Regarding meds, are people willing to share what kind of doses they are on? I take 27mg of Concerta, and I remember talking to someone taking like... 5x that? And being quite shocked, but there's always that curiosity about what dosages makes sense.
This is all is relatively new for me (got diagnosed this year after being misdiagnosed with depression for a very long time) and it's working out OK. One thing I'm still struggling with is break days. They seem to supercharge my (inattentive) ADHD, and I'm kind of dead all day long; maybe there's still room for adjustment and I go back to 36mg Concerta.
I’m on 15 mg Adderall XR - Tried 20 but it was too much. I’ll sometimes take 10 mg short release as well. 500 mg Gabapentin (100 mg for cat), and 150 mg Prozac.
I imagine the "weekend break", like a lot of ADHD advice, comes from treatment of children and teenagers, which - for better or worse - tends to focus on school performance, to the exclusion of all else. I mean, every now and then I see an adult ADHD article talking about med breaks and mentioning both weekend breaks and summer vacation breaks. It's kind of a tell.
Disclaimer: this is personal anecdote, not a recommendation.
I've been very lucky to have such a positive response to such a low dose, as it's helped me tremendously with only the mildest of side effects (occasional high pulse, sore jaw).
Higher doses do nothing but increase my heart rate.
A combination of factors made me decide to stop taking Vyvanse: a probably unrelated health issue, 40 mg of dextroamphetamine per day gave me unpleasant physical side effects, and my realization that 5 years of medication had profoundly hanged my habits and self-concept. I decided to see if I could go off meds and sustain the benefits. So I tapered off (no dependence!) and for 6 years I relied on habits, strategies, exercise, nutrition, healthy sleep and meditation.
But I am now taking Vyvanse again and there is no doubt in my mind now that no amount healthy living can do what Vyvanse does.
My current dosing: on a day to day basis, I take 0, 15, 30 or 45 mg of Vyvanse depending on what I need to get done, my energy level, and my habituation. I drink coffee with it because I find that caffeine helps me keep the Vyvanse dose lower. I organize my life to maximize the value of my medicated time. I experience a clear step function in executive functioning between "slightly too little" and "enough" Vyvanse and I can feel the gears shift in my head, takes about 5 seconds, as the drug concentration in my body crosses the threshold. I move the dose up and down in 15 mg steps and when reducing my dose I spend 2-3 days at each level to avoid crashing. I take Vyvanse holidays two to six weeks long, two or three times a year to reset my habituation and fix any sleep deficit. After a holiday I get the full therapeutic effect from 15 mg. My goal is to generate enough high-quality executive function hours to fulfil my responsibilities, but keep my dose as low as possible. It seems to be working so far.
These are the maximum doses where I live, and to be honest, I've not noticed too much of anything from either. If anyone has any experience/literature on what makes medication work/what determines the required dose for an individual, I'd appreciate it.
The most helpful thing I've tried is meditation, which doesn't really alleviate any symptoms, but it has enabled me to accept and be self compassionate and grateful for the life I have.
In general, AFAIK, there is no rule. The best type of medication and minimum effective dose seems to simply be an individual thing. Fortunately, unlike with e.g. SSRIs, it can be homed in on quite fast - the limiting factor is how quickly can you get your doctor to switch things up and write you new prescriptions.