Actually ADHD | Medication Strategies & Clinical Wisdom25 Jul

Vyvanse is the OVERHYPED (but still might be right for you)

Why Vyvanse became the internet's favorite ADHD medication and what patients and prescribers should actually understand about it.

Jonathan Murphy, PMHNP-BC, walks through the pharmacology, the Reddit hype cycle, and how Vyvanse fits into the real optimization pathway.

This episode covers:

Why extended-release stimulants became first-line and how insurance approval finally caught up to clinical reality

The two stimulant chemicals: amphetamine and methylphenidate, and why roughly half of adults respond best to one over the other

What "zombification" on methylphenidate signals and what "tweaking out" on amphetamine signals

Why Adderall XR gets prescribed first most of the time and what that pathway leads to

The Vyvanse pharmacology: lisdexamfetamine as a prodrug that converts in the bloodstream to dextroamphetamine

The dextro versus levo amphetamine distinction: dextro for the brain, levo for the peripheral nervous system

Why Vyvanse feels like a smoother ride for patients who don't tolerate the levoamphetamine in Adderall XR

The Reddit dynamic that keeps positioning Vyvanse as the best ADHD medication and why that framing distorts optimization

The Dexedrine Spansule as the older, cheaper alternative that does essentially the same thing pharmacologically

Why "all good, no bad" is the standard, not "good enough"

The big four extended-release stimulants: Adderall XR, Vyvanse, extended-release methylphenidate (Ritalin LA or Concerta), and Focalin

Why there is no best ADHD medication, only the right medication for your brain

This is the thirteenth episode of Actually ADHD.

The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T

For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

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Episoder(25)

Reacting in Real Time to the Lindsay Clancy Medication List | A Prescriber's First Read

Jonathan Murphy, PMHNP-BC, reads through the Lindsay Clancy medication record for the first time on mic, reacting in real time as he goes. No script, no preparation, no edits. Just a psychiatric nurse...

26 Sep 16min

Why the Lindsay Clancy Case Spread Like It Did (It's Not a PSYOP)

People keep asking whether the Lindsay Clancy case is a psyop. Jonathan Murphy, PMHNP-BC, grew up in Duxbury, and his answer is no — it looks organic. What's worth understanding is why a local tragedy...

24 Sep 10min

High Masking Autism: The Most Misunderstood Psychiatric Diagnosis

Autism spectrum disorder is the diagnosis Jonathan Murphy, PMHNP-BC, sees the most confusion around — from patients and clinicians both. People get evaluated, spend a lot of money, and come back witho...

15 Sep 18min

Got Adderall From a Friend? Here's What a Prescriber Wants You to Know

Is it illegal to share ADHD medication? What happens if you got Adderall or Vyvanse from a friend? Jonathan Murphy, PMHNP-BC, answers both the legal question and the one that matters more clinically: ...

10 Sep 11min

Understanding Creativity and Critical Theory

After the Clancy deep dive I was in a bad mood, and the antidote is always nerding out. So I pulled some books, took notes, and thought out loud about why the things we look at run us more than the th...

8 Sep 15min

ADHD and Creativity: Build the Structure First

Creativity can be the difference between depression and feeling motivated for someone with ADHD. It can also blow up your life, because the ADHD brain goes all or nothing and the hobby you barely pick...

5 Sep 14min

Lindsay Clancy DSM 5-TR Deep Dive

Jonathan Murphy, PMHNP-BC, opens the DSM-5-TR and works the Lindsay Clancy case the way a clinician actually works a differential, starting with the forensic cautionary statement at the front of the b...

4 Sep 34min

Media literacy amid true crime mobs and ADHD

Psychiatric nurse practitioner Jonathan Murphy, PMHNP-BC, connects the dots between true crime consumption, mob psychology, and ADHD executive function. In this episode of Actually ADHD, we discuss ho...

1 Sep 21min