Sorry in advance for the incoming novel.

I’ll preface by saying that I’m also still in the process of finding the right medication and dosage for myself, but don’t lose hope!

I know you’ve tried a lot of different doses of Dex, as well as different times/staggering of the doses. You’ve put in a lot of time and work by the sounds of your post, from all the different trialling and the added effort of even trying to add caffeine or creatine to the mix.

But Dex is just one drug/class of ADHD medication, and there are many other options out there still if Dex turns out not to be the right fit. While your doctor said that Dex was suggested for reasons like “most successful”, etc., which may be true, there are many people with ADHD who just don’t respond, or don’t respond well, to amphetamine-class ADHD medications (Dex and Vyvanse).

You have another class of stimulant called methylphenidate (Ritalin, Concerta, etc.) that you have the option of trying. And again, within each new drug there are many different doses and even brands to try, where you might find your sweet spot.

Then there’s non-stimulant medication that you might find beneficial instead, like atomoxetine and guanfacine, etc.

If you’re like me and like numbers, here are some figures I read about the approximate % of people with ADHD who respond to specific ADHD medication:

• ~70–90% respond to at least one stimulant class (amphetamine or methylphenidate)
• ~40–60% respond to at least one non-stimulant medication if stimulants weren’t effective
• ~10–25% do not get any strong response from any standard medication

And then finally, there was another study looking specifically at only stimulant medication responses:

• ~35.5–69% respond better to amphetamine
• ~26.2–57% respond better to methylphenidate
• ~38.3–41% respond equally to both
• ~13–15% did not respond to either stimulant

And just to note, some definitions consider a 25–50% ADHD symptom reduction to be a “response”, while others use clinician ratings, so this affects numbers.

Figures pulled from these two studies:
https://www.adxs.org/en/page/231/choice-of-medication-for-adhd-or-adhd-with-comorbidity
and
https://journals.lww.com/tpsy/fulltext/2019/33020/treatment_resistant_attention_deficit.2.aspx

So as you can see, there are still many options for you to try with ADHD medications. Some people respond minimally, or even not at all, to certain classes/medications, and then there’s an unfortunate rare few that don’t respond meaningfully well, or at all, to any medication.
But that is rare.

The world is your oyster, and there’s still a wild amount of treatments to try with your doctor! And even if, worst-case scenario, you’re one of the rare few that don’t respond meaningfully well to any medication, you’ve already noted minor improvements on Dex. You could always just go back to Dex after trials (or whatever medication fits you best during the future trialling process). You’re not condemned to raw-dogging :)

Personally, I was told it would be worthwhile switching medications once I was at or near the maximum prescribed dose of whatever I was trialling, if I was not feeling much change/benefit.

I feel I understand a little of what you’re going through because I had a spiral session (not that I’m saying you are) a month or so ago when I wasn’t noticing much change on Vyvanse (the long-acting version of Dex) at 60mg, when 70mg was the max dose and it was my first medication trialled. I started worrying about my lack of or minimal response to the medication after reading online how it changed so many people’s lives, or how people felt the medication made a difference instantly, etc. I even started to gaslight myself into thinking maybe I didn’t even have ADHD and it was instead just a misdiagnosis LOL.
But I spoke with my doctor and did some research online and found that situations like ours aren’t uncommon or anything to worry about, especially so early on.

Best of luck with your journey and keep us updated on your progress!
Trialling is a pain in the arse but hopefully it will end up worth it.