I struggle to get myself to do things I want or need to do, and I don’t know how to fix it

I’m 34F with both bipolar (type 1) and adhd. I was diagnosed with the ADHD long after I was diagnosed with the other stuff. I had to find a psychiatrist that specialized in mood disorders and adult ADHD, and I’ve been on Vyvanse since 2018 along with my anticonvulsant for the bipolar. This will be long but I’ll try to be concise.

These aren’t new issues, but I think I’m running into a crossroads where I can’t just live with it anymore. There’s many reasons: my health suffers for it, my relationships (outside of my relationship with my boyfriend) suffer for it, my overall mental health suffers. It feels like I’m at war with myself and both sides feel justified, so I don’t know how to reconcile them.

On one hand, there’s the side that isolates and everything feels like it requires an act of congress for me to get it done. I hate leaving the apartment. My bf will run errands and such for me so I don’t have to if I don’t feel like it (which is more often than not). I’m not capable of being social more than once a week and even that is too much for my liking. I find it mentally draining from start to finish. When I do go out for errands and such, it’s very quickly overstimulating. I’m both annoyed with people being people and feeling overwhelmed by taking up space figuratively speaking. At the same time I hate being in areas I can’t blend in. Certain noises really bother me too (kids crying, repetitive noises, etc). Overall when I go out, probably 80% of the time I’m constantly thinking about when I can go back home.

Self care is difficult for me. I have a thyroid disease that rendered me physically unable to do a lot that required exerted effort due to tachycardia and muscle weakness/atrophy, and that’s only really truly been stabilized in the last few months after almost 3 years of having the disease. My body is begging me to eat better and exercise because I haven’t regained much of that strength and I gained back the weight I lost plus some. I’m miserable with what I see in the mirror, but everything feels so hard. All I want to do after work is change into my comfy clothes and sit on the couch. I’ve been playing The Sims constantly since January, and it’s the only thing I do purely for enjoyment aside from collecting blind box dolls. I’m tired of being afraid when I go up and down stairs because my legs still feel shaky doing many things. I’ve managed to improve my shower, skincare and hair care routine at least. But cooking, going to the gym, it feels like a big project.

I’m very overwhelmed with trying to organize but it’s purely because a) I either want to do it all at once so I don’t have to come back to it and b) it’s all or nothing for me. Like for example, I either have a meticulous excel spreadsheet or I have a million papers of organized chaos on my desk. If I can’t organize something the way I want to, it all goes to hell entirely. I’ll put something off before I “half ass it” and then nothing gets done. I’ve been working on breaking up tasks, but that only works if it can be completed in 1-3 hours and doesn’t require having a bigger mess than I started with once I’m tapped out. Sometimes body doubling with my bf helps. Other times I’m doing the opposite of what I should be doing and the stress out about what I didn’t get done.

Reading all this I know logically it doesn’t make sense. It all feels so stupid and pathetic. I tend to be very black and white but my mind operates in one big grey area. I’m tired of feeling this way but fighting against everything in me that doesn’t want to do anything at all is so difficult. I don’t believe higher doses of medication will make a difference and I’m already close to the max (50mg, can’t take more than 70mg of Vyvanse) and stimulants have never fully fixed this issue, but I’m so much worse without them.

Advice or not I’d like to hear your thoughts and experiences, even if it’s just to know I’m not alone in this.