Hey there, fellow ADHDer!

I'm not sure whether HN is the optimal place for in depth discussions on the topic of meds, you might have more luck on the ADHD Subreddit and community Discords etc.

I would also recommend ADXS.org for reading up on medication or also joining their excellent forum. It's a non-commercial, science based information site run by a German association made up of researchers.

Link: https://www.adxs.org/en/page/179/treatment-and-therapy

Personally, I've only started taking medication in the last six months and use MPH myself.

Medications can differ and people differ by a lot, so take my experience with a grain of salt. Hope the perspective might still be valuable.

Albeit my experience is much more limited, from reading accounts of people who have been taking medication longer than myself, I often get the impression there is a growing bias mixing cause and effect when assessing medication effect over a long period. Because at the end of the day, ADHD has only in it's second order effect psychological symptoms. The root is always biochemical and, imo, pretty deterministic.

Let me clarify what I mean by that.

On energy/ drive in the early days vs. now: Vyvanse raises the level of dopamine in your brain whereas Concerta/ Ritalin slows down dopamine resorption. Obviously both aim at increasing the net amount of dopamine in the brain and lengthen the time it can be used as a neurotransmitter.

When you start out, these higher dopamine leves act in a brain that isn't used to increased levels and hence you feel the strong sense of stimulation.

Of course, the longer and more regularly you take the meds, neuroplasticity adapts to the increased amount of dopamine. Also, your system improves its capability to resorb and metabolize the meds, dampening the net effect size and shortening the effect duration.

It is pretty normal then to not experience the same initial strong feelings/ activation anymore.

Still, net, your baseline activation should be markedly different from taking no meds for a prolonged period of time.

On focus/ concentration: Just as with energy, there is a normalization effect for focus the longer you take the meds. Meaning the improved effects have become so normal and such a daily and integral part of your lived reality, you cannot even assess them/ compare them to baseline anymore.

I personally find focus hard to assess even as someone who only started taking the meds relatively recently. Yes, there are moments I'm conscious of it, but hours where it's a veeeeery subtle effect.

I can't really relate to tiredness, unfortunately.
Assuming you have a relatively good sleep hygiene I have a hard time seeing a biochemical link between meds and tiredness.

I would assess and adress that outside of the scope of meds.

Do you drink enough water? Stims make me thirsty and being dehydrated is a sure fire way to be tired cause your metabolism is not functioning well.

Are you burned out with work/ stuck in some area of life?
Had a significant impact on how regular dose meds worked for me.

Last but not least, I do know some adult ADHDers who have ditched meds in favor of magic mushroom microdosing and much prefer that.

They are experts in shrooms though and have tried multiple species growing them themselves.

Possible route but certainly not a fast one.

Hope this perspective might help a bit.
I am not a doctor, so I'd say do ask many more people on the forums mentioned above to get a more realistic impression of what's going on and if others have had similar experiences etc.

Best of luck to you!