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Adult ADHD from the board-certified PMHNP behind the YouTube channel Focus Path and the book The Process. Clinical perspective on medication, frameworks, and the conversations the internet hasn't been having.
Welcome back to Actually ADHD.
Sponsored by the Focus
Path YouTube channel.
I'm your host, Jonathan Murphy,
psychiatric nurse practitioner Today
I'm going to get into the various
different types of ADHD medication
This is often a curiosity on the internet
And the book that I wrote, "The
Process: An Adult's Guide to ADHD
Medication," it is the culmination
of 100 videos on the Focus Path
YouTube channel in eight months.
And during that time, in my first 30 days
of that push that started on September
12th, 2025, right about day 29, because I
did 30 videos in 30 days to kick it off.
And the end of those 30 days
was pretty, rough, let's say.
If there was ever a time I was
going to burn out, it was then.
But thankfully, the 30 videos in
30 days got the reps in, and then
I was able to come back fresh and
develop a good production cycle.
And on that 29th day, I made a video.
I had to just kind of go
off the top of my head.
So I did top 10 stimulant medications
because the first time I arrived on
YouTube, I had the content certainly, and
I knew what the audience needed or wanted,
the market gap in terms of the teachable,
uh, ADHD medication, diagnosis, all the
stuff that adults want and come to me for.
I know that it needs to get out there
because many patients have told me
that But when it came to making YouTube
videos,- providing the same value , to
the audience that I do with my clients.
And I really love making videos,
so it worked out pretty well.
But I didn't really understand
how to translate that into views
or what type of content, what
type of package to put it in.
So what do you do?
You look at and see what else is out
there, and there's very few platform
native creators that are clinicians.
They typically tend to be, based off my
observation, sort of a hybrid podcaster
talking head, which is not platform
native, YouTube platform native.
There's a certain aesthetic,
I have the most history
with that platform.
Switched over from cable a long time ago.
But I wasn't familiar with the
medication space because why would I be?
' Cause it's my job.
But there was another
creator The Kick Shrink.
Shout out to The Kick Shrink.
And, um, I enjoyed his content.
You could tell he's from TikTok.
And one of the things that I have
is a, I'm very specialized in ADHD
medication where The Kick Shrink kind
of has a multiple different things
he does, and he's mostly on TikTok.
Seeing h- his content style
helped me as a jumping-off point.
And he had - top five
stimulant medications.
So, as you do, I, uh, went for 10.
So I'm like, "Oh, well, I
should probably score it."
And it's called the doses system,
and it's sort of arbitrary.
It wasâ¦
The purpose of it was for
the mechanic of the video.
And as you really can't rank them.
But nonetheless, I was able to make
that video go off the top, and it
became one of my more popular videos.
So if you wanna check that out,
it's in the show notes, and you
can hear my voice is just, like,
gone 'cause I was getting used to
talking even more than I already do.
And in the service of that, we'll
get into the ADHD medication So we're
talking extended-release medications,
and you have two different types.
You got your amphetamine-based
medications, and you have
your methylphenidate.
On the amphetamine side,
everybody knows Adderall.
On the methylphenidate
side, Ritalin or Concerta.
Concerta and Ritalin, for all intents
and purposes, are the same thing.
Concerta has a different capsule.
The capsule, the Concerta
capsule is a different tablet.
It uses what's called OROS technology.
It's a laser-drilled hole in the tablet.
An oblong-shaped capsule And as you
digest the medication, the water
pressure sucks out the medicine.
And then all the other extended-release
medications, for the most part, use
micro bead technology, where there's
two types of beads, and they're very,
very small, and they're coated with a
coating, and that coating breaks down
based off the pH in your digestive tract.
That technology seems much more consistent
and reliable and really allows me to
develop this algorithmic process that
also accounts for insurance as well.
So Concerta is the methylphenidate
that insurance is like the most,
although I have been trying to go for
Ritalin long-acting lately because
it's comparable and comparable
to the other types of capsules.
But nonetheless, you have Concerta,
and that is the longest-acting, and the
milligram doses are slightly bigger.
So thirty-six milligrams is
the same as twenty milligrams.
And yeah, so you see those numbers
that are slightly odd, and they're
not the sort of clean, round
numbers that you come to expect.
Now we get into Concerta
more specifically.
It is the longest duration or
one of the longer durations.
A lot of people do great with it.
But if they don't do great, let's say they
get a good response, good symptom control,
but maybe the duration is too long.
Sometimes with Concerta, again, because of
the type of tablet, effectiveness can be
spotty, not as consistent, the absorption
of the medicine person to person.
I believe it's because the amount
of osmotic pressure in your
GI system is variable, right?
I know the pressure within mine, right?
If you get my meaning.
You know, the, once, once you
digest something, that's when
you're going to be absorbing it.
So it's just much more reliable.
Therefore, you move to twenty
milligrams of Ritalin long-acting if
Concerta You see a good response, good
toleration, but the duration is spotty.
So then you move to Ritalin long-acting
20 milligrams, and that's 50/50, meaning
50% of the beads in the beginning of
the day, 50% of the beads are later
in the day and that's what allows for
the duration to be through the day.
And when you hear the
durations, they're relative.
So we're looking for a duration and we're
measuring that duration as an average,
but we're looking for response over time.
