This is certainly very helpful as it is. The way I had to live below my potential, I need only like 50 good days in a year. If things don’t work out as I hope, I could use Methylphenidate 50 times per year to achieve that.

Overall, I thought there is not such a clear separation between the euphoria and fixing the ADHD symptoms, as both are caused by noradrenalin, among other things. However, after some reading today, I realise that the intended effect of the medication works with such neurotransmitters in the prefrontal cortex and can very well do so over years, while euphoria is caused by the same neurotransmitters, but elsewhere.

Definitely a good approach, maybe for people like ourselves even more so. But for it to work with my chaotic finances, I’d probably need a business account and pay myself a regular wage. If I’d do things in such an orderly fashion, I’d probably not be here in the first place, and we’d never have met :-)

I was afraid it might be like that. Also quite possible that the euphoria does part of the job, so I actually need more. Low dose opioids have a similar effect on me - I’m euphoric, I get things done. So currently, it might even be like 60 % euphoria, 40 % noradrenalin, explaining that I need only 12 mg when the lowest child dose even is 20 mg. I might end up with something like 30 mg.

The danger I see is that I think I need to up the dose to match the euphoria from the start, while I actually need to get to the point where it’s 0 % euphoria, 100 % noradrenalin.

Very much simplified, if not wrong, as noradrenalin might be a main contributor to the euphoria.

Really doesn’t work with my life. Extreme, sudden expenses, such as a 6k health insurance debt, hit me with as much surprise as a sudden project that pays 20k within 20 days. I just got to roll with it and hope it stays in the + somehow.

He seems completely incompetent altogether. I expressed concern that a stimulant would not be right for me, as even coffee has an extreme effect when taken after a long pause. But everybody, GP, therapist and psychiatrist, insisted that we should try MPH or AMP, as it is so much better, even though the whole prescription process is complicated for a schedule 2. And it worked out great from the very start.

He seems to worry about the wrong things. To rather let a patient in his care suffer with 3rd choice meds for months (?), followed up unmedicated than take the chance that you might be a 1%er who abuses it. For which there isn’t even much indication, as you have a prescription.

However, if I really try to give him the benefit of a doubt: A quick search shows that there are some risks in combining weed and medical stimulants. The positive effect can be reduced, and cardiovascular risks of stimulants increase. So, without medical training, I don’t know if that means that you have to search for alternative for either of those first (switch either the pain meds or the ADHD meds), and then continue treatment for both, or if it really is so risky that you absolutely must keep one of the conditions untreated. As far as I understand, weed is rarely the only option and, at best, only slightly better than the next best alternative. For ADHD, on the other hand, MPH or AMP or so much better than the next best alternative. I tried Modafinil myself, and the side effects were severe.

So maybe his tone was just off, and he should have explained those careful considerations for the best therapy options, rather than be like “eek junkie, get out until you are clean”.

I might be completely wrong here, it’s literally what spins off in my head after 2 minutes of search.

GP and therapist also said that methylphenidate is the way to go, without alternative, even. But the psychiatrist said that for adults, lisdexamfetamine is slightly better, both regarding best effect and lowest side effects. A quick web search seems to support that, as well as what people in this community, who tried both, said.

One disadvantage is the insurance: If I try some day to have it covered, it’s quite likely that they insist to pay only for the cheaper methylphenidate, and only switch if there are significant problems.

I found this German source for dosage and finding the right medication very good: https://www.adxs.org/de/page/232/eindosierung-von-medikamenten-bei-adhs#content-241-elvanse-lisdexamfetamin

I can relate to the paralysing “what ifs”.

I started with 5 mg, which had a significant, great effect for 4 hours, then crash. I worked up from there and think that 12 mg is the right one for now.

I followed this guide in German, and agree from experience that starting with 30 mg or even 20 mg is not a good idea: https://www.adxs.org/de/page/232/eindosierung-von-medikamenten-bei-adhs#content-241-elvanse-lisdexamfetamin

Interesting is their take that the right window +/- 5 mg must be hit, otherwise too low of an effect or very unpleasant side effects.

For Modafinil, I also went with 1/8th of a normal dose for a while, working up over months to 1/2.

First test: 5 mg (~ 15% of 30 mg) at 8:30 am.

It kicked in really hard, like a thick line of quality speed. It didn’t feel like something that a doctor would prescribe. Got a lot done, then hard crash at 12:30, lying down and dozing off for 20 minutes. The mental effect was at least as good as it was with Modafinil: I tackled the most urgent todo without mental effort and little chores just “happened”. But with a high like from recreational drugs.

Maybe what contributed was that I did a quick, but intense workout.

So it was perfect - a very safe dose, yet also the productivity boost I needed for the day. 10 mg might also have been fine, but taking the entire 30 mg (or even 20) would have been a mistake. Certainly no risk to not feel anything.

I wonder if I should take another 2.5 mg for the afternoon, or just use tea and coffee as usual.

This strange effect regarding intensity and duration was no surprise - I observed that with other medication and drugs before, the doctor understood it and took it into account, thus the individualised instructions.

I don’t know why he does what he does, but he said that I should find the ideal dose, which often is between two capsule sizes. He encouraged me to take any dose lower than 30 mg for the first month, and after he sees me again to fine tune it by dissolving in water.

I dissolved it in some water in a protein shaker with marks, so I can take exact 3 mg doses (10 % steps).

