Feeling discouraged 7 weeks in :(

This might be a little long but I’d love it if anyone could read through and give me any advice/encouragement or let me know if they went through anything similar.

Background: I’m luck to have had relatively good skin my whole life, a couple pimples every now and then. In August I started a new medication for narcolepsy (which I don’t have the option of stopping because it’s given me a functional life again) and one of the side effects I experienced from it was super oily skin, which led to me breaking out consistently for the first time at 24. For context, the third pic was July before I started my new medication.

Saw a derm, got put on tretinoin .025% at night and a clindamycin lotion during the day. I noticed with the tret I was still getting pimples but they’d clear up and the skin would heal so much faster than before tret. At this point I was still having about 2-4 active pimples/cysts at a time (which I thought was bad at the time, but little did I know it would get much worse for me).

After a few months of just tret, my derm added 50mg of spiro in the morning to my routine. I’ve been on it for about 7 weeks now. At first I didn’t notice much difference in my skin (still a few active pimples or cysts at any given time) but somewhere after a few weeks I realized one day I wasn’t super oily anymore. So that’s a huge improvement and since it caused the acne in the first place, I thought it would mean my face would start to clear up. However over the last 2 weeks especially, it feels like my face is just erupting with cysts. I had 4-5 active cysts, then a couple days later it became 7-8, now I think I have about 10 active cysts on my cheeks and jawline. I don’t understand how it’s getting worse than ever even though the spiro helped with my oil production. I did deal with the super oily skin for about 4.5 months before the spiro, so is it possible all of this was built up under the skin during that time and is just finding its way out now?

Did anyone else have a similar trajectory with the medication and did it get better?

Also, did anyone else have skin that looked like mine and saw success on only 50mg? It seems like most people are taking 100mg but since I’m a very side-effect prone person, I don’t want to increase from 50mg but also really want my skin to clear up.

Many thanks to anyone that read all that and has any advice to offer :)