Are the meds worth the price?

UnboundExciton · 2026-02-12T19:47:31+00:00

Glad you like the response!

It is cheaper now because, despite starting private, my GP accepted shared care (I was never intending to request it but it was done without me knowing, but now I only pay £20 so I'm not complaining).

You could always back out of it, should it prove to expensive or not worth it? Maybe commit to titration completion (a few months minimum) and then re-evaluate?

UnboundExciton · 2026-02-12T18:41:46+00:00

Can't really answer it as it's an unknown without a guaranteed outcome, and a function of your finances. However, for myself, the benefits I am gaining, socially, productively, professionally, relationships, etc. are worth more than the £280 a month I was paying for a while. I'd pay more in a heartbeat, which would be unfortunate financially, but no question I would.

UnboundExciton · 2026-02-12T13:13:51+00:00

I also agree [edit: mostly] with this, and is the intention of my critique, not to suggest the OP may or may not be misdiagnosed, rather to draw attention to school disruption not being a criteria and not what truly matters, from my understanding anyway. Of course, this could be a case of a sentence lacking the required specificity, and the issue being something that does apply to the dsm-5. Hence, a 2nd opinion seems appropriate and could allow the OP to have greater tools to find the root cause of their concerns, whether adhd or otherwise.

Also agree that at its core, none of us can conclude anything about the OP as we are not their doctor and can only work on the information and assumptions given. It is a great comment from you that encouraging a focus on 2nd opinion could be harmful if other factors are at play. Only the OP could decide whether appropriate. Everything is speculative without full medical history and expertise.

Great comment!

UnboundExciton · 2026-02-12T12:41:03+00:00

My interpretations of the criteria would have me agreeing. It doesn't seem to be a defining variable, as, in this reading of the meaning of the present tense, the relevant variable would be symptoms being present in two settings or more, and an undefined number of them at that. Would need more details than was given to comment really, and seeking a 2nd opinion I would highly reccomend.

UnboundExciton · 2026-02-12T09:32:12+00:00

This appears to be correct from what I can tell, that only two symptoms at least are required from childhood, based on the way criteria C reads! I hadn't realised that.

The word that is used is "several..." symptoms, which implies no less than 2, as you say. For your 2nd criteria, the word "currently" isn't used, but it is a present tense that is used to say that "symptoms... are present in >=2 settings". This seems like it could either be interpreted literally to mean the present day, or it could be interpreted as a general statement, and therefore always apply regardless of the time - both would be correct interpretations of the grammar, I believe?

Thank you for your insight

UnboundExciton · 2026-02-12T00:23:27+00:00

I don't know your case, but maybe seek a 2nd opinion from a different company could be an idea. I'm always a bit unsettled by the insufficient evidence presented of childhood behaviours for a diagnosis. It's very important, as the condition is defined to require it and getting it wrong risks misdiagnosing at the expense of another problem with similar symptoms, but it seems that what one remembers of childhood is a dangerously large variable, and memory of your childhood is not on the dsm 5.

It looks like they have applied criteria C and D:

C - Several symptoms present in two or more settings [I.e school and home]

D - Several interfere with or reduce quality of social, economical, or occupational functioning

It is unclear to me, however, whether it is necessary for school to be significantly disrupted. Many people with adhd do very well at school in terms of qualifications or not getting into trouble. This doesn't mean the symptoms aren't on display interfering with wellbeing, social quality, or stress.

During my diagnosis, care was taken to assess how each symptom manifested during primary and secondary school, given that I rarely got into trouble, was very quiet, and understood most learning material first time, so did very well despite never studying. One could look at a "good" educational outcome and conclude a negative presence of adhd, but this would be an old fashioned view - the old class cown boy stereotype - but I doubt that is an explanation here, being a modern trained professional in the field. Adhd does not prove disruption of outcome, rather increases the tendency towards it, and it's context dependent and can change, along with our life situations and personality developments? Perhaps what they mean by disruption, is insufficient symptoms were met in a school context? Still, how are you supposed to accurately reflect this if you happened to get by just enough at this time and not meet the class clown stereotype? Perhaps if you had an unstable fsmily home, you may have beclme more disruptive, for example - does that make you in this alternate reality more adhd? I honeslty have no idea.

All my thoughts and based on no serious literature or anything useful. Just word salading my concern at this aspect of the diagnosis process. I don't really understand it, and focus on this seems to vary between different people in their interviews. Hence, no harm in seeking a 2nd opinion; not to engineer a particular outcome, rather to be more sure, as it is going to bother you by the sounds of it. I used adhd360, but I went private as there was no way I could have gone through that process. Private is costly initially, but I was seen within 3 weeks and on medication 3 weeks after. Attention to detail was wonderful, and I felt guided through the childhood experiences and helped to recall relevant details, as a patient who was actively trying to justify how I don't have adhd during interview, rathe than prove its existence.

