If you have some important things coming up like the ACT, I would not risk a change in meds. You are doing OK on 20 mg. Why not continue on that until your tests are over? Then try 40 mg if you want to. If you are happy with where you are, just stay at 20 mg for the time being, and then discuss it with your pdoc next time. Whatever you do, do not lie to your pdoc and tell her you tried 40 mg but it didn't work for you. That helps no one.

Yes, you do have a choice.

Last time I saw my PNP we looked at ways in which my functionality had improved since starting on an AD two weeks before. She asked me if I wanted to try a higher dose and potentially see greater improvements. She said, "how good do you want to feel?" So we upped the dose a bit and so far I don't feel any different. She indicated we could go even higher if I wanted. I think with meds it is just trial and error, you keep experimenting until you find the right med and the right dose.

I hope you can share your fears about that the bad side effects might return.