Lamictal titration with valproate schedule

Demographics: 31M. 5’11” 220lbs
Dx: depression, ADHD, OCD(much worse in childhood, well managed now)
Meds: Prozac 20mg daily, Adderall 5mg BID, Lamictal 50mg daily (titrating up, problems started before this med)
Hi. I’ve had problems with fatigue and depression for quite a while but they have recently gotten worse. I saw my PCP to run some labs, but everything looked more or less alright and no explanation for the way I’m feeling.
I had a sore throat and a swollen lymph node in my neck with debilitating fatigue that put me down for days. I was negative for Covid, flu, strep, and mono (and maybe other viruses on a panel). They gave me augmentin and said follow up with PCP if swelling doesn’t go away.
So I’m about a month post that appointment. My lymph node is still palpably swollen but not very tender anymore. No sore throat. Still very fatigued. I’m scheduling with my PCP.
The fatigue has been something I’ve been treating as depression/ADHD for years now and it feels like I’ve thrown everything and the kitchen sink at it, and still hardly any relief besides some momentary improvement when starting a new med that eventually doesn’t work anymore.
I feel like something is really wrong with me and this is really touching every aspect of my life. Any insight or advice?

A new patient was brought in who was planned for ECT in a week. Though she might actually be bipolar (atleast on the spectrum). She was terrified of ECT.
She had severe depression including suicidality and severe agitation.
She was on Lithium 600mg/day (Started recently), Lamotrigine 200mg, Lexapro 20mg and clonazepam 1mg with quietiapine 50mg for sleep.
Since 2023 she'd been experiencing strange episodes according to her family.
Here's all the history and symptoms provided about these episodes since 2023 :

• Inner restlessness:Getting EXTREMELY restless (CAN NOT sit still). Inner restlessness that makes her want to slap /kill herself just to escape it. She'd beg her family to kill her so she can escape this.This comes and goes daily during these episodes and is the main symptom. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness). Suicidal attempts in aggression where she had to be stopped with a lot of physical force.
  
• Guilt and worthlessness
  
• Irrational/Questionable decisions were almost always noted by family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  
• Pupils were dilated when I saw her.
  

After her lexapro was increased to 20MG her symptoms have been just worsening and worsening including suicidality.
Benzos would do nothing even injectable ones for the agitation.
Then today when she came to me during the severe agitation I immediately thought of a mixed state. Gave her zyprexa and asked to taper down the lexapro.
After she took the zyprexa (sublingual) in about 2 hours experienced tremendous relief - felt calm, brain went silent and took a long nap quite refreshing. She wasn't bothered by people talking. She wasn't irritated. She just felt normal. The relief seemed never-ending.
It makes sense now how being put on lamictal back in 2023 put her into remission and it kept masking Lexapro's rebound effect(in bipolar)
I'm honestly unsure why high dose Lexapro was continued over a year (even though there was a clear worsening of symptoms with dosage increase) and why high dose benzodiazepines were constantly being used to control the agitation despite having little to no effect. Even effexor was started in cross-titration with Lexapro which further worsened her suicidality etc?
Sorta leaning towards ECT and later on adjusting the medications because it does seem to be severe and ECT it is quite effective though the patient wants to try the no-ssri approach.
If we do go with the latter approach, I plan on : - Switch to Vraylar for its good evidence in mixed states. Cariprazine is dirt cheap here.

• Stick to Lamotrigine and increase Lithium/ Switch to Valproate(Good evidence in mixed features).
  
• Wellbutrin for depression if it does not or only partially responds to psychotherapy.
  
• Gabapentin.
  
• Low dose Trazodone for insomnia.
  

Perhaps the increased energy from the (hypo)mania and the activation from the SSRI is resulting in the restlessness which explains the relief from Olanzapine.
What's your go to treatment for mixed states? What about the efficacy of Lithium in mixed bipolarity? Which mood stabilizers seem to work best?