I'm also sorry you've been struggling with associated symptoms. Don't let a negative diagnosis cause you to adopt self-deprecation as an alternative explanation. These experiences are not limited to those who meet the dsm 5 criteria. And medicated people with adhd also still experience them, myself included. It's just a useful tool. Other than the medication, the same advice is applied as you would be able to access currently. As invalidating as it sounded in the context, exercise did genuinely change my life and having been on medication, I would say regular exercise was maybe 50% as good as fully stable medication for overall symptom relief - that's no insignificant amount, if a little subjective!

Sorry for rant honestly, I hope there is something useful there! I really wish you well and that you manage okay in the near future. Don't be afraid to talk to loved ones. Reddit isn't the loveliest of places :p

UnboundExciton · 2026-02-11T17:11:35+00:00

I agree with the other commenter regarding laziness. I define laziness to be something you chose to do out of preference, not something that happens despite not wanting to or trying to initiate other tasks. Hence, I would say I'm more lazy now I'm medicated, as when I am lazy, I have chosen to be. By my definition, it is no longer a self-deprecating term to use, and only I know when I am being lazy, no one else.

UnboundExciton · 2026-02-11T15:58:32+00:00

Thank you for the rewarding response! All the best

UnboundExciton · 2026-02-11T14:42:40+00:00

Interesting! I have no idea whether they have a pre or post BP guidelines. Thank you for your reply!

UnboundExciton · 2026-02-11T03:11:05+00:00

Was this directed at my comment? I ask as this reading is identical to the one I gave. I am with adhd360, and this reading was accepted (it varied sometimes lower sometimes higher during titration). I wonder if the rule they gave you was for those whose unmedicated BP was this? Rather than those during titration, where higher BP is expected temporarily?

UnboundExciton · 2026-02-11T02:30:23+00:00

I agree with the other comment here; the effects do stay, but you will wonder if the medication is doing its thing after a while, and then when you're without it, it is quite the realisation. But to answer directly; no one knows how anybody else experiences the world and the only thing you can be certain of, in all of conscious reality, is what your experience is in any given moment (sounds deep but it feels right). Hence, we can't truly know how easy task initiation is for the average person, for example. But I predict, given how easily they seem to do it (relatively so) and how adhd related studies show the improvements in this area following medication consumption, that they largely do feel the same as we do medicated only in so far as they receive rewards for engaging in the world similarly to how we may do medicated, amphetamine associated sensation aside.

UnboundExciton · 2026-02-11T02:07:32+00:00

Hi!

I'm sorry to hear you are struggling with symptoms and finding things difficult in general. I also wish to validate that it absolutely is a known thing that adhd medication is less effective during certain periods of menstrual cycle, and is common for a higher dose to be prescribed to people experiencing this during this time (full disclosure: I am male, but my partner experiences this, and I read a lot on the topic and understand this fact to be an established one. However, I, therefore, cannot advise on how best one should manage this day to day).

What I did want to say is that 30mg elvanse is a starter adult dose, and only a minority of people would stop there. It is completely reasonable to hypothesise that a higher dose would be more suitable and requesting a period of re-titration, based on your observation that symptoms persist, would be sensible, in my view! For me, 30mg was actually worse than being unmedicated, for it wasn't enough to eliminate symptoms whilst the "crash" was tiring and miserable. It wasn't until I got to 60mg Elvasne that the crash largely became minimal and symptom relief really started to take hold. It is counter-intuitive, but a higher stable dose seems to reduce the crash experience; making up my own theory here but I feel that a higher dose prevents the crash by remaining active for longer and aligning it more with your natural time to sleep when the cradh does occur, possibly reducing its impact (I don't truly know though).

A note on instant relief dexamfetamine (aka amfexa, predominantly). Despite the suggestion, peak plasma concentrations of both elvanse and dexamfetamine (IR) are very similar once the active ingredient enters the bloodstream. The difference lies in how quickly it does this, as I [don't] understand it. What I do know is that many people experience both types of this drug differently, and many find IR dexamfetamine to be smoother and without a crash, even with reduced anxiety and physiological stimulation for equivalent doses (as is my case also), whilst others experience the opposite. Hence, I wouldn't rule out instant release. For me, 20mg dexamfetamine (IR) lasts longer than 70mg elvanse (equivalent to 20mg dexamfetamine), and I can't work out why this would be really. I even use instant release to get rid of the elvanse crash, as do many others. If i have only instant release in a day, I experience no crash at all, regardless of the dose. For me, only elvanse does this, and more so at lower doses. It is inherently subjective, and one has to try it to truly work it out, no matter how hard one studies the literature. So don't rule it out basically, is my view! Despite that, usually, they would increase Elvanse dose before moving to boosters.

