90 mg Instant release

[Belikemike1183]

Need suggestion.



Here’s some information.



28 year old, male, 170 lb., 5’7, medical student.


I am about to start my medical residency. Currently studying for my USMLE exams.



I have been on Adderall since 2010 for ADHD (obtained legally via prescription). Originally started with 10 mg instant release. Over the years, have taken XR and IR and never had too much problem with it.



In December 2017, I got my dose increased from 40mg instant to 60 mg. For first few weeks it worked fine but then I started to experience severe tolerance to it. So In May 2018, I got my dose increased from 60 mg to 90 mg instant release. 90 mg has been working better than 60 but not as well as it should.



So what is the problem with 90mg IR Adderall?


Morning routine:

Get up at 530 am. Out the door by 600am and drive for 60 minutes. While driving I start drinking baking soda + water. Empty stomach makes me nauseous quickly so I have to take less baking soda. I have tried Tums but it does not work as well.



600am: 400 mg chelated magnesium


730am: take 30 mg IR orally


830am: Take about 15 mg crushed sublingually.



9 am: quick breakfast (eggs + oatmeal)


Rest of the day, I just take 15 mg at a time sublingually as I need it.



8pm: Take 4 Benadryl + 4 Doxylamine succinate + 50 mg melatonin.



1030pm: I take B complex vitamins, Tyrosine, fish oil and Ready to pass out.

Diet: Diet is good. I try to eat small meals which are somewhat healthy. I try to stay away from acidic things and I don’t starve myself. I usually have granola bars or protein bars to eat. I try to drink water but I can try harder.



Problems:


1) In the morning, it takes me 2-3 hours to really get going. I feel sluggish, foggy and slow mentation. I have always taken Benadryl, doxylamine to sleep.
a. I have started to take Benadryl at 7 pm instead of 8pm and this has decreased morning fatigue and sluggishness a lot.
What can I do to get myself going a little quicker in the morning?



2) Often in the middle of the day, I feel slow and feel at the verge of being focused to get a lot of stuff done. But I usually don’t get over that “hump” and never get pass the verge. It’s like I feel so close to being more productive but just a little behind. Since I am not therapeutically focused, I tend to flip flop while studying. Meaning, I want to read this particular subject. I open up notes and feel like nah I don’t want to read it. Then I try to do something else but I feel the same. So more or less, I just waste time. And this leads to increased frustration because I am supposed to be studying. I don’t think taking more Adderall is going to help with that.



SSuggestions?
a. Perhaps spreading out doxylamine succinate + Benadryl even more (meaning take it a little earlier in the day??


Holidays + Delsym (DXM):


I have taken DXM polistirex but the results are not consistent. I have tried to take this at night (i.e. 10 ml = 60 mg) and have taken smaller dose about 90 minutes before my morning dose of Adderall. Results are not consistent. It works well for first few days and then it does not. Plus, DXM can make me loopy, give a nagging headache so it’s not really worth it. I have also tried DXM-HBR which is cheaper than DXM-Polistirex but it DXM HBR does not work. Why? My quick research showed that DXM HBR is more of quick acting and it helps if taken about 10 minutes before Adderall (or at least for me it works this way). DXM-polistirex works when taken about 90 minutes before first dose of Adderall. Results from DXM are not consistent and don’t worth the hassle because once I get that loopy feeling and nagging headache, I am done for the day.



Holidays + breaks from Adderall:


For me it does not work. I have to take at least a week or two off in order for break to work. If I take 1 day off or even a weekend off then the following day, I have to take almost twice the normal dose to get to some sort of functioning level.

Re stating the problems:

1) Need to get going much quicker in the morning instead of taking 2-3 hours.



2) Figure out a way to get over the verge of being productive and actually be productive and get stuff done. Lack of productivity leads to frustration because time is limited and I need to be getting stuff done.



I am fully aware that it's all about tolerance of adderall. I need to study for about 6-8 weeks and then I am done. So I am not sure what else I am missing? Any suggestions will be greatly appreciated.

My vitals for those who might be worried about my health.

Weight: 170 lbs. HR: 93, BP: 126/82, RR: 17


Thank you!

[Little Missy]

If you just take it as directed, it will be easier.

[ImaADHDGuy]

50mg of melatonin? Is that a typo? If not, that's a lot, and will most definitely effect the next day. With meltonin, less is more in many ways. It's more important to take it at the same time every day, and go to bed right after taking it.