A new patient was brought in who was planned for ECT in a week. Though she might actually be bipolar (atleast on the spectrum). She was terrified of ECT.
She had severe depression including suicidality and severe agitation.
She was on Lithium 600mg/day (Started recently), Lamotrigine 200mg, Lexapro 20mg and clonazepam 1mg with quietiapine 50mg for sleep.
Since 2023 she'd been experiencing strange episodes according to her family.
Here's all the history and symptoms provided about these episodes since 2023 :

• Inner restlessness:Getting EXTREMELY restless (CAN NOT sit still). Inner restlessness that makes her want to slap /kill herself just to escape it. She'd beg her family to kill her so she can escape this.This comes and goes daily during these episodes and is the main symptom. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness)
  
• Guilt and worthlessness
  
• Irrational/Questionable decisions were almost always noted by family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  

After her lexapro was increased to 20MG her symptoms have been just worsening and worsening including suicidality.
Benzos would do nothing even injectable ones for the agitation.
Then today when she came to me during the severe agitation I immediately thought of a mixed state. Gave her zyprexa and asked to taper down the lexapro.
After she took the zyprexa (sublingual) experienced tremendous relief - felt calm, brain went silent and took a long nap quite refreshing. She wasn't bothered by people talking. She wasn't irritated. She just felt normal. The relief was long lasting.
It makes sense now how being put on lamictal back in 2023 put her into remission and it kept masking Lexapro's rebound effect(in bipolar)
I'm honestly unsure why high dose Lexapro was continued over a year and why high dose benzodiazepines were being used to control the agitation despite having little to no effect.
Sorta leaning towards ECT and later on adjusting the medications because it does seem to be severe and ECT it is quite effective though the patient wants to try the no-ssri approach.
If we do go with the latter approach, I plan on : - Using either VraylaLatuda for their good results in mixed states. Cariprazine is dirt cheap here.

• Stick to Lamotrigine and increase Lithium.
  
• Wellbutrin for depression if it does not or only partially responds to psychotherapy.
  
• Gabapentin.
  

What's your go to treatment plan for mixed states? Is this a mixed state rather than unipolar depression?
A new patient was brought in who was planned for ECT in a week. Though she might actually be bipolar (atleast on the spectrum). She was terrified of ECT.
She had severe depression including suicidality and severe agitation.
She was on Lithium 600mg/day (Started recently), Lamotrigine 200mg, Lexapro 20mg and clonazepam 1mg with quietiapine 50mg for sleep.
Since 2023 she'd been experiencing strange episodes according to her family.
Here's all the history and symptoms provided about these episodes since 2023 :

• Inner restlessness:Getting EXTREMELY restless (CAN NOT sit still). Inner restlessness that makes her want to slap /kill herself just to escape it. She'd beg her family to kill her so she can escape this.This comes and goes daily during these episodes and is the main symptom. When this comes the other symptoms which I'll mention come along too:
  
• Crying and shouting loudly (simply can not control this to sorta escape)
  
• Excessive anger and snapping at/blaming others for no reason: Involuntarily blame people for the most random and petty things who've been the most helpful and kind.
  
• Very Irritable.
  
• Suicidality (to escape the restlessness)
  
• Guilt and worthlessness
  
• Irrational/Questionable decisions were almost always noted by family members during these periods accompanied with extreme impatience.
  
• Energy: Being fatigued and unmotivated that she can't even move or do stuff. But at the same time having so much Energy to shout so loud and rip her chest open to escape the "agitation".
  

