Immediate-Release ADHD Stimulants: Why They Don’t Work and What to Do Instead

About this episode

A comment from Australia. The system gives you Vyvanse and an immediate-release tablet and says go away. Jonathan Murphy, PMHNP-BC, explains why that second-line prescription is the problem, why immediate-release stimulants are too dopaminergic to optimize, and what to ask for instead. This episode covers why immediate-release stimulants peak too fast and crash too hard, why tolerance builds when you take them multiple days in a row, why the sweating and teeth grinding means it is too much, why wanting to be on medication for less time is an anxiety signal not an ADHD signal, why OCPD needs to be examined when someone resists daily medication, why ego syntonic versus ego dystonic matters for treatment readiness, why Dexedrine Spansules might be available where immediate-release dexamphetamine is, why Wellbutrin is better to have on hand than Adderall, why the crash at the end of the day is a side effect not a given, and why you must take the medication consistently for at least two weeks before you can assess anything. Also covered: B.F. Skinner did not want you to know how behavioralism works, why intuition takes you far but not the whole way, why Russell Barkley’s legacy matter