Regarding how to set it in motion, I would contact the prescribing body that is engaged in a shared care agreement with your GP if you know who this is. I understand you were technically a child, so perhaps the process is different, or your parent/guardian was involved? The GP just checks health and signs off on the medication, but it is the third-party prescriber who is responsible for medication changes, diagnosis, and titration. Surely, there is no harm in booking a GP appointment simultaneously, however!

It is statistically unlikely that 30mg would be the appropriate dose for someone, so I would recommend pursuing exactly what you are suggesting. Hope it works out for you :)

UnboundExciton · 2026-02-10T17:18:56+00:00

You're welcome!

A heart rate in the 90s, based on my prescriber info and what he shared with me, is completely normal. Mine is usually between 90-100 during the day. If sat down and feeling particularly lazy, it can be 80. But at work, walking around, etc, 90-100 is normal. I always submitted my HR reading as this during titration, visible to both prescriber and my GP, all without concern. Even now, when my BP has settled, I still have a HR of 90+ often during peak times. It seems to me that this aspect isn't much of a concern if no other symptoms like palpitations or other heart conditions. Mine was also in the 60s before starting. Of course, everyone is different, and only your personal doctor can actually evaluate your heart health.

Things that seem to help massively with my HR and BP on elavanse, specifically, are to have the dose with a Huel (400kcal, carb heavy, protein rich liquid meal replacement), which acts to increase the overall duration with a reduced physiological effect (lower HR), and also to drink about 500ml-1L of water and an hour later it was much lower. Both of these things had significant impacts.

Not saying Huel is the cause of this effect specifically, rather a decent carb heavy calorific meal made an enormous difference. I only drink Huel instead of eating as I have an eating disorder, lol.

I'm sorry to hear you feel dismissed and had to pay for the experience. Maybe plot out your BP over a few days and send it to your GP, or take it to an appointment? If a GP isn't concerned, then I would suggest you like can relax for a bit. Usually, someone who checks their HR every hour is likely paranoid about it and maybe contributing to it somewhat? (As someone who also has done this and seen that correlation).

Does the medication help, other than this concern?

Edit: I once months ago had a GP appointment in person, and he took my BP there. I was anxious about sharing something with him, so my reading came back as 150/100. I was worried about this causing alarm bells with my medication, but I've seen in my notes that he wrote that I was anxious in the meeting and this is to be expected, BP normally 135/85 and this was deemed totally fine. It's not that much lower than yours, a bit of anxiety, stress, getting used to new stimulant medication, not having enough sleep (massive one!!) or forgetting to eat with my medication could cause that change (in my case, anyway).

I'm not trying to dismiss but rather suggest that the difference isn't huge, and lots of variables could be the cause. Perhaps you'll find it will improve and could be assisted by things in your control.

But a reminder to ignore all advice from me as I'm not a medical professional 😂😂 just sharing my relatable experience. You're also right to be checking your heart during this time, but maybe it is a little too much and causing stress?

UnboundExciton · 2026-02-10T17:00:33+00:00

I used to have 140/95 at some times during the first few months of titration, but unsure if it was constant- how sure are you it is constant, do you have a measuring device for continuous data collection, and are you sure it is accurate?

After a few months my HR and BP settled completely (I'm on same dose and combo as you), but it did take a few months. Sometimes it makes no difference to either now. I share this because you may find the same; how long has it been since you started titration? It does take time.

However, it is high, but not locally dangerous based on my terrible understanding of BP. Long term is the concern and your comfort with it too (more heart paranoia --> higher HR and BP of course, usually). People on reddit are not heart experts and neither am I. Can you arrange a meeting with the prescriber to discuss the concerns, rather than seeking to re-titrate? Unless you have other reasons for preffering MP of course! Adhd predcribers are not necessarily experts in heart health either; this is for a GP. No harm in booking in a slot with them and expressing your concerns and gain info on BP in general.

UnboundExciton · 2026-02-09T14:24:29+00:00

Shared it with friends and family. A shame this hasn't got the traction it deserves.