After her lexapro was increased to 20MG her symptoms have been just worsening and worsening including suicidality.
Benzos would do nothing even injectable ones for the agitation.
Then today when she came to me during the severe agitation I immediately thought of a mixed state. Gave her zyprexa and asked to taper down the lexapro.
After she took the zyprexa (sublingual) in about 2 hours experienced tremendous relief - felt calm, brain went silent and took a long nap quite refreshing. She wasn't bothered by people talking. She wasn't irritated. She just felt normal. The relief seemed never-ending.
It makes sense now how being put on lamictal back in 2023 put her into remission and it kept masking Lexapro's rebound effect(in bipolar)
I'm honestly unsure why high dose Lexapro was continued over a year and why high dose benzodiazepines were constantly being used to control the agitation despite having little to no effect. Even effexor was started in cross-titration with Lexapro which further worsened her suicidality etc?
Sorta leaning towards ECT and later on adjusting the medications because it does seem to be severe and ECT it is quite effective though the patient wants to try the no-ssri approach.
If we do go with the latter approach, I plan on : - Switch to Vraylar for its good evidence in mixed states. Cariprazine is dirt cheap here.

• Stick to Lamotrigine and increase Lithium.
  
• Wellbutrin for depression if it does not or only partially responds to psychotherapy.
  
• Gabapentin.
  
• Low dose Trazodone for insomnia.
  

What's your go to treatment for mixed states? What about the efficacy of Lithium in mixed bipolarity? Which mood stabilizers seem to work best?

I (21M) got diagnosed with bipolar disorder two weeks before my ADHD evaluation. I do think the diagnosis makes sense because I was DEFINITELY in a manic state last fall and have since been in a really bad depression.
However, I was holding out hope that my ADHD evaluation would come back positive because I have been struggling with executive function my whole life, even before the mood issues began. I was a gifted kid and was able to skate my way through middle and high school with straight A’s, but it feels like I have “hit a ceiling” in college. It’s like no matter how hard I try I can’t organize myself and “lock in” to my work, no matter how much I enjoy it or am interested in it.
I was started on Lamictal 25mg for the bipolar and am slowly titrating up. I haven’t noticed any differences in my mood or cognition, but I assume that’s typical early on.
Again, I do think the bipolar diagnosis makes sense. I thought I was unipolar up until last fall when I became so manix that I thought the government was trying to kill me. But going into my ADHD evaluation, I’m scared that all the doctor is going to see is the bipolar and ignore all my other symptoms which have completely debilitated me from living the life I want to live.
Are there any bipolar AND ADHD people in this sub who have had a similar experience? What should I keep in mind going into my evaluation?

I (21M) got diagnosed with bipolar disorder two weeks before my ADHD evaluation. I do think the diagnosis makes sense because I was DEFINITELY in a manic state last fall and have since been in a really bad depression.
However, I was holding out hope that my ADHD evaluation would come back positive because I have been struggling with executive function my whole life, even before the mood issues began. I was a gifted kid and was able to skate my way through middle and high school with straight A’s, but it feels like I have “hit a ceiling” in college. It’s like no matter how hard I try I can’t organize myself and “lock in” to my work, no matter how much I enjoy it or am interested in it.
I was started on Lamictal 25mg for the bipolar and am slowly titrating up. I haven’t noticed any differences in my mood or cognition, but I assume that’s typical early on.
Again, I do think the bipolar diagnosis makes sense. I thought I was unipolar up until last fall when I became so manix that I thought the government was trying to kill me. But going into my ADHD evaluation, I’m scared that all the doctor is going to see is the bipolar and ignore all my other symptoms which have completely debilitated me from living the life I want to live.
Are there any bipolar AND ADHD people in this sub who have had a similar experience? What should I keep in mind going into my evaluation?

3 years ago I went to see a therapist once suicidal thoughts started to rise, as my mental health was deteriorating.
I was diagnosed with mood disorder being Unipolar.
He prescribed lamictal and I started titrating up to 100 mg and i helped alot.
But recently its cons exceeded its pros,
And that's annoying me so bad, i had perfect hair now i lost that perfection, I used to be the cool but staright As guy but now constant brain fog, can't concentrate at work, while studying even during buying my weekly groceries. I have a brain of a fish. Sometimes I make mistakes speaking my mother language imagine the other 2.
Studying is hell now. Brain fog ( check) Sleeping like a hibernating polar bear for long hours I still have some depression phases every now and then, but they don't last for long.
So long story short, I'm thinking about titrating down till I quit within a month and see how will it go.
So for those who got off it. 1) How were the withdrawals like? 2) did you feel fine after quitting or did the good ol' problems come back crawling? 3) did your memory come back to normal and your brain started functioning as sharp as it used to be?! 4) did your hair grow back 😢?
Thanks.