Here's a article about a study that showed 0.3mg was enough to cure insomnia. https://news.mit.edu/2001/melatonin-1017


And another article about how less is more:

Low-Dose Melatonin
A Little Melatonin Goes a Long Way in Promoting Sleep
"Less Is More" When it Comes to Melatonin - For Sleep, and Perhaps Even for Sex

Too much of a good thing can be wonderful. - Mae West

Although sleeping (of sorts), as well as certain hormones, might have been on her mind, we can be pretty sure that Miss West wasn't referring to melatonin - the "sleep hormone" - when she made her classic remark. Melatonin is a hormone whose secretion by the pineal gland in the human brain is associated with our natural sleep-wake cycle. During the day, our melatonin levels are very low. At night, however, they rise dramatically, apparently in response to the fading light. Darkness is known to stimulate melatonin production, and it is believed that this is nature's biochemical signal for us to go to sleep.

Exactly how and why all this occurs is something of a mystery, especially when we realize that, although melatonin is found in most vertebrates, many of them are nocturnal, hunting by night and sleeping by day. So the melatonin effect as we know it is certainly not universal. In any case, we humans have it, and we have been trying for some time not only to understand it better but also to exploit it for our benefit, especially in cases of insomnia and jet lag. Both of these can occur at any age, but old age typically brings with it a marked increase in insomnia. Not coincidentally, it seems, melatonin production declines sharply in old age, often "drying up" almost entirely.

SUPPLEMENTATION MAKES SENSE
It is natural, therefore, to look to melatonin supplementation as a possible aid in sleeping, and there has been much research on this subject. (One new study on the effect of light levels on melatonin production is reported here.) In some of the studies, however, the amounts of melatonin given were much higher than those produced naturally by our bodies during the night. Although there is little reason to believe that such amounts are harmful in the short run, the long-term effects of sustained high doses of melatonin are unknown. Prudence suggests that anything as intrinsically powerful as hormones should be taken in amounts that are consistent with normal physiological levels.

TESTING MELATONIN AT NATURAL LEVELS
That kind of concern is what prompted a study, conducted at MIT, to determine whether short-term behavioral effects, including the induction of sleep, could be induced by small daytime doses of melatonin that significantly elevate the serum melatonin levels while keeping them within the normal nocturnal range.1 If this were the case, it would suggest a similar role for the normal nocturnal increase in melatonin levels.

Some of the effects of that increase are to reduce core body temperature, to alter thermoregulation, to modify brain levels of monoamine neurotransmitters, to stimulate secretion of prolactin (a pituitary hormone that stimulates and maintains the secretion of milk), and, as we already know, to induce sleep. It is also possible that the nocturnal increase acts as a time signal affecting the temporal characteristics of other circadian rhythms (daily biological activity patterns that follow a 24-hour cycle).

To see how the diurnal (daytime) administration of melatonin might induce such effects, the MIT researchers recruited 20 healthy young men, aged 18-24, who were not prone to depression or seasonal affective disorder. All of them participated in five 8-hour testing sessions (from 9:30 A.M. to 5:30 P.M.), with at least five days between successive sessions. The study was double-blind and placebo-controlled. The test group received capsules containing 0.1, 0.3, 1.0, or 10 mg of melatonin at 11:45 A.M. on each of the five test days, while the control group received placebo.

Throughout each session, oral temperature was recorded hourly, and blood samples were taken at regular intervals for analysis of melatonin levels. Except for a half-hour lunch break (11:00 to 11:30), the occasional quick bathroom break, and a half-hour sleep period (1:30 to 2:00), the men were required to sit at a computer terminal with eyes open, performing a variety of assigned tasks designed to assess their alertness and mental acuity. They also had to answer "mood questionnaires" pertaining to their state of mind and sleepiness level at 10:30 and again at noon and every hour thereafter.

During the half-hour sleep period, the men were asked to lie down and relax in a quiet, darkened room, with eyes closed, while holding special electrical pressure switches designed to register the exact moment when they fell asleep. The idea was to see whether sleep-onset latency (the time interval from ingestion of the melatonin or placebo to the onset of sleep) would be decreased in the test group, i.e., whether the test subjects would fall asleep more quickly than those in the control group (they did, by an average of 10 minutes). After 30 minutes, the subjects were awakened, if necessary, and asked to get up and resume the test protocol.

