Actually ADHD | Medication Strategies & Clinical Wisdom

Jonathan Murphy, PMHNP-BC
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Adult ADHD from the board-certified PMHNP behind the YouTube channel Focus Path and the book The Process. Clinical perspective on medication, frameworks, and the conversations the internet hasn't been having.

  1. 21h ago

    Reacting in Real Time to the Lindsay Clancy Medication List | A Prescriber's First Read

    Jonathan Murphy, PMHNP-BC, reads through the Lindsay Clancy medication record for the first time on mic, reacting in real time as he goes. No script, no preparation, no edits. Just a psychiatric nurse practitioner who prescribes these medications daily working through the list chronologically, from the first Zoloft prescription in September 2022 to the toxicology on the day of the crime. This is a first read, not a considered analysis. Thinking out loud, including the parts where he's unsure. What comes up, in order: ▸ Sertraline (Zoloft) 25mg, September 2022 — why the dosing ladder is clunky and what SSRIs actually treat well ▸ Positive vs. negative symptoms of depression, and why SSRIs hit one and not the other ▸ Low-level mood irregularity and what it looks like when someone can't tolerate an SSRI ▸ Transient first-week side effects and why people quit too early ▸ Lorazepam (Ativan), Benadryl, and buspirone, October 2022 ▸ Why Benadryl isn't the best option for sleep ▸ Buspirone's dosing flexibility and its low-risk profile ▸ Benzodiazepines: Schedule IV, physical dependence, rebound anxiety ▸ Trazodone at South Shore Hospital, November 16 — and why it isn't as benign as people assume ▸ Fluoxetine (Prozac), started and stopped in four days ▸ Ambien, mirtazapine (Remeron), clonazepam (Klonopin), November 25 ▸ Mirtazapine for appetite, including in stimulant-treated kids ▸ Quetiapine (Seroquel) and the increase to 400mg on November 29 ▸ The December diazepam (Valium) string: 12/6, 12/7, 12/9, 12/13, 12/19 ▸ Lamotrigine (Lamictal), Stevens-Johnson syndrome, and the benign rash that gets mistaken for it ▸ The McLean Hospital admission, December 31 to January 5, and what was discontinued ▸ The return to the original outpatient prescriber ▸ Day-of toxicology: diazepam, lorazepam, lamotrigine, mirtazapine, quetiapine, trazodone ▸ What the fill pattern suggests about which medications were actually being taken ▸ Thinking out loud about what benzodiazepines do to anxiety, and why that matters here Everything here is a live reaction to a public medication record. It is educational pharmacology and speculation stated as speculation. It is not a clinical opinion about any individual, not a diagnosis, and not an assessment of anyone's mental state. Nobody in this episode is a patient of mine. Case status: the trial ended in a mistrial on September 4, 2026, after the jury deadlocked. No verdict was reached. The Plymouth County DA has not announced whether there will be a retrial. ⚠️ Educational purposes only. Not medical advice. Never start, stop, or change a psychiatric medication without your prescriber. If you are in crisis, call or text 988. Jonathan Murphy, PMHNP-BC | Focus Path Licensed in MA, NH, WA, OR | NPI 1821441965 Board Certified | ANCC 2017007119 📕 The Process: An Adult's Guide to ADHD Medication — https://www.amazon.com/dp/B0H2Z6PM4T 📗 Cheat Codes — https://www.amazon.com/dp/B0FMJLQKBW 🔗 https://myfocuspath.com 🎥 https://www.youtube.com/@focuspathsystems

  2. 2d ago

    Why the Lindsay Clancy Case Spread Like It Did (It's Not a PSYOP)