Just saw this on Medscape so thought I'd share for all the slow losers out there. It essentially says that eventually nearly everyone will lose at least 5% body weight. It also blames the low starting doses and titration schedule moving up on Tirz therapy for some of this since some people just are going to have to be on higher doses to see the metabolic benefit.
It all makes a lot of sense, but for people paying OOP, or with an insurance policy watching over their shoulder to verify that you're losing an acceptable amount of weight, I can see this still being an issue for a lot of folks.
https://www.medscape.com/viewarticle/if-first-tirzepatide-doesnt-succeed-keep-trying-2024a100090d?src=mbl_msp_iphone&form=fpf

I am very curious to understand more about your journey with Lamictal. What was your dosage titration like? Do you feel like it's the right dosage? Any side-effects both positive and negative? I could go on and on with questions but I imagine you understand.
Personally I was introduced to Lamictal after Seroquel was not handling the depressive episodes. I was told Lamictal would help fill that gap. It's been a very interesting journey. For example, I've never had a "psychotic" episode prior, but that isn't all bad. Mostly just auditory hallucinations and losing time. One of the tougher side effects is dreaming. Everything is so insanely vivid that I have to go back through my emails/texts/etc to have some idea what really happened and what was imagined. It has led to some awkward conversations. The most notable effect has been the ability to feel. I know I'm part zombie at this point and I don't care.
Just curious about your journey. Feel free to message me if you want to talk more specifically about meds and dosages.

Hello! I am on schedule to up my dose on Wednesday, 5/15, to .5mg. However, I am seemingly doing fine on the .25mg. I have little to no negative side effects and I am losing weight at a decent rate. I have lost 11 pounds in 24 days. I do make sure I get 30 minutes of exercise of some kind each day, a goal of 8.000 steps, and I eat between 1200-1300 calories a day.
Started April 17, 29F 5’2” SW:174.5 CW: 163.5 GW:120-130
I still feel like I have control over my eating habits, but I did notice some food noise on Tuesday the day before my most recent shot. My worry is, if I titrate up, I may be risking side effects for no reason. From what I have read on here, many people don’t titrate up until they see a plateau while others stick to the schedule. I have a goal of 145 by July 22, and 125 by the end of September, so waiting for a plateau to up my dose seems like torture.
I would love to hear people’s weight loss experience with titrating up on the “every 4 week” schedule as well as those who only go up as weight plateaus.
Thanks in advance for sharing!

Hi guys, I just finished my first titration follow up after my first month of starting meds.
It was a self assessed follow up, filled it in, submitted that & the other measurements they required aswell. Earlier in the week I asked them to move my payment date by 1 week, it’s for the first year fee & I only needed the last 2 payments of £272 to be moved by one week.
They did this for me, everything showed okay and the payments said ‘scheduled’ with the correct date.
However when I just checked the portal after paying for my home script delivery fee, it says that my remaining 2x payments are now ‘cancelled’ after speaking to there support team they have no idea what has happened, and I assured them I did not cancel them, they said they’ll speak to there accounts team and get back to me.
Has this happened to anyone else? I’m freaking out a little bit here it took me so long to get diagnosed & I feel like there gonna withdraw care or something.

Hi! I’m currently taking Zepbound, but as it’s the same medication as Mounjaro, figured no harm in asking here…
Anyone change injection day when titrating up? Tuesdays have been my injection day of choice at 2.5mg, however I am moving up to 5mg this week.
With travel plans for MDW, I want to allow myself a buffer to 1) get used to the medication before traveling and 2) try to limit and negative side effects when away.
Since I’m driving myself insane over this, thinking of doing my first 5mg injection this Sunday, but scared I’m going to be doing myself wrong. If I proceed with this, by the time I go away, I’ll be 96 hours post shot 2 and can adjust back to Tuesdays upon my return.
I’ve done 8 weeks of 2.5mg and for the last 4 have had no side effects except for minor acid refill and injection site reactions.
Alternately, I could do the first shot on schedule and skip the week of 5/20, but not sure how smart that is. Help!!!!!