MELATONIN IS USEFUL IN INSOMNIA
The results of this study were summarized by the authors as follows: ". . . the 0.1- and 0.3-mg doses generated peak serum melatonin levels that were within the normal range of nocturnal melatonin levels in untreated people. All melatonin doses tested significantly increased sleep duration, as well as self-reported sleepiness and fatigue, relative to placebo. Moreover, all of the doses significantly decreased sleep-onset latency, oral temperature, and the number of correct responses on the Wilkinson auditory vigilance task. These data indicate that orally administered melatonin can be a highly potent hypnotic agent; . . ."

In a subsequent study, several of the same authors reported that oral administration of low doses of melatonin (0.3 and 1.0 mg) at 6, 8, or 9 P.M. (i.e., close to the time period when natural melatonin levels normally begin to rise) also decreased sleep-onset latency.2 The authors concluded that "These data provide new evidence that nocturnal melatonin secretion may be involved in physiologic sleep onset and that exogenous melatonin may be useful in treating insomnia." (Exogenous means "from outside the body.")

ANIMAL STUDIES SHOW MELATONIN IS GOOD FOR SEX
Lest we think that inducing sleep is all that melatonin is good for, consider its effects on sexual activity in rats. It is known that large doses of melatonin inhibit sexual behavior in male rats. But in yet another example of the "less is more" phenomenon, it has been found that small doses of this hormone (10 to 100 micrograms per kilogram of body weight) stimulate sexual activity in normal male rats. [The equivalent doses for an 80-kg (176-lb) man would be 0.8 to 8.0 mg.]

A new study done in Italy has shown that these small doses of melatonin cause sexually active male rats to initiate copulation with receptive females more quickly and more frequently than normal.3 Furthermore, the same authors have shown that these same doses of melatonin actually restore potency to impotent rats.4 Whether these results have any bearing on humans is unknown, but this is surely one of those times when we wouldn't mind too much being likened to rats.

GOODNIGHT
If you have problems with sleep, don't count sheep (or even rats). Much more effective help than that is available for getting to sleep and staying asleep. The best place to start is with the article which appeared in the September 1999 issue of Life Enhancement. There you will learn more about the sleep-inducing qualities of melatonin as well as of 5-HTP, choline, and valerian root extract.

When you do sleep tight, may your sleep be restful and your dreams sweet, as in the Brahms Lullaby . . . .

References

Dollins AB, Zhdanova IV, Wurtman RJ, Lynch HJ, Deng MH. Effect of inducing nocturnal serum melatonin concentrations in daytime on sleep, mood, body temperature, and performance. Proc Nat Acad Sci USA 1994 March;91:1824-28.
Zhdanova IV, Wurtman RJ, Lynch HJ, Ives JR, Dollins AB, Morabito C, Matheson JK, Schomer DL. Sleep-inducing effects of low doses of melatonin ingested in the evening. Clin Pharmacol Ther 1995 May;57(5):552-8.
Drago F, Busa L, Benelli A, Bertolini A. Acute low doses of melatonin stimulate rat sex behavior: the role of serotonin neurotransmission. Eur J Pharmacol 1999 Nov 26;385(1):1-6.
Drago F, Busa L. Acute low doses of melatonin restore full sexual activity in impotent male rats. Brain Res 2000 Sep 29;878(1-2):98-104.

[sarahsweets]

Originally Posted by Belikemike1183

This is going to seem blunt but there is nothing I can do about it...

Morning routine:

Get up at 530 am. Out the door by 600am and drive for 60 minutes. While driving I start drinking baking soda + water. Empty stomach makes me nauseous quickly so I have to take less baking soda. I have tried Tums but it does not work as well.

This is just like potentiation...which is very much like recreational users behave. If it makes you nauseaous to the point where you need to drink baking soda and water... you need to eat first.

600am: 400 mg chelated magnesium


730am: take 30 mg IR orally


830am: Take about 15 mg crushed sublingually.



9 am: quick breakfast (eggs + oatmeal)


Rest of the day, I just take 15 mg at a time sublingually as I need it.

I take chealted magnesium for sleep. I can tell you that taking it during the day doesnt work.
Quite honestly, I am a bit shocked that you are a med student talking about taking meds as prescribed and also under your tongue and crushing them. Totally against medication guidelines. And TBH sounds very much like the recreational drug using websites.

8pm: Take 4 Benadryl + 4 Doxylamine succinate + 50 mg melatonin.



1030pm: I take B complex vitamins, Tyrosine, fish oil and Ready to pass out.

