You've already watched everything on YouTube about ADHD medication and you still have questions. Jonathan Murphy, PMHNP-BC, goes deep on optimization — how the formulations actually work, what to assess and when, and what to switch to when something isn't landing.
In this episode:
▸ Why extended release over immediate release, and what the half-life problem actually is
▸ Microbead capsules: the ratio of immediate-release to extended-release beads
▸ Where the medication goes — stomach as a non-permeable membrane, absorption in the small intestine
▸ Food on board vs. empty stomach, and how to use that deliberately
▸ Why duodenal pH breaks down the first beads and the rest absorb further along
▸ Why "10 hours" and "12 hours" are population standards, not your duration
▸ Matching duration to your circadian rhythm: all good, no bad, from waking to bed
▸ Response and tolerability are two different things
▸ What a crash and what insomnia each tell you about duration
▸ Absorption, distribution, and elimination as the real determinants of how long it works
▸ "You can't have a process because everyone's different" — answered
▸ Why the response to the medication tells you about the reliability of the diagnosis
▸ What it means if someone gets through the whole merry-go-round and still gets nothing
▸ Why you need the full month before you can assess anything
▸ Sympathomimetic side effects leveling out, and what's left once they do
▸ Why the crash is typically the last thing to dial in
▸ Methylphenidate as a more precise target — 50% of patients, and the autism overlap
▸ Concerta and osmotic pressure: the laser-drilled hole
▸ Why GI variability makes Concerta spotty for some people
▸ Ritalin LA 50/50 as the switch, and why insurance matters
▸ Jornay PM as the Cadillac, and the prior authorization problem
▸ Aptensio vs. Metadate CD 70/30 — the move when Ritalin LA runs short
▸ What it might mean when a patient is very particular about which chemical they get
▸ When the medication stops working after months
▸ Wellbutrin as an augmenting agent for fatigue and motivation
▸ Dopamine receptor downregulation, the slot machine, and how serotonin can reactivate the response
▸ Why you don't need to feel depressed for an SSRI to help an ADHD patient
▸ Why any history of mood irregularity changes that calculus
📕 The Process: An Adult's Guide to ADHD Medication — https://www.amazon.com/dp/B0H2Z6PM4T
📗 Cheat Codes — https://www.amazon.com/dp/B0FMJLQKBW
⚠️ This episode is for educational purposes only and is not medical advice. It is not a treatment recommendation for any individual and does not establish a clinical relationship. Never start, stop, or change a medication without your prescriber. If you are in crisis, call or text 988.
Jonathan Murphy, PMHNP-BC | Focus Path
Licensed in MA, NH, WA, OR | NPI 1821441965
Board Certified | ANCC 2017007119
CHADD Professional Member | ADDitude Professional Directory
🎥 https://www.youtube.com/@focuspathsystems
🔗 https://myfocuspath.com
🔗 https://www.myfocuspath.blog
📧 https://mailchi.mp/myfocuspath/focus-path-pmhnp
