I'd try centanafadine and see a top ADHD specialist. There are a lot of variables: molecule, dose, release profile, melatonin timing.
What is worth checking:
* Comorbid anxiety or trauma symptoms (PTSD)
* Hormone imbalance
Just because your blood work is perfect, it doesn't mean all is good. I have hypomagnesemia - the tests were perfect, yet my body needs way more magnesium to function properly.
I desperately wanted ADHD meds to help, but in the end the juice just wasn't worth the squeeze so I stopped. I tried all 3 or 4 different stims and 2 non-stims.
Thank you for the pointers, I will look into them.
For example for methylphenidate, I'd recommend starting on 2.5mg (1/2 the smallest pill) for a week or two, until side effects go away, and then up the dose to 5mg.