Anyone change injection day when titrating up? Tuesdays have been my injection day of choice at 2.5mg, however I am moving up to 5mg this week.
With travel plans for MDW, I want to allow myself a buffer to 1) get used to the medication before traveling and 2) try to limit and negative side effects when away.
Since I’m driving myself insane over this, thinking of doing my first 5mg injection this Sunday, but scared I’m going to be doing myself wrong. If I proceed with this, by the time I go away, I’ll be 96 hours post shot 2 and can adjust back to Tuesdays upon my return.
I’ve done 8 weeks of 2.5mg and for the last 4 have had no side effects except for minor acid refill and injection site reactions.
Alternately, I could do the first shot on schedule and skip the week of 5/20, but not sure how smart that is. Help!!!!!

I had an appointment with my fairly new (3 months) psychiatrist. She’s basically the only one covered by my insurance. She told me if I test positive for thc in my urine sample when I get my physical done, then “her hands are tied” and she will not be able to prescribe my medicine. I’m on 100mg Lamictal and 150 mg Zoloft with plans to titrate up. I smoke a few bong rips once a day usually when I get home from work/ going to bed. Says how she told me how risky smoking weed is and is now saying I’m knowingly engaging in risky behaviors. I feel so judged. I’m not like smoking ¢raćk or anything???? Like literally a gram a day max. I feel so judged by her and literally don’t know what to do with this ultimatum. I live in NY. She said something about the NYS DEA laws or some shit. Weed is legal here so I really don’t get it. She’s also Indian so I think it could for sure be a cultural thing as well but she thinks I’m gonna get laced weed since I’m not getting it from the dispensary. Says she saw one patient have a seizure??? Idk. I get she could be held accountable to some extent if that happened but wouldn’t it be more of a liability to just cut me off from my prescription and I end up doing some actual crazy shit? What the heck do I do I don’t want to lie and I know I need to tell the truth because my medical health is on the line but I really don’t see a problem with a little weed. I don’t drink or do any other substances other than caffeine and nicotine (which i think is what gets me through my 9-5) so yeah idk what to do but she really pissed me off

It’s been a month since I’ve been able to retrieve my prescription. I’ve never had lamictal but my insurance won’t cover the starter pack, they said they would, came back & the pharmacy said they wouldn’t, I’ve been going through the run around and my psychiatrist hasn’t answered me or the pharmacy even though we’ve called several times to change the script as a written out titration instead of the starter pack.
If the psych doesn’t come through tomorrow after all of this time, is there a way for me to get it anyways even if my insurance doesn’t cover it? Like pay out of pocket but not full price 😬
This is totally unfair it’s been this long and I’m doing everyone’s job, doing all the foot work and nothing is coming out of it it’s actually making me so unwell hence is why I need the medication and she was aware of my suicidal ideations yet is lazy and won’t answer the phone/fix my script so I can pick it up. I’m sick of how careless some people can be, it’s so disheartening and I’m struggling big time. 😔🤦‍♀️
On another note, any success stories with lamictal? I have no energy right now no motivation I’m unstable to put it lightly I’m all over the place as most of us are with bp2
Edit* This has been such a shitty road. They are open today on a Saturday till 2 I called and told them again I need this situation fixed didn’t do anything and neither did the pharmacy. I think this is why people off themselves cause these drs and pharmacies SUCK!!!

