Those who have been on prescribed stimulants for many years (>5), how do you manage tolerance and crashing?
I have been on ADHD meds for about 7.5 years now. I started with Vyvanse and my dose was at 70mg in the first year. I was having bad crashes at night, so I switched to Adderall 40mg with 10mg Dexidrine and stayed on it for a few years. Recently, I switched to Concerta 90mg because my tolerance was getting too high and it wasn't working anymore, hoping that by switching it will reset my tolerance. It didn't. In fact, my tolerance drops to being feeling depressed/unmotivated in about 3 days now. So that sucks.
Taking breaks is agony for me. I have the worst stimulat headaches, no motivation, and can't sleep. My doctor knows this but does nothing. He won't raise my dose.
I just try my best to function without meds on the daily, and save the meds for times when my focus is most needed. It's truly terrible. But, as much as stimulants help, they are really a bandaid, and will always end up in this cycle you're experiencing.
Short of behavioral therapy, and/or switching away from stimulants, there's not much more your doctor can do. Stimulants are hell on your heart, and increasing your dose would greatly increase the risk of heart issues, including sudden death.
Our society wasn't built with people like us in mind, and no amount of chemical therapy will change that.
Consider a lower dosage of a long-lasting stimulant instead. You won't feel a rush like instant release, but it'll manage symptoms much more sustainably in the longer term. Shouldn't be any issues for your heart this way (I'm monitored regularly and have never been healthier).
This is what I do too. I can usually just get away with two-three days during the work week with meds, and the occasional Saturday or Sunday where I need to get a lot done. I don't really need to force myself to do more than that; seems on par with everybody else's productivity. If I use stimulants more than 3 days in a row my brain kinda turns to mush, so that already puts a cap on my usage.