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I'm not sure how to help you but I've been having similar problems due to a different cause. I take Adderall XR 50mg at 9am and 30mg at 3pm but I also take Klonopin 1mg at 9am 3pm and 9pm and the Klonopin has really interfered with my concentration to the point that I basically can't do anything but I need it for severe non-adderall related anxiety.
I know you said you don't have time for more mental health professionals and more pills but maybe your physical problems are not being effectively treated at least thats what it sounds like. Your quality of life and your relationship with your fiance is clearly suffering so its worth a shot if you can scrounge up the money somehow which will prove difficult if you happen to be on medicaid or medicare so I guess it comes down to asking yourself...is it worth it?
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No guts no glory
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