After first diagnosis, under the care of a psychiatrist, I went though a typical escalation over a couple years to reach 80 mg Vyvanse + 15 mg of Dexedrine per day. 50 + 10 at ~5AM and 30 + 5 at ~noon. That's about 40 mg of dextroamphetamine per day. I enjoyed the euphoria but never experienced dependence except in the sense that I became attached to functioning like my neurotypical colleagues. My psychiatrist's professional opinion was that some people required fairly high doses and the therapeutic benefit at those doses would stabilize long-term. I will note that he was reasonably diligent in ongoing blood tests and monitoring my health, etc.

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.