of a few weeks, but if something isn't working after a month, your doc should be willing to change it up. If they're giving you a hard time, I'd explore other options. There seem to be a number of providers that have a prejudiced view of stimulants. If you needed to switch/increase the dose of say, an antidepressant, no doctor would think twice.
Ah, I see. Sorry for rambling. I can understand why you would not be happy with this schedule.
Timeline-wise, when I started medication, I was given only IR. As methylphenidate is shorter acting than Adderall, this resulted in me taking 3 doses per day and active levels fluctuating a lot throughout the day, so about a week later I decided to set up another appointment and was given additional XR to be taken once per day, and the IR only when needed.
Your doctor does not sound very competent. I would not recommend increasing dosage if the problem is a too short duration, as a higher dosage will not prolong duration, but adding IR to XR is indeed a common course of action to accomplish that.
Also, I should note, try making sure to always keep your stomach full during the day. I'm not sure if the same applies to Adderall, but I've observed diminished duration and bioavailability of XR without food.