I started Zoloft back in March(50mg) and was titrated off of 150mg Effexor and moved up to 100mg over that same period. I found it hard to tell what was a side effect of starting one and coming off of the other. I did notice significant nausea, headaches and “floating” in and out of what I now realized was mania.. but that was only for maybe a week when I started and then going up to 100..i currently take it in the morning with my other meds (Adderall and Lamictal) and I’m pretty sure its the reason I’m deadass tired every day. I need to be at least somewhat attentive to my work, so I’m thinking of switching it to night time but I’m worried I won’t sleep.. and I can’t confirm if it’s helping, which worries me. My motivation is severely lacking in just about everything. So naturally, I’m a little apprehensive of going up to 150mg as recommended by my psych a few days ago. Has anyone felt significantly better at 150mg?? What was your experience with side effects? I wanted to start this weekend but my anxiety is getting the best of me.

i have a hard time in general with starting new meds. just started lamictal 25 mg at night and am supposed to titrate up to a therapeutic dose. the intention to start the med was to help dissociation and stabilize me during this “crisis” period… however my suicidal thoughts have revved up, i feel so far from everyone in my life and can’t even be present at work. i’m scared i wont feel normal again and right now it’s agony. i guess my question is could the new med be making this worse? it’s my last ditch effort at medication and it hurting my soul knowing this made have just made things worse

I've been taking OptiNAD and NMN for quite some time and very much enjoy the effects. The energy and changes to my circadian rhythm they provide have been a net positive and worked well with my schedule.
My employment situation will be changing in the next week or so in such a way where I will have to work a few evenings per week, and therefore I will likely need to "sleep in" an hour or two extra to ensure I am properly recovering and well-rested. It won't be an extreme change to my sleep schedule, but given that I am mostly unable to sleep past 5:30-6AM while using NAD+ boosting products, it could become an issue.
My questions are:
Has anyone found a minimum effective dose of any NAD+ booster that won't affect sleep?
Would microcycling NAD+ boosters still provide benefit? I will need to work 2 nights and 3 days per week. Would, say, dosing only on the days where I won't need to sleep-in on the following morning be beneficial for me? In this scenario, should I be expecting a rebound effect on the off days?
Is there any other ND product that may counteract the circadian rhythm modulating effect of NAD+ boosters?
Do NR, NMN, or NADH in isolation all modulate circadian rhythm? Or is this an intrinsic property of all NAD+ boosting supplements?
If you made it this far, thanks for reading. I look forward to any and all replies!
Update: just ordered a ND scale and will be starting with a NMN dose of 25mg. I'll be keeping track of my sleep quality nightly. If 25 mg doesn't affect my sleep, I'll be titrating up by 25mg weekly until my sleep is impacted negatively, after which I'll drop back to the highest dose taken that left no impact on sleep

I recently had my diagnosis changed from MDD to bipolar 2, and I mentioned to my psych that I have been prone to auditory hallucinations for much of my life, and during the mixed episode that prompted my bipolar 2 diagnosis I had both visual and auditory hallucinations. He wanted me to document any hallucinations going forward. Since then I have noticed A LOT more hallucinations (visual, auditory, and most recently tactile). They’re mostly fleeting and so far haven’t been distressing, but I’m concerned with their frequency. Now I’m paranoid that 1.) I’ve been having way more hallucinations than I thought for my entire life and am just now realizing it, 2.) I’m somehow making up the hallucinations, or 3.) the pace of my hallucinations is rapidly increasing since my mixed state. Any of the 3 would be a tough pill to swallow. Has anyone here experienced something similar?
I did just titrate up on lamictal, I’m now at 100mg for a week and will up my dose to 200mg next week. Maybe that has something to do with it?

Or in conjunction with Lamictal?
I’m glad to see all your responses, my daughter has had epilepsy since she was nine years old, 18 now. So many medications, side effects, different levels of functionality over the years and nothing stopped the seizures, until now. Almost nine months seizure free. Just finished titrating off Zonisamide, hoping we can lower Lamictal.