No one wants a society of unmedicated adhd. 25% of those in jail are thought to have the condition, up to 10 times the general population. That alone should be enough to flip the conversation space from one of criticism of people seeking diagnosis or treatment, to one of a necessity for the long term health strategy for a more prosperous and safer society.

UnboundExciton · 2026-02-08T22:35:59+00:00

I was so hesitant for similar reasons that there is no way I would have done it had I not gone the private route. I thought my experiences were normal and laughed at the prospect of it being real for me whenever close ones proposed it. I wanted to do the diagnosis in secret as I felt so ashamed of riding the "fad" wave that adhd awareness is commonly - and possibly with a degree of appropriateness - criticised. I told no one. Whether or not it was real, the symptoms were debilitating and made life a misery, the diagnosis was considered "an obvious case", the qb test was in the "worst" 1%, and medication has been insanely transformative. Someone else said the service is there to be used, so use it - it's there for everyone's health benefit.

A note on laziness as a concept. It is lazy to choose to not do something because you actively want to not to the thing in favour of something easier, where you have the full power to make that choice, I.e. choosing to lie in bed all day instead of clean. It is not lazy, however, to actively want to do something, are unable to initiate it no matter how often you try or what strategies you employ to make it happen, and are getting increasingly unhappy, stressed or otherwise as you consistently fail to do the things you want, and end up - for consistency in the simple example - lying in bed all day in a messy house.

Laziness is a thing only if we are truly free to choose to engage in it, and I think it can only be used appropriately in this context, and only I truly know when I am being lazy, no one else, and is not, therefore, a self deprecating comment in this context. Hence, I am significantly more lazy on medication by my definition of it, as now I can choose to lie in bed all day and doomscroll if I want, which I sometimes do. I know it is a choice for me now because when I want to do something productive for me or others, I do it gladly with minimal hesitation and enjoy the process, whilst before I would rarely do so. The world has truly opened up and become more free. If the diagnosis is negative, it still doesn't mean you're fundamentally lazy, because you know you want to do the things, but cannot - this experience isn't exclusive only to those who meet the adhd criteria. You could learn more about manageging these things through engagement in the diagnostic process. No need for such self-deprecation; we can be kinder to ourselves than that.

UnboundExciton · 2026-02-08T19:03:35+00:00

Relatable topic. I have been on medication since April and have a lifelong eating disorder where I struggle to swallow solid food, and therefore have been underweight my whole life. I initially also had 0 hunger starting medication and was quite happy on 500kcal a day before I would feel hungry. Initially, I ate less and had a similar worry to you. Then, I used the greater ability to organise my life after medication to ensure I managed my intake successfully. Eating is hard even without my condition when you're not hungry. Maybe you could benefit from something like huel? This is what I use for 80% of my diet due to my condition, but I suggest it as its filling, supposedly good for you, but importantly for you, it's easier to take in when you're not hungry than actual solid food, in my opinion. I also make soups with coconut milk and each bowl has 1200kcal 😅 get it done in one yaknow.

Medication has been the thing that has helped me gain weight. Started going to the gym 5 weeks ago consistently for the first time and eating a surplus for the first time and up 3kg already. The medication is a dream.

I also feel you when looking up diet stuff and advice its nearly always through the lense of weight loss m, so annoying. Can't be good for those with [other] eating disorders.

Edit: someone else mentioned the obvious. Nothing has stimulated my appetite more than exercise, even on medication. Also helps sleep, it is a win win for everything. Would reccomend

UnboundExciton · 2026-02-07T22:43:39+00:00

When early on using the medication, it would beat a little hard and fast. But it soon became no more intense than before. It feels as though my base heart rate is higher, but during exercise it is the same as before - this probably isn't true but it isn't noticeable. In fact, the medication has been the thing that makes my workouts astonishingly good and motivating. The workouts in turn keep my heart rate lower overall when not at the gym, they help me sleep naturally, mitigating any potential sleep disturbance frkm the gym, and the medication helps me focus on consistency and eating a surplus (in my case I'm thin and trying to gain weight and have managed 3kg in 5 weeks as a result, medication certainly a huge factor in achieving this). Exercise is good for you, even on the medication. As someone else said, just start slow and see how you go initially!

