To my Elvanse has been the best thing. I was in a horrible position mentally before getting my meds. They truly helped my excessive rambling thoughts that always made me feel worse about me, my situation, my history and everything I do and am. Then when I started on the meds they just kinda went away and my ability to kinda think critically and put an effort into feeling better came back.
It was truly a life saver back when I started taking them and even today if I forget to take them two or three days it all blows back on me again.
I don't have a lot of input on this sadly but I would believe that the audio thing you mentioned could probably easily be fixed with pipewire.
As an example you can look at qpwgraph and see that you can pipe one input into several programs at once. I'm however unsure how KVM will handle it.