So we're using these medications to
provide the right amount of stimulation
to someone with ADHD that should line up
with their circadian rhythm, enough for
behavioral modification to occur as a
consistent benefit alongside medication.
So Ritalin long-acting, get the 50/50.
And something about methylphenidate
is there's different ratios of beads.
You got 30/70, 60/40.
Aptensio is the 60/40.
Metadate is the 70/30.
Metadate works great for people that
maybe in the beginning of the day don't
require as much stimulation Or maybe the
best way to put it is Ritalin long-acting
when people have the duration is not long
enough, switching to the Metadate, which
is a 70/30 ratio, tends to do a good job
for those patients for whatever reason.
Whereas previously they would be crashing
in the crash is another piece to this.
I'll get into that the next episode.
I'll talk about the Goldilocks zone.
But, um, from there you assess
response and toleration,
They have many options to choose
from, one of them being Jornay PM.
You actually take that at night, but
it is brand only and can be expensive.
But that one people love.
However, sometimes people
do have some side effects.
Maybe they just feel not like themselves
or a little keyed up and anxious, but
they acknowledge that it's the right
medication in terms of symptom control.
That's when you go to Focalin
or dexmethylphenidate.
So that's the sort of alternative
methylphenidate that you
wanna go to as a second line.
Tends to work really well.
It is more potent, so doses start at
ten milligrams which is the equivalent
to Ritalin long-acting twenty.
Then you go into the Jornay.
I just wanna bring up the
dosing, twenty to one hundred.
So the dosing is generous where the
way I'm titrating the medication,
it's always based off the labeling
and FDA-recommended dosing, it doesn't
make sense to, to do anything else.
Limitations that are recommended are,
are there for a reason, and I've never
had a reason to venture outside of them
So that covers the bulk of
methylphenidates, and I'm not talking
about immediate-release tablets or
the patches or the dissolvables.
Those are the most important ones to know.
And then maybe someone gets a
poor response or maybe they don't
like the way it makes them feel.
Sometimes people report feeling a bit of
the zombification, as I like to call it
Just feeling, uh, yeah, zombified.
Either zombification and other
side effects, poor response,
then you go to Adderall.
And you could start with Adderall too.
And I talked about that last time a
little bit in the optimization blueprint,
but it's 50/50 at the end of the day.
And if you are a patient that is
on one or the other and you're not
sure, it's probably worth trialing
the other one, because half the issue
The goal is to find a medication that
works at all because that's gonna
confirm the diagnosis, so therefore
the other medications will work too.
We want to find the medication
that works the best.
So a lot of people, they take
Adderall and it's so life-changing
they don't want to let it go as if
they won't be able to get it back.
But that's not the case at all.
It's just really finding the right
medication so that you can have that
resolve, 'cause you want to find
the one that's all good, no bad.
So looking at the amphetamine
side, you got Adderall XR.
It's the great starting
point, twenty milligrams.
You want to start with twenty
milligrams on either side.
some people say, "Why not
a lower dose of Adderall?"
Because we should just try a
regular dose of methylphenidate.
If someone is inclined to have a lower
dose of Adderall, that would tell me
it's probably too over-stimulating
and a methylphenidate would be a
better starting point because you can
keep the variables more consistent.
Makes the most sense to keep the
dosing variables as consistent as
you can and avoid the tinkering.
I'm not a big tinkerer.
Then you got your Adderall XR.
Now, it does have levoamphetamine,
three parts dextro, one part levo.
Levo is the peripheral, dextro is
the central nervous system stimulant.
For most people, that's gonna be good
or let's say 25, 30% of adult patients.
But there are some patients that don't
require the peripheral stimulation.
In other they may have baseline
somatic activation, if you will,
or stress, or they're already sort
of in motion, the types to have a
million unfinished tasks as opposed
to difficulty starting them at all.
These types are more likely to
do well on a dextroamphetamine,
which is like Dexedrine was the
original brand name, and now we have
Vyvanse, which is lisdexamfetamine.
Lisdexamfetamine converts to
dextroamphetamine, so it's a pro drug.
Works slightly different, so
the subjective experience, it
can be smoother, people say.
The dosing goes 30 to 70 on that,
although I stop at 60 with Vyvanse.
I would say it's slightly lower
stimulation than Adderall XR.
Then you get people with Adderall
XR, you go up to 40 milligrams,
and it's got a short duration.
This isn't most people, but
s-small percentage of people
need a bit more stimulation.
And Mydayis is a longer
version of Adderall.
It goes all the way up to 50
milligrams, and there's three
beads in it as opposed to two.
So it's really for the people
that need that long duration.
In all the times I prescribed it, I
really wanna make sure that people
are know what they're getting into.
I don't go up too quickly on that one.
And I have had patients insist
it's what they need, and then I
follow up, go, "You know what?
Let's go back to the other one."
So those are all the ADHD
stimulant medications, the
extended-release stimulants.
And next time, I know I'm-- I
mentioned I'm gonna get into the
Goldilocks zone, so I'll do that next.
Non-stimulants are, of course, an
important thing to talk about as well.
But I just info bombed you, so
I'm gonna leave you for now.
I hope this was an informative episode.
And that's gonna do it for
this episode of Actually ADHD.
I'm your host, Jonathan Murphy,
psychiatric nurse practitioner.
I'll see you later