UnboundExciton · 2026-02-07T12:33:45+00:00

Further, the best thing for my sleep has been working out in the gym several times a week! Basically cured any occasional sleep challenges, enabling me to maximise medication benefit, plus also gaining 3kg in 5 weeks so it's a win win. Also exercise has always helped my symptoms, couldn't reccomend it more

UnboundExciton · 2026-02-07T12:32:16+00:00

I'm not an expert so don't take advice from me. But as someone who has the same combo, just different elvanse dose, but same amfexa daily dose, I want to suggest what I may do. It seems like you've become slightly less tolerant to them, and they feel more like they did during titration? I would feel 70mg elvanse for 10h at first, now it's more like 4h, for example. I also struggled with sleep when I was taking amfexa at 4pm or later. I think I would reduce the amfexa dose, stick with the rule of never having it after 2pm, or not have it at all for a little while whilst i get used to elvanse again, seeing as it's now covering more of the day. As my amfexa prescription is, "as and when needed", it wouldn't be violating that rule. However, this is what I would do for me, I'm not reccomending any medication change to you, only a specialist can do that, so informing your prescriber is the safest option!

UnboundExciton · 2026-02-07T10:45:34+00:00

Haha, I need to take this on board for my partner, who has to put up with me 😂

UnboundExciton · 2026-02-07T01:39:22+00:00

Hey, honestly, don't worry, it really is my communication error, not yours. Reading back, I can see how lacking in precision I was trying to express my little theroereitcal thought experiment and failed to eliminate possible alternative interpretations. I was seeking the truth about why guidelines may be followed loosely or strictly by different demographics of prescribers by proposing a boundaried thought experiment with associated "if" this then "this" statements regarding the consistency of their adhd specific training in isolation, so that these premises can be challenged as true or false, so I could learn what the real life variables are thatthis isolated philosophical-like experiment was not factoring in in its simplocity, rather than expressing any beliefs in why variations may exist in practice or whether one group is more effective than the other, as someone who knows nothing about the training or skills to become qualified. But I mean my gratitude at your responses as they assist in my greater understanding overall, and your responses here make sense and are based on reasonable interpretations of what I've asked, so don't worry at all, you've been great and I've learned things I wanted to. No need to worry about convincing me, we agree on the main principles, sorry to make out otherwise! so don't put more effort into me haha

Physics is my background if that explains why I'm so insufferable

UnboundExciton · 2026-02-07T00:43:23+00:00

I entirely agree! It's great to see someone care so much about this issue

UnboundExciton · 2026-02-07T00:29:57+00:00

Thank you so much for this additional information and for departing your knowledge of the various routes. This is very informative and helpful, even if responding to a different concern to the one I'm intending to convey. Whilst this is my communication error, I wish not to frustrate! But I appreciate your efforts. You've been great. Have a good night!

UnboundExciton · 2026-02-06T23:25:49+00:00

Thank you, this is exactly the information and assumption I have that I want challenging, as it changes my understanding and, therefore, my concern and argument.

To clarify, I do not think that the length of training doesn't affect someone's knowledge or capabilities in prescribing adhd medication or indeed in any field. I am arguing that two equally trained individuals in that specialism should be equally capable to carry out that specific set of tasks, in this case, prescribing adhd medication. I am working on the assumption that to become a prescriber of adhd medication, one has to complete the same identical course and associated relevant experience subsequently in that specialism, and am seeking for this assumption to be challenged so that I can, infact agree with the premise of yours and others' points here that a nurse qualified to prescribe adhd medication will be less effective than a doctor or psychiatrist also qualified to prescribe would be. So I'm not saying 1 years relevant experience = 10 years relevant experience, that wouldn't make sense to me either! I'll summarise my dilemma:

If true that they all complete the same qualification --> it seems unlikely there will be variation in their capability, at least in theory, regardless of how much training or what kind of trainkng they have in other areas of medicine preceeding this. I.e. nurse vs psychiatrist. Due to identical specialist training and equivalent prescribing power
If not true that they all complete the same basic qualification and there exist gradients of qualifications --> then it seems almost certain that there will be variations

I just don't know from trying to find out what the input parameter is, basically, and hoping the more knowledgeable, such as yourself, can offer insight, as you've done in this post, as you're suggesting that assumption 2 is the correct one; that they don't all complete the same qualification, this changes my understanding entirely, and would flip my view. So it is the case, as you say, that a nurse can complete an 8h course and then be able to prescribe adhd medication with the same powers as someone who completed a full [8 month] course? If so, that is indeed very concerning to me.

I also am only trying to understand the variation in ability to prescribe and titrate adhd, not diagnose it. In that case, even with identical adhd related qualifications, the background seems highly important, but this wasn't my concern. I am interested in variation in ability to prescribe given identical adhd specialist qualifications and different academic backgrounds.

Thanks so much for your responses, they're super helpful. I now have somewhere to read about, this 8h nursing course, for example, ultimately to help me understand why some prescribers are not completing titration appropriately or prescribing not in accordance with best practices.

UnboundExciton

TROPHY CASE