Actually ADHD is ranked #1 on Apple Podcasts and Spotify for ADHD medication. In this episode, Jonathan Murphy, PMHNP-BC, ADHD-CCSP, a board-certified psychiatric nurse practitioner with more than 20,000 clinical hours treating adult ADHD, gives an off-the-cuff brain dump on how to start ADHD medication the right way, from the first dose through the first month.
If you're about to start a stimulant for the first time, just got a new prescription, or started medication and aren't sure it's working, this episode walks through what a prescriber actually looks for and how to set yourself up for the best possible response.
What this episode covers:
Methylphenidate vs amphetamine: which stimulant to try first and why. Why most adults do best starting on a methylphenidate, and when an amphetamine makes more sense. How alcohol interacts with methylphenidate. Why people on the autism spectrum often do better on methylphenidate, and when a non-stimulant is the right call.
Extended release vs immediate release: why extended-release capsules give a steadier, more predictable response, and why immediate-release tablets and "as needed" dosing keep side effects going and work against long-term results.
Your first day on ADHD medication: why to take the first dose in the morning, why to skip caffeine on day one, and how caffeine can cause anxiety and panic that looks like a medication problem.
Weeks one through four: why consistency matters more than week-one impressions, why side effects often fade by week three or four, what to track, and what to bring to your follow-up appointment.
What a therapeutic response feels like: why many adults with ADHD feel calm, not wired, on a stimulant, and why that calm is often the sign the medication is working.
Mood, anxiety and depression before ADHD treatment: why mood irregularity needs to be addressed first, how anxiety and survival-mode activation affect stimulant response, and where mood stabilizers like Lamictal (lamotrigine) and Latuda fit.
When medication isn't enough: how Wellbutrin (bupropion) can help with fatigue and low motivation alongside a stimulant, and how serotonin and dopamine interact.
How to talk to your prescriber: why to describe functional impairment and your lifelong story instead of asking for a specific drug, and how to navigate the system as an informed patient.
Online myths: generic medication fears, conspiracy theories about the FDA and stimulants, and why the loudest voices online aren't the people who do well on treatment.
Medications discussed:
Methylphenidate: Concerta, Ritalin LA, Focalin XR (dexmethylphenidate), Jornay PM, Metadate CD, Azstarys
Amphetamine: Adderall XR, Vyvanse (lisdexamfetamine), Dexedrine Spansule (dextroamphetamine), Mydayis, Desoxyn (methamphetamine)
Other: Wellbutrin (bupropion), Lamictal (lamotrigine), Latuda (lurasidone)
Questions this episode answers:
How do I start ADHD medication? Should I start on Ritalin or Adderall? What should my first day on ADHD medication be like? How long does it take for ADHD medication to work? Why do I feel calm on a stimulant? Is extended release better than immediate release? Can I drink coffee on ADHD medication? What if my ADHD medication isn't working?
About Actually ADHD:
Actually ADHD is a daily podcast on adult ADHD medication and treatment from a practicing prescriber. No guests, no scripts, just the clinical reasoning behind ADHD treatment that patients rarely get to hear.
Educational content only. This podcast does not provide medical advice. Talk with your own prescriber before starting, stopping or changing any medication. If you are in crisis, call or text 988 (US).
YouTube: @FocusPathSystems
X: @ADHDAuthority
Practice: myfocuspath.com
Oct 28 20269 min