Thanks everybody for your experiences. It looks like irritability and agitation are more common than I realized with atypical antipsychotics. I wonder how closely related it is to akathisia/restless leg, which I've never noticed with anything but seroquel.

Regarding the Prozac/Zyprexa combo, it's something to consider but Prozac by itself (before my bipolar diagnosis, in fact it's what led to my bipolar diagnosis) was great for me for maybe a year or more, but then tipped me into a stretch of apocalyptic ultrarapid cycling the likes of which I've never seen before or since. It was truly unbelievable. My old pdoc had lost his license and so I wasn't under care for a while and just kept taking it. So if we do end up trying it, it would be very closely monitored. But Zyprexa also has bad physical side effects for me, the weight gain is unbelievable, I naturally have high cholesterol and it pushes it into heart attack territory, and I got gynecomastia on one side on 2.5mg the first time :|

Regarding the older typical antipsychotics, based on recent flowchart type recommendations for bipolar II, in my understanding they would be last-resort treatments with the exception of clozapine. Everything is on the table here but seroquel alone is actually one of the first suggested treatments for bipolar II with resistant depression, followed by seroquel plus a stabilizer like Lamictal or Depakote. I am scared to death of getting TD (the tongue flop / chewing / hand twisting movement disorder) which is a lot more likely with the older antipsychotics. It's always a cost-benefit analysis - I don't end up hospitalized ever and the most intensive outpatient I've done is DBT. Bipolar II is still destroying my life but in a lowkey way that hopefully will need less severe management.

Regarding hand and leg motions, if it is due to a feeling of restlessness that would be akathisia. With Zyprexa, I had tremor and I thought maybe I had some twisty hand movements rarely while walking. I am super paranoid about this and brought it up to pdoc. She said it was very unlikely to be TD but that there was an easy test, namely you increase the dose of the medication for a few days and see if the movement issues stop. It's paradoxical but I looked it up and it's a known thing and the way it works based on understanding of TD in the brain makes sense. Anyway we did this and nothing changed, later we figured out it was my ADHD meds and changed them which solved it.

That being said, ANY movement issues and/or physical restlessness with antipsychotics, talk to your pdoc ASAP and if they blow it off consider getting a second opinion. Once it gets going it can be permanent.