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In my experience with ADHD medicine/stimulants (both adderall and lisdexamfetamine) there was a terrifying drop off in efficacy / tolerance level increase after a very short time.
This was around Covid and there was some kind of shortage, so I got prescribed 40s of Elvanse (lisdex) and told to halve them. That was incredible for like 2 weeks. Then I had to take the whole pill. After another 3 weeks, even that stated to fade. That’s around when I quit. From time to time when I need to do long, uninterrupted, boring work I take one, and it works well, but I never do it more than three days in a row for the reason above.
Do they really work for you daily, years on end?
For 90% of my life, I never had to take them daily. Back in India, I'd normally use my methylphenidate SR infrequently, and take a sustained course only before my exams or when I had to study. I'll do anything but open a textbook when not on medication, and even then, it takes a lot of willpower to not end up procrastinating. It's not a coincidence that my Motte-posting goes up drastically around then.
That changed in the UK. I thought I could work unmedicated and save it for my professional exams. No luck. I need something like 20mg of methylphenidate SR just to keep myself going through a 9-5. Then I might need 20-50mg to get studying done on days when I'm not working. I find it borderline impossible to study at all after a full day's work.
When I'm taking methylphenidate at a stretch, over 4-6 months almost daily (as I have done for serious exams in the past)? I think there's an escalation from 20mg a day to 40mg a day over that period, which isn't that significant. And when the exam is over, I get a long drug holiday which resets any tolerance.
I was switched to dextroamphetamine (IR) last year, which is much, much easier to tolerate for me. I was being titrated up, and I was only on my second month and 5mg twice daily when I fell off the train and stopped seeing my psychiatrist. Because I was depressed. Because that's the sensible thing to do when you're getting depressed, of course. Stupidity induced by sickness aside, 10mg a day is a modest dose, and I expect that I'd have gotten up to something much higher by now.
So tolerance hasn't been a serious issue for me, or at least I never seem to get to the point where it's inadvisable to increase doses. The methylphenidate fucking sucked, so I didn't even want to increase the dose.
You probably know the usual advice: drug holidays. If you have a more experimental psych, they might be willing to swap you around between different drugs so that you never become entirely tolerant (I don't remember the degree of cross-tolerance, but methylphenidate and amphetamines have somewhat different mechanisms of action).
There's personal idiosyncracy involved, but in general, most adults on ADHD meds settle down to a steady-state and can keep it that way. It sounds like you're unlucky in having unusually fast tolerance buildup.
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