ADHD has proven neurobiological causes. Deficits in dopamine signaling and noradrenaline signaling specifically, and glutamate and choline signaling and nicotinic signaling have also been implicated. If you have a bad case of ADHD, there is no mistaking it, and functioning normally usually requires the use of some kind of medication, not necessarily an amphetamine based stimulant, but something to improve functioning of the dopamine/noradrenaline signaling in the prefrontal cortex. ADHD can arise from a whole host of different signaling issues, which is why clonidine, which smooths out the noradrenaline response in the stratium works for some, but only high doses of amphetamine work for others, despite the fact that these two drugs have essentially opposite effect, one decreases noradrenaline and has no affect on dopamine signaling and the other massively increases dopamine and noradrenaline concentrations.
You have to work with your doctor, sometimes trying different ones before you find one you can work with. Unfortunately, in a lot of states, like CA, many shrinks don't take insurance, so the ability to find someone is limited by your means. But it is a lot of trial and error and it can take time, and it requires constant montitoring and can require adjustments along the way. If you indeed have something like ADHD, you just have to come to terms with the fact that you have a life long, but treatable disease that you will have to manage for the rest of your life, no different than diabetes or immune deficiency diseases. Personally, I take straterra (100mg), Vyvanse (100mg) and dexedrine (20mg) in the morning, and I take memantine twice a day 10mg in the morning, 10mg in the afternoon. I have taken adderall in the past at 60mg a day. If you truly have a bad case of ADHD, then really, the way to avoid the crash is not to have it. IF 20-30mg a day worked wonders for three weeks, and then didn't and you crashed, the solution is usually to up the dose until you stabilize and have a constant level of medication all the time. 60mg is the FDA top dose, 80mg is what most shrinks will go up to. Vyvanse and dexedrine are longer lasting, and most shrinks will go up to 60mg of dexedrine daily. 100mg of Vyvanse is about 40mg of dexedrine, and the prodrug delivery makes it last all day. I also had dips throughout the day with IR adderall, this is not the case with the current dosages. I was surprised at how effective the Strattera was. The memantine is of questionable efficacy, but it has no negative effects, and its theoretically neuroprotective, so I just keep taking it. I would not discount stimulant therapy if 20-30mg worked for you, but you don't want to continue because of the crash. The key is consistency, finding a dose that lasts through the whole day, and taking it everyday, at the same time everyday. There are however a whole host of other non stimulant treatments out there, such as as you mentioned straterra. There is also clonidine, guanfasine, and others. However, the efficacy of the lower doses for three weeks seems to indicate that stimulant therapy is the way to go. But you have to work this out with your doctor, thats the only way to do it, everyone is different. Also, dex tends to be much smoother than the mixed salts of adderall and may solve the crash issue.
Saying you don't believe in ADHD or any other neurological cognitive psychiatric disorder, or that it is just a "collection of symptoms" is no different than saying you don't believe in diabetes, it can be entirely controlled in most cases with diet, and it is just a collection of symptoms. Symptoms are diagnostic tools in the DSM, they aren't the disease itself. And we know diabetes is none of those things, but a malfunctioning of insulin signaling that for a small subset of people can be brought under control by diet, for most requires a drug (insulin), and for a small subset, could never be brought under control with diet (type 1 sufferers). ADHD, bipolar, depression, etc, are no different.