Diet: Diet is good. I try to eat small meals which are somewhat healthy. I try to stay away from acidic things and I don’t starve myself. I usually have granola bars or protein bars to eat. I try to drink water but I can try harder.

You can really develop a tolerance to benedryl. Not only will it not work as well for sleep but its ability as an antihistamine is compromised as well when you take it regularly.

Problems:


1) In the morning, it takes me 2-3 hours to really get going. I feel sluggish, foggy and slow mentation. I have always taken Benadryl, doxylamine to sleep.
a. I have started to take Benadryl at 7 pm instead of 8pm and this has decreased morning fatigue and sluggishness a lot.
What can I do to get myself going a little quicker in the morning?

First of all give yourself more time to wake up and eat slowly and do not jump right into the car.. I know this means waking up earlier and I get it..but I had to adjust my sleep schedule and it does help.

2) Often in the middle of the day, I feel slow and feel at the verge of being focused to get a lot of stuff done. But I usually don’t get over that “hump” and never get pass the verge. It’s like I feel so close to being more productive but just a little behind. Since I am not therapeutically focused, I tend to flip flop while studying. Meaning, I want to read this particular subject. I open up notes and feel like nah I don’t want to read it. Then I try to do something else but I feel the same. So more or less, I just waste time. And this leads to increased frustration because I am supposed to be studying. I don’t think taking more Adderall is going to help with that.

Taking more definitely will not fix this.

Holidays + Delsym (DXM):


I have taken DXM polistirex but the results are not consistent. I have tried to take this at night (i.e. 10 ml = 60 mg) and have taken smaller dose about 90 minutes before my morning dose of Adderall. Results are not consistent. It works well for first few days and then it does not. Plus, DXM can make me loopy, give a nagging headache so it’s not really worth it. I have also tried DXM-HBR which is cheaper than DXM-Polistirex but it DXM HBR does not work. Why? My quick research showed that DXM HBR is more of quick acting and it helps if taken about 10 minutes before Adderall (or at least for me it works this way). DXM-polistirex works when taken about 90 minutes before first dose of Adderall. Results from DXM are not consistent and don’t worth the hassle because once I get that loopy feeling and nagging headache, I am done for the day.

OK.... as you are a med student I am surprised by this also... DXM is not safe to take frequently..and not intended for the use you are using it for. Around here you cant buy it if you are under 18... it is bad for the liver, among other things and if it was an accepted practice for taking adderall the there would be positive medical evidence behind it...not warnings. It falls into the potentiating category as well.

Holidays + breaks from Adderall:


For me it does not work. I have to take at least a week or two off in order for break to work. If I take 1 day off or even a weekend off then the following day, I have to take almost twice the normal dose to get to some sort of functioning level.

I do not know of any evidence that supports holidays to reduce tolerance.. Yes after a holiday you will feel the meds more but as far as actually reducing tolerance... I am still waiting to see how that actually pans out.

I am fully aware that it's all about tolerance of adderall. I need to study for about 6-8 weeks and then I am done. So I am not sure what else I am missing? Any suggestions will be greatly appreciated.

So you are interested in treating your adhd for 6-8 weeks only? I look at what you are using it for like someone who uses performance enhancing drugs.... not to treat adhd. Not to be rude but I wonder if you have it honestly.. The way you take it, and all the hoops you are jumping through to take it are the exact same things recreational users do to enhance the high. You may very well respond and say you arent using it to get high... but when someone does all the things a recreational user does like crushing, under the tongue...dxm..baking soda..what would your prescribing doctor think about that?

[Little Missy]

So what do you do when it wears off in about 4 hours?

[Belikemike1183]

Originally Posted by ImaADHDGuy

50mg of melatonin? Is that a typo? If not, that's a lot, and will most definitely effect the next day. With meltonin, less is more in many ways. It's more important to take it at the same time every day, and go to bed right after taking it.


Here's a article about a study that showed 0.3mg was enough to cure insomnia. https://news.mit.edu/2001/melatonin-1017


And another article about how less is more:

Funny thing is, I have heard and read mixed reviews regarding Melatonin. I have heard and read that therapeutic dose is around 30 mg. I did not know about taking it at the same time every night. How many hours in advance should one take it? Preliminary reading suggests that taking it about 3-4 hours before bed should be good.

[Belikemike1183]

Well, entire point behind using baking soda is to take less. By using this, I am hoping that I won’t have to take more Adderall than I need. Perhaps, consuming a light meal or even snack upon waking up and then perhaps using baking soda might be a better route to go. Never thought about it this way. Seems like a good option. Thanks!