Only thing I don’t like about this is that children are in the house, and there should not be deadly poison water standing around anywhere. The capsules are in a lockbox.

Thanks! I’ll play it safe and would rather start with 5 than 10 mg.

Not sure if related, but I have absolutely no problem getting things in the household done when I’m voicechatting with a friend. Odd as it is, videos that don’t require watching while listening (e. g. youtubers that just talk into the camera) also work, but podcasts don’t (must be mental).

When I can’t get my “fix”, no friends with time online and no interesting video of that type, I end up searching for it so long that I get too little sleep, rather than just do the 15 minutes work without.

I think it should work exactly like the fire department. Entirely tax funded, no hassle. A hospital is, in my eyes, more similar to a fire department or a police station than it is to a super market, and that’s how it should work.

But it only works well all-in. A strange system of compromises forged between parties with entirely opposing views over 50 years is terrible.

Most recent example: Started freelancing in July again, got to pay nearly 1k per month. First money received is EUR 4400 end of September.

I tried the alternative route last time, and it’s no fun: Write in certified mail that I make less and need a lower rate, they’ll ignore it, say they didn’t get anything, I’m not insured any more. Go to a lawyer with the proof of certified mail, win, get the lower rate and they have to pay back medical bills, EUR 500 lawyer costs though. Have to pay back 1k per month anyway if it turns out I make enough in the last few months of the year, so it was all for nothing.

I will never understand how the land of fast food and unnecessarily pre-packed products fills pill bottles by hand in the pharmacy. Like, milk I would understand; I lived near a farm, and we would go over with huge milk cans and have them filled there by the farmer. But that same concept seems strange to me for a pharmacy. Like, even our weed and coke dealers have pre-packed little plastic bags, you don’t like bring your joint papers and have them individually filled.

Also, this seems like a really complicated process that causes lots of problems. Isn’t it pretty much likely that even in your best state of mind, you’d fill about 1 out of 200 wrong, and about 10 % of those mean near certain death for the patient? So weird.

It’s nice that US still ALLOWS to not be insured. In Germany, it’s mandatory, it’s nearly EUR 1,000 if you don’t provide proof that you can’t afford that (and they accept the proof), and if you dodge them and they catch you later, you have to backpay for the uninsured time.

So in contrast, we go a little broke always, but we don’t go more broke when we get sick.

It happens, even with popular kids. A friend from daycare invited many people for her 5th, but due to bad timing with vacation, nobody showed up. Nobody. Her 6th was fine, as about 8 out of 14 came.

My son invited 5 for his 5th, but due to some misfortune with sickness etc., only two siblings came. It turned out to be one of his best birthdays ever.

Best to ask for a commitment, a clear yes or no. But in your case, 5 is a good number for a party! 1 or 0 would have been kind of awkward.

The biggest issue was that when I was in a phase where I pursued something worthwhile, such as a science project, electronics, programming, they stopped me and said I obsessed too much over it, took it away, said I needed to focus more on something else. Which then did not stick, as it was forced, of course.

That’s exactly the kind of obsession that leads to success, though, and it took me years to recover after moving out. Wish I had those skills I wanted to get in all those areas, but I had to focus on one thing at that point, as the end of my 20s was approaching.

Also when they forced me to do something like “clean your room, immediately, until it is done”. With the tools at hand now, I know that I have to talk to myself like “in 20 minutes, set a 15 minute timer and get as much done as you can” or “pick one aspect (garbage, floor, desk) and do that immediately”. Or with homework: I know now that one tool I needed was to set everything up at the desk ready to start to get over that first step. An order like “all homework needs to be done immediately to perfection” does not work.

With my own child, the problem is that I don’t know who he really is down to the core. Is “10 minutes of cleaning on a stopwatch before dinner” just the right push, or too much sometimes, or too little?

I think a little push is right, to yourself and to your children, but it needs to be a “relative push”, depending on the person, the day etc. Some days, just staying in bed and crying is already the best you can do. At our best, we might be capable of doing 10 hours focussed tasks and just need a little “come on, do it”. Which of those is it? That’s the question. I find that meditation helps best to get a feeling for that. Sometimes, I just need a nap and didn’t realise, and that’s why it felt like the world is ending.

Engineered staple foods (such as Jimmy Joy, Huel, …) really took the pressure off for me. I can still cook or make something else, but having this very decent fallback plan puts me at ease.

Relatable. Fuzzing around going to an appointment early in the morning with poor preparation is one of the worst things about it. Being in place X at time Y, having packed A,B,C and being showered and dressed appropriately is something I’m struggling with. For decades, I thought the reason was that I’m just an assclown.

A typical day can feel like a series of appointments, to which I show up late, unshowered and sweaty, stammering my excuses, getting scolded and doing some kind of sad clown performance.

A perspective that helps me sometimes: It’s all just a quest to keep the pets alive and well, in a world of arbitrary rules and events.

Regarding the specific water bottle thing: The only thing that helps me is to place these things BLOCKING the door.

But indeed, Modafinil got me in a state where I could handle normal everyday things like that with ease like normal people. Had to stop it due to handling side effects poorly and hoping for new meds next month. Try to find the right thing for your specific situation. Like others pointed out, it might be an anti-depressant, can’t tell from just one text.

Over the years, I actually managed to change my inner monologue narrative. When a day like yours happens, I pat myself on the back and say: Pretty impressive how you pushed to the absolute personal limit, even towards a goal that turned out to be too high.