    People keep asking whether the Lindsay Clancy case is a psyop. Jonathan Murphy, PMHNP-BC, grew up in Duxbury, and his answer is no — it looks organic. What's worth understanding is why a local tragedy became a national fight, and what that says about how anything spreads now. This episode covers: ▸ What people actually mean when they say "psyop" ▸ Why this one appears organic rather than manufactured ▸ Duxbury, the image of the perfect seaside town, and what sits underneath it ▸ Why the case disappeared from the news and then came back much bigger ▸ The contrast with how Karen Read was covered from day one ▸ Astroturfing and how apparent grassroots movements form ▸ Why the reason behind almost anything now is engagement, and engagement is money ▸ How a story big enough to matter gets steered into men vs. women, left vs. right ▸ The psychological character she occupies — the external perfect life — and why that drives the reaction ▸ Objective truth vs. subjective reasoning, and why the distinction matters for navigating any of this ▸ Why this matters specifically if you have ADHD: impulsive thought, impulsive action, and the need to know your own truth first Where the case stands: the trial ended in a mistrial on September 4, 2026, after the jury deadlocked. No verdict was reached. The Plymouth County DA has not announced whether there will be a retrial. This episode is commentary on media dynamics, not on the facts of the case or the defendant's mental state. Nothing here is a clinical opinion about any individual. ⚠️ Educational purposes only, not a substitute for professional medical advice. If you are in crisis, call or text 988. Jonathan Murphy, PMHNP-BC | Focus Path Licensed in MA, NH, WA, OR | NPI 1821441965 Board Certified | ANCC 2017007119 📕 The Process: An Adult's Guide to ADHD Medication — https://www.amazon.com/dp/B0H2Z6PM4T 📗 Cheat Codes — https://www.amazon.com/dp/B0FMJLQKBW 🔗 https://myfocuspath.com 🔗 https://www.myfocuspath.blog 🎥 https://www.youtube.com/@focuspathsystems

  3. Sep 15

    High Masking Autism: The Most Misunderstood Psychiatric Diagnosis

    Autism spectrum disorder is the diagnosis Jonathan Murphy, PMHNP-BC, sees the most confusion around — from patients and clinicians both. People get evaluated, spend a lot of money, and come back without much. This is what he actually looks for, and what high masking autism looks like from the chair. If you're a late diagnosed adult, or you've wondered whether you're autistic and the evaluation didn't give you an answer, this one is for you. This episode covers: ▸ Why a diagnosis only has to be documented when you need to access something outside the appointment ▸ Autism as one of the rare psychiatric diagnoses where people feel better just by knowing ▸ High masking autism vs. autism spectrum disorder, and why it's about observable signs rather than function ▸ Monotonous tone and speech patterns as an early cue, and why it isn't required for diagnosis ▸ Sensory sensitivity and difficulty processing multiple inputs at baseline ▸ Concrete logical thought sitting on top of and taking precedence over other senses ▸ Why typical neurodevelopment includes a felt social sense that doesn't require thinking ▸ Concrete communication, taking people at face value, and vulnerability to manipulation ▸ The mismatch between deeply felt emotion and limited external expression ▸ Developmental Reinforcement Theory and the eight survival modes ▸ The Strategist as the most common mode on the spectrum, and how it leads to shutdown ▸ The Operator, avoidant cohesion at the periphery, and the path toward OCPD ▸ The General, agitation as protection, and why you can't tell you're dysregulated when you're stuck in your head ▸ Regulate before you navigate ▸ Staying in the job, the marriage, the boiling water, and where meltdowns come from ▸ Why attachment is different from autism, and why autism explains the attachment pattern ▸ Autism and bipolar, and what that co-occurrence usually reflects ▸ What a narcissistic parent does to someone on the spectrum ▸ Social skills training, and checking the environment before assuming the problem is the person ▸ Reading the room calmly versus feeling activated and mistaking it for reading the room On the "fashionable diagnosis" argument: most high masking adults on the spectrum don't identify with internet groupthink at all. Separate what happens online from what happens in real life. Jonathan Murphy is a board-certified psychiatric mental health nurse practitioner specializing in adult ADHD and autism. Licensed in MA, NH, OR, and WA. 20,000+ clinical hours. For educational purposes only. Not medical advice. Consult your own provider for clinical decisions. If you are in crisis, call or text 988. 📕 The Process: An Adult's Guide to ADHD Medication — https://www.amazon.com/dp/B0H2Z6PM4T 📗 Cheat Codes — https://www.amazon.com/dp/B0FMJLQKBW Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog, including the Developmental Reinforcement Theory and Survival Modality series: https://www.youtube.com/@focuspathsystems

