Evening issues for years with no answers.

Most info I can recall:

Clinician is adhd360
34 years old male 5"6 130kg AuDHD, CPTSD in the works, unemployed.

2023 - Titrated up to 70mg Elvanse rather quickly, noticed side effects I didn't like, tried to lower to 50, but I built dependency etc etc, went back to 70.
2025 November - Quit vaping (was abusing nicotine badly, especially at night) and my 70mg elvanse was switched to concerta (lowest dose)
2026 January - 54mg concerta, 1 month of lansoprazole
2026 May - 36mg concerta (Reason being libido increase, inability to focus , impossible to begin tasks, dancing between 10 things at a time)
2026 July - 36mg concerta, started repeat prescription of lansoprazole ( I asked if I could try Guanfacine to help with my emotional regulation and stuff at night, apparently I can't do combined treatment anymore)

Main issues I try to combat with treatment

1. Binge eating / weight managment - I maintain roughly 286lbs/130kg while putting EFFORT into eating better/less and moving more (Especially at night time, struggle to even start to think I can go to bed unless I've had lots of food - carby food - for that dopamine hit)
2. Becoming stable enough to have a job without having weeks/months of burnout
3. Social interest - I go out a lot now, I walk everywhere I can, and have unlearned a great deal of shame I learned from my upbringing.
4. cleaning my home - its not happening. I mgiht get a few things done here and there but, yeah. When I dropped from 54 to 36mg I did manage to clean up more but it's back to inaction I guess.

As far as I can tell, the stability and social interest has been mostly solved.
HOWEVER..
This night time problem (and binge eating problem in general) is insane.
I tried for years to tell clinicians things along the lines of "something's not right, the medication fades, and then I'm in a danger zone where I could just lose complete control over my eating and I'll regret and hate every second of it, but I can't stop myself. Even if I eat well in the day, even if I try to have eating windows and different night time rituals, like, I don't even use my PC anymore barely. I'm outdoors alot, I get home at 9pm or later, during the day, food is just a choice to me, but during the night, seemingly after medication wears off, it's just not possible for me to resist overspending (through takeout) or bingeing on food wasting effort, money, etc)
But, nothing. I asked about medication that covers the night time or medication to increase coverage, I get refused. Under the most unfair reasons in my opinion.
(Reasons like the initial onset of concerta being 'too much' where I said I get a little erratic and stuff, like, the spike is too high, but the rest of the dose is too low. What I tried to tell them was like 'There's like a 7-10 hour window, where the first 4 hours is too much, then theres a 2 hour window of being decent, then the rest is not enough')

My GP gave me Lansoprazole because it seemed like an acid issue, but ive only just gotten to get the prescription for that again.
Then they gave me Mirtazapine which has been making me sleep SO LONG and wake up with no energy, feeling weak and starving for food, and it's been making me eat EVEN MORE, and i'm just exhausted. There's not enough hours in the day to collect my thoughts, I journal, but its like... IDK

My clinician told me that I can't do combined treatment anymore - it's ADHD360 by the way

Thats only thinking about the food and hunger and binge eating side of things. At night, everything is worse and I know it's a problem with dopamine. It HAS to be.
I'm more sensitive to rejection, or the sensation of rejection - I can tell my interest in things is just automatically lower, I'm less interested in what people are saying, I can't think of responses to things, I lose focus on what they're saying, I get more easily angry and frustrated, I start getting distracted by every little thing and train of thought goes away all the time, My default mood just drops aswell. It's clearly not just "oh hurhhurhuhr you need to eat during the day" like, It's a distinct dopamine deficit that only occurs when the medication wears off, and I clearly need night time coverage from either a nonstimulant or more stimulant coverage on a more 'flat' release schedule? idk.

This is frustrating. I've tried every month (the reviews of the medication are once a month) to talk about this and all I ever get is "well see how this goes, now get lost"

I try to ask about more coverage in the way of boosters, but i'm told a full on no, and I think my clinician does not actually understand what I'm saying.

The options I'm given are basically "continue concerta 36, lower it, raise it... switch back to elvanse.... or switch to non-stimulant"

Bearing in mind, when I wanted to lower my dose of concerta, my clinician was EXTREMELY PUSHY about trying to get me to stop my medication. "to see my baseline" and im just like.... I had a week a few weeks prior to that call, where my doctors didn't do the shared care form properly or something, and i had no medication for a week. I was lethargic, depressed, no energy, sleeping every 10 minutes, annoyed by everything, self harm thoughts, like... Im not going back to that by choice.

I dunno what to do and I'm wondering if I should change clinicians so i can actually get more treatment options? maybe the GP can give me medication that actually DOES reduce appetite at night? or, i dunno. I hate this. I want to lose weight, and eat less, and move more, but every night, I undo whatever progress I make.

And for clarity, a binge to me.... Well, any time I eat, could be me eating 3000 calories + in the span of 1-2 hours. I used to binge every day, and now, It's less frequent, and I did consider that my medication is creating dopamine rebounds.... hence why i dropped to 36mg, but i'm still so unsure. I do not know if a nonstimulant is the answer, because I dont know if a nonstimulant is going to address whatever things my brain is getting from the stimulant.

It's also extremely disconcerting that my clinician specifically said 'we no longer give combined treatments' -- like... Why do I suddenly feel like they COULD have tried other options for me, when I was saying its not working enough, im still having issues, clearly being medicated during the day is HELPING, but the lack of medication at night is causing issues? i dont know.

Ugh. I shouldn't have to try SO HARD after 6pm to NOT stuff my face or give in to the smallest craving because once i start eating it's just gonna be a binge, wasting the little money I have, wasting the food I have, and wasting the effort I put in to being healthier in that same day. Its like I have lists of things and strategies and thoughts and habits or just.. ANYTHING to distract my brain enough... but nothing ever works. A ritual that used to work was Glycine in a chamomile tea, but now its not enough. I don't want to have to worry about night time, idk..

I'm thinking more and more that the nonstimulant option is a good idea, at least just totry it... but they will of course want to start me on the LOWEST dose and obviously im just gonna have all my bad habits and bad states of mind absolutely dominate my mental space while thats going on.. and if i want to go back to concerta, itll be the same god damn thing, i just.. sigh.
Erm.... yeah.. I asked af ew friends about their treatment and they said they only take the boosters, and im just like, you know, if i need more 'flat' treatment, and less "zig zag all over the place" concerta/elvanse treatment.... idk. This clinician seemingly does not want to give me boosters at all. Way too cautious and she doesn't even know me. And the limited variations of treatment available? i dont know, it doesnt feel right at all.. And now i've got mirtazapine and lansoprazole in the mix, i hate this.

Thanks in advance for anyone who has something to say.