Have talked to Sylvia’s psychiatrist about the possibility of him prescribing my ADHD meds rather than having to get them from the uk.

The problem is that my prescription is a hybrid Elvanse 70mg, Amfexa 20mg regime and whereas the Elvanse (lisdexamphetamine) is available here, the Amfexa (dexamphetamine) is not.

The latter is literally pharmaceutical grade speed. That’s not hyperbolic. That’s literally what it is. Some countries are a bit funny about prescribing it. Portugal is one such. They were going to before the pandemic but it seems to have fallen but the wayside.

The former is a prodrug which converts to dexamphetamine in the blood. This makes it much less attractive to addicts because you can’t snort it and it has a delayed effect.

That delayed effect makes it rubbish as a booster. It’s also fickle. Sometimes it just doesn’t work very well. I am extremely reluctant to give up my dex.

Said psych suggested a few possibilities:

1 - take Elvanse later in the day. That’s literally rationing sanity. An Elvanse 70 pill is 6-7 hours of Flowers for Algernon speed run. That’s no way to
Live. My facial expression made him discard that.

2 - switch to methylphenidate, the other arch stimulant. Available in sustained release form as Concerta and in instant release as the very well known drug, Ritalin.

Problem with that is as far as my body is concerned (I have tried methylphenidate. I will not elaborate on this point), it’s basically “a bit shit”.

I free to it as “a coffee tribute act”, or if I’m in a scathing mood, “shitalin”. It’s a very big the “sit in the corner and shut up” zombie drug that was always used as a threat as a kid if I didn’t “act more normal”.

3 - Elvanse with Ritalin booster. See 2 for explanation as to why this can get in the bin and stay there.

4 - Elvanse with Elvanse booster.

Ok. Not ideal. Elvanse is at least amphetamine, which is the med that actually works for me, even if the neurotypical world seems to treat it as basically raw addition fuel (weirdoes), although it’s fickle. And slow.

But I was encouraged to experiment.

So I have done

Some months ago I tired 70+30. The 30 gained my about 90 minutes and had me running back to my beloved dex at the end of that. Useless.

In November I tried 70+50. Got 4 hours extra. They were rubbish hours. And the drop was horrible.

Getting a bit despondent here.

Today I tried the nuclear option. At 10:28 I took my usual Elvanse 70 and waited.

20 minutes later I started to feel myself turning into a functional adult.

Bit rubbish and distractable for the next 6 hours. Despite being trans I do have a monthly cycle (I can see it oh my resting heart rate graph. It also syncs with Sylvia’s period which is freaky) and I’m at my low and - see previous comments about Elvanse being fickle.

At about 17:00 I started to feel what I now know is noradrenaline imbalance in my peripheral nervous system. Dopamine drops faster leaving noradrenaline to go after. It means my brain is going to follow within the next 15-60 minutes and when that does … Flowers for Algernon.

At this point I would usually take my die at Amfexa of the day.

I didn’t. At 17:20 I took another Elvanse 70.

Peripheral noradrenaline imbalance continued to climb because … Elvanse. Amfexa would fix the problem in about 2 minutes.

But it doesn’t take a big rise in serum dexamphetamine to ward the drop away. Within 15 minutes I was fine.

So the question is, how long? As a primary med, the difference between Elvanse 50 and 70 was about half an hour, so I was a little pessimistic.

But then a curious thing happened. The executive function I’d been a bit rubbish on all day came roaring back. Nice!

Got to 10pm ish and had something to eat. That causes Elvanse’s prodrug conversion to increase usually and indeed, it did.

“Have the lambs stopped screaming, Agent Starling?”

That never gets old. I sat upright I stared into space. The earworm fell silent. Intrusive distractions went away. My sensory overstimulation dropped to zero. Emotions fell into line and got fully with the programme.

And after a few minutes of enjoying the utter utter bliss of a quiet mind, I got up and tidied the living room and kitchen.

At 01:10 I felt peripheral noradrenaline imbalance. That’s it. The end was coming. I have to let it happen.

Turn coffee machine on. “Esvaziar bandeja de gotas!” (Empty drip tray). COME ON! NOT FAIR!

Urgh! Hands feel gungy. Thighs are touching. It’s horrific. Every sound is loud. Getting louder. Lights so many lights. So many. So bright. Tension. Stress. Fiddle with hair. Scratch at arms. Empty the drip tray.

Double long espresso, with maximum brew strength.

Sensory issues building. Coffee grinder runs for the first shot. LOUD.

Coffee pours.

Grinder runs again. MAKE IT STOP. PLEASE. NO. EVERYTHING EVERYWHERE ALL AT ONCE!

01:17. Jaw starts trembling. The neural pathways that make me into a functional adult abruptly cease function as the dopamine needed to regulate the synapses became simply unavailable. Emotions go haywire. I am so sad. There are air molecules touching my skin. I have internal organs. It’s all horrible. The world is noisy and bright. I think there’s supposed to be a squirrel at this point?

30 seconds later I stabilise a little below my pre-medication baseline. My brain is now the brain of a mildly confused child. The focus, executive function, emotional regulation, clarity of thought, neural interconnect that I had enjoyed 15 minutes earlier was just gone.

It’s a lot like being two different people. One of them has to parent the other.

Oh, and the one that’s writing this has no bloody impulse control. That’s fun. I’m also twitchy as hell.

I drank the coffee. I’m now on my fourth shot of espresso. It doesn’t get me back to that beloved state but it takes the edge off and it will help me sleep.

Anyway, experiment a success. My drops are pretty much all like that so whatever. I got almost fifteen hours, and the latter few were really nice.

I’m sticking with the UK for now but I might make an appointment with the psych and present 70+70 as a hypothetical.

I feel like 70+50 he’d have no issue with but 70+70 might make him suck his cheeks a bit.

But … doesn’t ask, doesn’t get.