  4. Sep 10

    Got Adderall From a Friend? Here's What a Prescriber Wants You to Know

    Is it illegal to share ADHD medication? What happens if you got Adderall or Vyvanse from a friend? Jonathan Murphy, PMHNP-BC, answers both the legal question and the one that matters more clinically: what borrowing a controlled substance does to your relationship with a medication you may eventually need. Covered in this episode: The legal exposure on both sides — giving and receivingWhy ADHD stimulants are Schedule II and what that classification meansThe difference between a drug and a therapeuticWhy "as needed" dosing creates a behavioral problemWhether to disclose prior use to a prescriber, and what a prescriber actually does with that informationWhy people who borrow medication struggle more with long-term treatmentFinding a provider who evaluates adult ADHDJonathan Murphy is a board-certified psychiatric mental health nurse practitioner specializing in adult ADHD, licensed in MA, NH, OR, and WA. 20,000+ clinical hours. This is general education, not medical or legal advice. Corrections and notes: Sharing or distributing a prescribed Schedule II stimulant is a criminal offense in every U.S. state, but the charge varies. Depending on jurisdiction, quantity, and whether money changed hands, it may be charged as a felony or misdemeanor, and federal charges are possible. Consult an attorney about your specific situation. The German military distributed Pervitin, a methamphetamine preparation, to troops beginning in 1938. Mid-century American amphetamine use involved different compounds and regulatory conditions. Related but distinct chapters. The Process: An Adult's Guide to ADHD Medication — https://www.amazon.com/dp/B0H2Z6PM4T

  5. Sep 8

    Understanding Creativity and Critical Theory

    After the Clancy deep dive I was in a bad mood, and the antidote is always nerding out. So I pulled some books, took notes, and thought out loud about why the things we look at run us more than the things around us. Jonathan Murphy, PMHNP-BC, on Walter Lippmann's pseudo-environment, why stereotypes are cognitively necessary rather than simply bad, and what any of it has to do with a frontal lobe that isn't fully online. This episode covers: ▸ Why the screen is the problem for a creator whose work is about mental health ▸ Medium as the thing in between, and why 99.9% of our communication is reception ▸ Lippmann on the feeling aroused by a mental image of an event you never experienced ▸ The amygdala, hippocampus, and adrenal response happening before you can think ▸ Why ADHD makes you a passenger on that ride ▸ The pseudo-environment: behavior responds to it, but acts land in the real world ▸ Where the contradiction develops, and what that looks like with a true crime case ▸ Fiction, fidelity, and why a novel doesn't mislead you but a feed can ▸ Being told about the world before you see it, and what preconception does to perception ▸ The landscape in the parlor: recognizing the sunset because you already saw the painting ▸ Why abandoning all stereotypes would impoverish human life rather than free us ▸ Bertrand Russell's code of science from The Impact of Science on Society ▸ Marcuse on the welfare state as a state of unfreedom ▸ Why the first move when you're anxious is to look at what's been going in The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: [link] Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog. For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