In all honesty, I am not sure if Chelated magnesium works. It might work but I am not sure how one feel would. I had always taken it at night but for last few months, I have been taking it in the morning. Early in this routine, I wrote down how I felt after switching chelated magnesium from night to morning. Not a significant difference.
I have that Benadryl has smaller half-life than doxylamine succinate but I think its appositive. I used to wake up with severe headaches about 2 years ago, when I was taking more Benadryl than now. Also, taking it earlier in the evening/night has alleviated morning fog significantly.

I do understand your thought process and reasoning behind waking up earlier to give yourself more time but I am not sure how early can I get up. I say this, because I am finishing my preliminary surgery residency in 3 weeks and then I will start my Integrated Orthopedic – Trauma surgery residency for next 6 years.

DXM is not safe, I agree. But I don’t take it regularly. I have taken it previously but not more than 7 or 8 days in a row. It is too unpredictable and definitely expensive if you try to Delyn. Generic DXM-HBR capsule from amazon or Walgreens are cheaper but they seem to produce inconsistent results so not worth taking extra stuff. I do know it’s bad for the liver and I have witnessed it firsthand. However, “you” need to take seriously high dose for an extended duration to screw up your liver. Regardless, that’s not the point. It’s bad and should not be taken.

For treating it 6-8 weeks, is not true. Yes, I did mention 6-8 weeks because I have my boards coming up in 8 weeks so until then I would rather not explore the luxury of “waking up earlier” and or giving myself more time to wake up to get going. All these methods of potentiating Adderall were geared towards getting through next 6-8 weeks. After the board, I’ll have an easier schedule relatively speaking.

I have been on Adderall since 2010 and there’s no point in arguing if I am taking it too get high because I’m not. I have no way of proving this via this platform so it does not matter. But regardless, it will be difficult to be high and get through residency.

[Belikemike1183]

So far it seems like suggestions are:

1) Eat something in the morning, if even only a small meal or item and then use baking soda.

2) Take it as it should be taken

3) Stay away for DXM and others - I agree.

4) Anything else?

Thank you!

[Belikemike1183]

Sorry forgot to add couple of things.



1) Should I take heavy dose off adderall in the morning? Let's say, taken 40mg or 60mg PO and then take rest as needed before 3pm? Or take them evenly spaced out?



2) Sometimes, I suddenly get sleepy in the middle of the day. Doesn't happen all the time but sometimes. Happened yesterday. Just curious and no i don't have any other sleep disorders especially narcolepsy.



3) Anyother suggestions? advice?


Thank you everyone! (how about a free knee/hip replacement when you get to 80? )

[Lunacie]

You say you're taking it through the day "as needed" which I take to mean
when you feel it wearing off.

Much better to take another dose before the last one completely wears off
and you're basically starting from scratch again. True of most meds.

I suggest setting an alarm for 30-60 minutes before you have to get up and
have a 30 mg dose waiting on your bedside table. Nod off again for awhile.

It should have kicked in when you wake up. Eat breakfast. Go to work/school.

Take the other doses at 3 hour intervals whether you feel it wearing off or not.
Just try that for a few days and see how it goes.


Don't you know that if you crush it and take it sublingually although it starts
working faster ... it also wears off faster? Just STOP doing that.

[Belikemike1183]

Originally Posted by Lunacie

You say you're taking it through the day "as needed" which I take to mean
when you feel it wearing off.

Much better to take another dose before the last one completely wears off
and you're basically starting from scratch again. True of most meds.

I suggest setting an alarm for 30-60 minutes before you have to get up and
have a 30 mg dose waiting on your bedside table. Nod off again for awhile.

It should have kicked in when you wake up. Eat breakfast. Go to work/school.

Take the other doses at 3 hour intervals whether you feel it wearing off or not.
Just try that for a few days and see how it goes.


Don't you know that if you crush it and take it sublingually although it starts
working faster ... it also wears off faster? Just STOP doing that.

Yes, you are correct regarding taking it as I feel it is starting to wear off.



It's a good idea to set up an alarm and then other doses at 3 hour interval.





Thank you!

[ImaADHDGuy]

Originally Posted by Belikemike1183

Funny thing is, I have heard and read mixed reviews regarding Melatonin. I have heard and read that therapeutic dose is around 30 mg. I did not know about taking it at the same time every night. How many hours in advance should one take it? Preliminary reading suggests that taking it about 3-4 hours before bed should be good.

