My doctor has been prescribing different meds to see which work for me. He's reluctant to prescribe Adderall because of the (artificial FDA-created) shortage. Here's what we've tried so far:
Wellbutrin: Awful, made me feel depressed and generally shitty, quit after a few days.
Strattera: Better reading comprehension, less scattered thoughts. But I was sometimes tired, confused, and unfocused after meals. Also I had a weird tingly sensation on my tongue like I was drinking soda.
Strattera plus Methylphenidate: My doctor had me take a lower dose of Strattera with 10 mg time-release Methylphenidate for a week as a transition between the two. The combo was effective in that it got me to focus, but it effectively killed my inner monologue and made it nearly impossible to have any creative thoughts. Made me feel like the aliens in Blindsight: intelligent but not sentient.
Methylphenidate: What I'm on right now. 10 mg time-release first thing in the morning, plus another 5 mg quick release in the afternoon if I'm feeling tired or unfocused (not sure if I should make that an everyday thing). Generally, it seems very similar to caffeine, but more mellow and consistent over time, and I've been able to cut my caffeine use in half. It seems to help with focus and energy, but not as much with procrastination (I should really be doing chores right now).
I've seen people on here and elsewhere say that Vyvanse helped them, should I ask my doctor if I should try that next? Or does it have the same problems with shortages that Adderall does? Would Strattera plus Vyvanse have the same effects as it did with Methylphenidate?
DISCLAIMER - I AM NOT A DOCTOR JUST AN ADHD NERD (but your doctor really should have told you this):
Methylphenidate (MPH, Concerta, Ritalin) and Dexamphetamine (Adderall, DEX, as Vyvanse/Elvanse: Lisdexamphetamine/LDX) are stimulants and the most well researched ADHD medications with highest efficacy rates. They are considered the first-in-line medication when treating ADHD. DEX has slightly better response rates in trials, but it's really a coin toss what works for you.
Strattera (Atomotexetin) is usually the third choice when the other two fail. Lower response rate than MPH and DEX, but works for some people. The combination with a short release MPH or DEX is fairly common to get started / help in criticial situations.
Wellbutrin/Bupropion shows strictly worse response rates and is not registered as ADHD medication in many places. Sometimes it gets prescribed as anti-depressant or if all other medication attempts have failed, but it should not be first in line for ADHD at all. I am honestly a little worried that your doctor would prescribe it for ADHD.
I am not familiar with the medication availability in the US, but unless there are very specific contra-indiciations, a first treatment attempt should be done with MPH or DEX, a second with the other one. I personally take LDX (Vyvanse) and it absolutely changed my life for the better.
Your medication level falls over the day, even with an extended release and a "rebounding" effect in the afternoon is extremely common. Do not feel bad about treating your ADHD if you need it. On the other hand: Being tired in the afternoon if you have been active/working during the day is just... normal. I use an advanced recovery technique i call "napping", but of course it's upon you to decide what you need. You could also consider increasing your XR dosage and see if that helps you through the afternoon.
Could Wellbutrin/Bupropion be proposed if lack of motivation could be caused by either ADHD or Depression and the doctor is unsure?
If the doctor is unsure, they should perform proper differential diagnostics or request a second opinion. Many doctors of course will never admit that they lack the knowledge to perform a proper ADHD diagnosis beyond the standardized questionnaire.
If there is a strong indication for both, a psychiatrist must figure out if the ADHD is the (or one of the) major cause of the depression or the depression is it's own thing. And then treat first what is more critical to the well being of the patient.
Bupropion is an anti-depressant and should be prescribed as such, even though it is an amphetamine-derivative. Pharma companies have tried to qualify it as ADHD medication as well, but it simply doesn't show efficacy beyond placebo.
Likewise, if you give a depressed person some Adderall, you now have an highly anxious, still depressed person tweaked out on speed that's gonna get a serious dopamine crash after 3-4 hours. The stuff is, unfortunately, highly specific and can be dangerous if admitted wrongly.
US doctors are fairly known to... let's say, medicate first and ask questions later, due to the broken for-profit healthcare system and pharma lobbying. I don't blame any patient struggling to take what they can get, but maybe we shouldn't throw useless psychoactive drugs around because we couldn't bother to have another session of diagnosis.
That fits with my experience