For context, I am bipolar. I take lamictal, gabapentin, buproprion, Adderall(long acting), and Ativan(as needed).
We schedule an appointment every 6 months where I am charged $350. It was $275 until I was diagnosed with ADHD by a neurologist. Since I now have to call her every month she charges me more. It is one week until 6 months. She won't send me a prescription for the Adderall(I've only refilled 3-4 times, just for work) and she denied sending in just a weeks worth of buproprion(or less depending on the appt date)..
I promise you this is for no good reason, she's just a mean person, even my former psychologist dislikes her. I've also been on the same medication forever and it has had me stable, there's nothing complicated about it, nothing has changed.
I was supposed do facetime at 8pm but I called her to explain that I need those medications for tomorrow. She has gotten so angry with me about it and this isn't the first time.She says if this is the way I feel that I should get a new psychiatrist and that we won't be speaking tonight.
I don't know what to do. I've tried to contact different psychiatrists in the past and they just never get back to me but now I'm desperate and legitimately scared. Even if I am able to get in contact with someone I still need to set up and wait for an appointment.
Please help, I need serious advice:(

Tl;dr: on a 70mg Elvanse and 20mg Amfexa mix, but it is only minimally effective. Not sure whether to accept this is the best it can be, or risk rolling the dice on trying something new which might just result in being the same or worse.
Longer form post: I’ve been on Elvanse for around 9-10 months now with ADHD 360. I was titrated up to 70mg quickly, and for the first 2-3 months that worked wonders. I wasn’t euphoric or riding a high, but I was able to focus and get things done, and overall my default mood was ‘good’ or at a minimum ‘not bad’, rather than my usual default of ‘pretty shit’. It was amazing to experience what neurotypicals get to feel like.
Then it started to become less and less effective. If I took it at 8am, I would get the benefits until around 2pm, and they’d be less noticeable. I had a call with ADHD 360, who prescribed me Amfexa 10mg to take to boost the length of time it was effective if I needed it. Well, turns out, I need it every day.
Also, I found the first 2 hours of the day until the Elvanse kicks in absolute unbearable. I would feel tired to the point where I couldn’t function. When you have 2 young children you have to get up for no matter what, this is not tenable. I found a morning Amfexa solved that problem.
So, the routine became: - take an Amefexa the second I open my eyes. - around an hour later take Elvanse 70mg, which will kick in around 2 hours after I take it. - when that wears off around 2pm, take another Amefexa.
I have a call scheduled for tomorrow to ask ADHD 360 to prescribe the two lots of Amfexa so I can make this my official routine.
The problem is, even being on that much medication, I still find the effectiveness low. It does enable me to focus and get some stuff done, which I suppose is the goal. But my mood often feels low, my physical energy feels low, and I just feel flat and tired. The level of productive I am, despite being better than my default unmedicated self, is still not great.
I just feel so disheartened and stuck. I either stick with the plan, ask for the Amfexa, and accept this is the best I can hope for. Or I say I feel it’s not working, and see what else is on offer.
I’m just not sure I can go through it all again. Yes, I guess there’s a shot it will make things better. But there’s also a chance it will keep things the same or make them worse. And I think if I go through months of testing and titrating just for that to be the case, it will break me in a way I’m not sure I can come back from.
Any perspective on this would be greatly valued. I feel so lost and stuck. I just want to be a good dad, husband, and worker. Not even to be great at those things! I accept that’s beyond my reach. Just good, or at least good enough.

Non smoker, 5'7 160 lbs, taking Lamictal and seroquel. Diagnosed with bipolar depression and ADHD.
I recently learned that the local community mental health center where I have been getting treatment at has included information about substance abuse in their record of me.
Can they share this information with my insurance company or anyone else without my consent?
I'm desperately hoping that information has not been put into some kind of permanent record that will follow me around for life. For example, if I change doctors will the new doctor somehow have this information also?
The reason for my concern is because I have been completely unable to function for quite some time now so I recently had an evaluation and was diagnosed with ADHD and now I'm afraid I may never be able to get treatment for it since ADHD meds are schedule 2's.