  6. Sep 5

    ADHD and Creativity: Build the Structure First

    Creativity can be the difference between depression and feeling motivated for someone with ADHD. It can also blow up your life, because the ADHD brain goes all or nothing and the hobby you barely picked up becomes a new career by Thursday. Jonathan Murphy, PMHNP-BC, on why structure has to come before creativity, what the music industry sold us about who gets to make things, and what thirty years of trying to write songs taught him about the actual creative act. This episode covers: ▸ Why creativity destabilizes ADHD brains without structure in self-care, emotional, and occupational function first ▸ Friction as the target of your effort rather than the obstacle to it ▸ Why school systems crush ADHD brains, and why that does not mean school systems cause ADHD ▸ The lineage of American music: Tin Pan Alley, parlor pianos, radio, recordings, MTV ▸ How MTV divorced us from the song and sold us the artist instead ▸ The myth of the rock star and why the celebrity has little to do with the music ▸ Performing versus songwriting, and why they are different jobs with different motivations ▸ Why virtuosity is not required to write a good song ▸ Negativity as the opposite of creativity, and why you cannot evaluate the work until it is done ▸ Suno, AI music tools, and why the human has to be the curator ▸ Why AI cannot be the end product but works as a conceptualization tool ▸ Seventy songs, Udemy courses, and learning your way through a wall ▸ Breaking creative work into steps small enough that resistance disappears ▸ Why a step is not an endpoint If you have ADHD and you have been circling a creative project for years without starting it, this one is for you. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: [link] Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog. For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

  7. Sep 4

    Lindsay Clancy DSM 5-TR Deep Dive

    Jonathan Murphy, PMHNP-BC, opens the DSM-5-TR and works the Lindsay Clancy case the way a clinician actually works a differential, starting with the forensic cautionary statement at the front of the book that almost nobody covering this trial has read. This episode covers: What the DSM-5 actually is, including its function as a billing and coding system and why "it's all made up" misses the pointThe manual's own instructions on use, and why criteria are not meant to be applied in cookbook fashionThe cautionary statement for forensic use and why a diagnosis carries no necessary implication about control over behaviorBrief psychotic disorder criteria and the one day to one month duration requirementMalingering and the four indicators the manual says to consider, three of which are present hereAntisocial personality disorder and why it does not fitNarcissistic personality disorder read directly from the criteria and diagnostic featuresThe OCPD differential and where it separates from narcissistic presentationWhy ADHD and impulsivity make fast conclusions from media coverage particularly riskyGrowing up in Duxbury and what the status dynamics look like from the insideTelepsychiatry versus in person for clinical observationThe longest episode of Actually ADHD so far. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog. For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

  8. Sep 1

    Media literacy amid true crime mobs and ADHD

    Psychiatric nurse practitioner Jonathan Murphy, PMHNP-BC, connects the dots between true crime consumption, mob psychology, and ADHD executive function. In this episode of Actually ADHD, we discuss how information bypasses logical thought, why intelligent people lose rationality inside mobs, the DSM-5-TR definition of trauma through media exposure, the difference between the Karen Read and Lindsay Clancy cases, and how law tubers pivoting from one trial to the next reveals more about the business model than the justice system. This is not a true crime breakdown. This is a mental health professional explaining what consuming true crime is doing to your brain. The first crime statistics published for public consumption changed nothing about the crime rate. They changed the perception of it. (New York City, late 1800s) DSM-5-TR Criterion A for PTSD includes exposure to traumatic material through electronic media — if it's part of your job. True crime creators qualify. (APA, 2022) Astroturfing: a coordinated effort to manufacture a grassroots movement. If you don't know whether the comments you're reading are bots, you can't know what the consensus actually is. Just like we put food in our body, we put information in our mind. Make sure there's a point to it. Actually ADHD is sponsored by the Focus Path YouTube channel — practical ADHD strategies from a nurse practitioner with 20,000+ hours of clinical experience. Subscribe at @FocusPathSystems The Process: An Adult's Guide to ADHD Medication — available now on Amazon

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About

Adult ADHD from the board-certified PMHNP behind the YouTube channel Focus Path and the book The Process. Clinical perspective on medication, frameworks, and the conversations the internet hasn't been having.

Information

  • Creator
    Jonathan Murphy, PMHNP-BC
  • Years Active
    2026
  • Episodes
    25
  • Rating
    Clean
  • Copyright
    © 2026 Focus Path Systems