bpcyclist, are you severely depressed right now? Or is psychosis your main issue? I am no doctor and I don't have the same brain as you, or the same illness course that you have had, or all of the same reactions to medications you have had (and vice versa). However, I can't help but think that continuing to add add add a mix of really powerful stuff (on both ends of the spectrum) to an already hefty cocktail, wouldn't make for a very confusing and chaotic situation.

When I saw you mention the stimulant, I had a very similar reaction as bluebicycle. It's hard not to. If you're psychotic, I can't in a million years see how a stimulant could help? I don't know. Me knowing my own situation, and knowing all of the medications you have in your cocktail, I would see that for me, reducing or eliminating something might be a good plan to consider, if depression is a major concern. As for psychosis, I am a fan of Trilafon. You've read my posts on that. I took double what you've been taking and did well. I can't say you will, but again, if some doctor said that instead of fixing my psychosis with an antipsychotic they'd give me a stimulant? I'd declare "YOU ARE CRAZY!!!!!" But that's just me.

Another point to consider that I think some, not all, will relate to: Antidepressants were the single most destabilizing medications I have ever been put on, regardless of whether or not I was also on a moodstabilizer and antipsychotic! When I say destabilizing, I don't just mean "making me manic". I mean "making me depressed", too. An antidepressant making a bipolar person depressed? Yes! They screwed me up, royally! Sometimes what seems like an angel is actually a devil in disguise. We think we're being granted a great deal by such a risky bugger, but in the end it is like a deal with the devil that eventually goes bad.

Some moodstabiizers are not the most depression friendly for everyone. Remember I called Depakote "Depressakote"? I was so depressed for such a long time I agreed to ECT. Then they put me back on the Depakote, and the depression came back. They had the brilliant idea of putting me on Wellbutrin SR, and I got worse yet. I only started to improve when that stuff was finally scrapped. Not saying Depakote is bad for everyone. It can be a lifesaver. Or that Wellbutrin is bad. But for me, my sanity came back long-term only after certain elements of my cocktail were removed.

I've been on behemouth bipolar bipolar cocktails before. At one time, I simultaneously took Lithium 900 mg, Lamictal 100 mg, Tegretol XR 1,400 mg, Geodon 160 mg, Navane 10 mg, Seroquel XR at perhaps 350 mg, and Klonopin 0.5 mg. At that time, I was not in need of any hospitalization, but I was not well-off. I think I was having musical hallucinations and/or some weird-butt symptoms they thought could be psychic and sensory simple partial seizures. And yet I wasn't manic or particularly depressed. At some point(s) I even had bad migraines. Unfortunately, I developed a dystonia that was clearly from Navane, I was taken off gradually and my Seroquel XR was upped. Unfortunately (BUT also fortunately) I developed kidney damage from Lithium. I was slowly weaned off Lithium and my quality of life only improved, including the ending of some of that "weird butt stuff". A lot of stuff improved by going off Lithium. And I had had (I counted) 10 different side effects from that medication over the years I took it, though not all simultaneously. Then I got an evil case of akathisia. I mean, really really bad! Geodon seemed to be the clear culprit. I was weaned off that very very slowly. Geodon withdrawal is a bugger, especially having been at the highest recommended dose for years. As I was weaned off the Geodon, my Seroquel XR did go up up up, because manic symptoms appeared. Things improved. Now, instead of taking 7 bipolar medications, I only take what you see below (4 bipolar medications). Now, I know exactly what each and every one of those 4 medications does. It's possible, maybe I could even get rid of the Lamictal. Maybe. I'd love to get to rid of the Klonopin, but you know what a B that can be. Did I know what each of that past 7 did when on all of them? Not really. I only figured that out when some were gradually removed from my mix.