Unless you have a particular medical condition that prevents your body from creating its own melatonin, you technically have enough to get you to sleep. Therefore, taking a melatonin supplement is just a way to tell your body, "OK, release it now." Therefore, you don't need much. The pill is just a way of controlling when your body decides to go to sleep. The body and mind are very habit oriented -- it prefers to do something the same way at the same time every time. That's why it's important to take it at the same time every day. Also, once you trigger it, it's time to go to bed. By delaying, you're just training your body to resist the hormone, which will trigger a possible increase in production, which will cause all kinds of side effects, like depression (groggy and unable to wake up properly) or even anxiety. It is a hormone, and hormones have a huge influence on mood and emotion.



My guess is that this is a primary reason you're having trouble getting up in the morning. Not the only reason, as you're taking very high doses of Adderall and counteracting it with several sleep agents, which is the fundamental issue. Point blank, if you need sleeping agents, you're taking too much Adderall. But your doctor may decided that's needed as a special case. Given that you're crushing the stuff and downing baking soda, though, I'm pretty sure you're not using as directed. It might be time to admit you have an addiction problem that you can't solve all by yourself or only with online forums. Is there a real-life person you trust and can talk about this with?

[Belikemike1183]

Originally Posted by ImaADHDGuy

Unless you have a particular medical condition that prevents your body from creating its own melatonin, you technically have enough to get you to sleep. Therefore, taking a melatonin supplement is just a way to tell your body, "OK, release it now." Therefore, you don't need much. The pill is just a way of controlling when your body decides to go to sleep. The body and mind are very habit oriented -- it prefers to do something the same way at the same time every time. That's why it's important to take it at the same time every day. Also, once you trigger it, it's time to go to bed. By delaying, you're just training your body to resist the hormone, which will trigger a possible increase in production, which will cause all kinds of side effects, like depression (groggy and unable to wake up properly) or even anxiety. It is a hormone, and hormones have a huge influence on mood and emotion.



My guess is that this is a primary reason you're having trouble getting up in the morning. Not the only reason, as you're taking very high doses of Adderall and counteracting it with several sleep agents, which is the fundamental issue. Point blank, if you need sleeping agents, you're taking too much Adderall. But your doctor may decided that's needed as a special case. Given that you're crushing the stuff and downing baking soda, though, I'm pretty sure you're not using as directed. It might be time to admit you have an addiction problem that you can't solve all by yourself or only with online forums. Is there a real-life person you trust and can talk about this with?

It makes sense as far as melatonin is concerned. Yea, I am not using it as directed. I do have an appointment with my doctor in 2 weeks to go over all this in detail.



For time being, it seems like suggestion by Lunacie seems reasonable.



Anything else that I can try to see some consistent results as far as being productive goes and get stuff done.



Thanks

[psychopathetic]

Have you tried other meds? Maybe adderall just isn't right for you.

Also the fact that you're on such a huge dose, that you crush it, and that you use it with baking soda to try and increase it's effects...
I honestly don't think you can handle these meds on your own. Just my grumpy opinion.

[psychopathetic]

To me it sounds like you're VERY close to trying to abuse Adderall. I mean...look at the long list of stuff you're trying to do to increase it's effects. It's no wonder you have a tolerance to it...you're borderline abusing the stuff.

After re-reading your original post...I guess I really don't have any suggestions for you.

I know I'm coming across as being harsh here...and it's because, well...I am being harsh lol.
But I do feel bad for you . It's not like you wanted to be at this point with these meds. They were helping, and then they stopped...it's only natural that you try and get that back. That help.
And you absolutely do need and deserve it. And it sucks cause you're moving into a part of your life that will be very stressful and highly demanding...so damn! You could REALLY use something to help out.

It freaking sucks that Adderall is no longer doing that for you. It sucks that you're having to push so hard to try and get it back to where it use to be.

I guess I do have a suggestion...and my suggestion would be to work with your doctor to try a new medication.
That's not a great suggestion either for you right now...because what a freaking mess switching to new meds can be right now at this point in your life with all the stress of starting residency soon and all the studying and everything.

But I do feel you're on a dangerous path where you are with Adderall. Maybe it's time to let it go before it becomes a very serious problem.
There are other meds for this.

Sorry for being so harsh with my words. I do wish you well though, and I do empathize with you. You're not being a 'bad' person. You're just seeking help for this damned difficult disorder that drags you down in the mud all day. You do deserve that help, and I hope you can find it safely again soon.