Hi everyone,
I’m a 30-year-old woman with ADHD, complex childhood trauma, and lifelong extreme fatigue and executive dysfunction, and the only thing that reliably gives me normal functioning, emotional stability, and a livable life is very high-dose IR methylphenidate (120–180 mg/day).
Standard doses and multiple alternative ADHD meds (Concerta, Vyvanse, Adderall, Foquest) have either done nothing or caused intolerable side effects, yet most doctors dismiss my experience, call it depression or “performance enhancement,” and refuse to consider why my dose-response is such an outlier.
I’m now trying to find specialists and communities who will actually engage with this complexity and help me build a safe long-term plan that doesn’t destroy the functioning I’ve finally achieved. I’m not asking anyone to prescribe or tell me what to take, I’m just looking for insights that could help me better navigate my current situation.
Brief Overview
Lifelong symptoms:
extreme fatigue, executive dysfunction, “everything is a chore,” chronic insomnia, depression, and anxiety.
Childhood:
significant physical/emotional abuse and long-term stress at home.
Teens–early 20s:
heavy daily cannabis use (basically high 24/7 from ~14–24) and nicotine.
Recent:
ADHD diagnosis this year. Multiple med trials. Only regimen that truly works: high-dose immediate-release methylphenidate (Ritalin) ~120–180 mg/day, taken in divided doses.
I fully understand this dose is far beyond standard guidelines. My issue is that it’s the only thing that has ever given me a “normal” life, and I’m struggling to find clinicians who will both:
- acknowledge how dramatic the benefit is, and
- help me explore why I might need so much, and what safer long-term options exist.
What life is like on this regimen
On Ritalin IR 120–180 mg/day (roughly 20–30 mg in the morning, then 10–20 mg every hour as needed):
Depression:
I genuinely feel I’ve recovered. No persistent sadness, no hopelessness.
Anxiety:
my chronic anxiety has disappeared. I feel grounded and calm.
Executive function & work:
I can work at a high professional level, plan, start and complete tasks, and feel deeply engaged. This gives me a huge sense of purpose and fulfilment.
Sleep:
for the first time in my life, over the last couple of weeks I’ve managed a stable sleep schedule while on this regimen.
Emotion regulation:
I’m more stable, less reactive, and generally content.
I sometimes take “drug holidays” on low-demand days and have gone weeks without Ritalin. I don’t feel classic withdrawal or craving – my old fatigue/exhaustion just comes back and I can’t function at my current professional level.
My heart rate, blood pressure, EEG, and blood work have been normal so far, and I’m not noticing side effects at this dose. I know that doesn’t mean there’s no long-term risk.
What life is like off stimulants
Without Ritalin (or before any meds):
- Just doing breakfast and cleaning up can leave me exhausted and out of breath for the rest of the day.
- I spend a lot of time lying on the couch; basic chores feel “atrociously” hard.
- I lose all drive for cognitively demanding tasks (work, planning, admin). I don’t even have the mental energy to reply to messages sometimes.
- I can sometimes enjoy lower-demand things (sports, seeing friends, cooking), but I absolutely cannot sustain my current career or functioning.
Doctors often describe this as “depression” and recommend SSRIs or telling me I’m overworking/using stimulants as a “performance enhancer.” Internally, it does not feel like my past depression. It feels like severe underpowered neurology plus years of trauma.
What I’ve already tried
Very condensed version:
-
Ritalin IR (methylphenidate):
• 10–20 mg/day: tiny, very short-lived benefit (~30 mins).
• 60–90 mg/day (20–30 mg x3): brief clarity but then anxiety/rebound.
• 120–180 mg/day: stable attention, mood, motivation, no noticeable crash – the only truly life-changing regimen. -
Concerta (ER methylphenidate) – up to 72 mg/day:
• Lower doses did nothing.
• Higher dose caused overstimulation, anxiety, emotional flattening, and loss of drive. -
Adderall XR/IR (mixed amphetamine salts) – 10–20 mg/day:
• Energy + alertness, but overstimulation, emotional volatility, jaw tension, intrusive thoughts. Unsustainable. -
Vyvanse (lisdexamfetamine) – 20–80 mg/day for 4 months:
• 2 hours of clarity, then intense crashes, overstimulation, and depressive episodes. -
Foquest – 50–100 mg/day for 2 weeks:
• Brief clarity, followed by crashes and heavy lethargy.
Multiple psychiatrists (in UAE and Canada) have tried lowering my dose or stopping stimulants, all recommending SSRIs instead. None have been willing to consider that my optimal stimulant dose might be far outside the standard range, even as a temporary or carefully monitored plan.
Why I think this might be an “edge case”
I suspect a mix of factors:
• Complex trauma and chronic childhood stress → long-term changes in cortisol and dopamine/norepinephrine systems.
• Heavy adolescent cannabis use during brain development → blunted reward/motivation circuitry.
• Possibly undiagnosed sleep-wake disorder (narcolepsy/idiopathichypersomnia/circadian issue) on top of ADHD, given the extreme baseline fatigue and the way stimulants feel like “normalization” rather than a boost.
Right now I have no clear medical explanation for why my dose-response curve is so shifted.
What I’m looking for from this community
I know no one here can give me personal medical advice or “approve” a dose. I’m specifically looking for:
-
Others who needed unusually high stimulant doses (methylphenidate, amphetamines, modafinil/armodafinil, solriamfetol, etc.) What ended up being the underlying diagnosis or combination of diagnoses (ADHD + narcolepsy? trauma? endocrine? something else)?
-
People who discovered an underlying sleep disorder after ADHD diagnosis? What symptoms led someone to refer you for polysomnography (sleep study) and multiple sleep latency test (MSLT)?Did your stimulant dosing change after a sleep diagnosis?
-
What worked-up did your doctors insist on before they were comfortable with more aggressive stimulant treatment?
-
How you navigated clinicians’ concerns? How did you find doctors who were willing to explore complexity instead of defaulting to “you’re just depressed” or “this is performance enhancement”?
Where I’m at emotionally
I’m very aware that my current regimen might not be a safe long-term plan, and I’d love to eventually reduce my dose or even come off stimulants if my brain and body can support that.
At the same time, I’m finally living a life that feels worth living. I have a career I care about deeply, I’m stable and happy for the first time ever, and each attempt to lower/stop my dose feels like I’m being asked to give up my life and go back to surviving on the couch.
If anyone here recognizes themselves in any part of this story, I’d be incredibly grateful for any conversation. Thank you so much for reading this long post and for any insights you’re willing to share. 