What's the difference between a "watch and monitor" approach versus needing an immediate medication change?

Some medications have initiation effects that pass, the same is true for dose increase effects and other interactions (eg Lisdexamfetamine absorption can be impacted by high levels of estrogen, so this may change over someones monthly cycle) . It is often worth watching and waiting to see what changes over time vs making an immediate change. Its worth noting that ADHD medication in particular can have a psychological effect, it makes you feel different, sometimes act differently. All those comping mechanisms you have lived with your entire life are now sometimes not needed. This can feel unsual, frightening for some. Sometimes people also notice their own body more as they are less distracted by their own thoughts, for example hearing their own heart beating, it was always there just before you didnt notice it.its often best to let these experiences or side effects pass and settle, see what is still around in 1-2 weeks. That said if they are intolerable, you can maybe reduce your dose and take a slower titration pathway.