For a while it was believed that I had treatment-resistant, intractable Bipolar I w/ psychotic features, with 3 sui attempts in history. Usually with intractable, Clozapine is prescribed, but I could not tolerate even the tiniest doses of Clozapine because it made me debilitatingly depressed, to the point of physical immobility. Then I became resigned to the fact that only Zyprexa works. And it did for a while, Zyprexa in combo with Gabapentin. I was on it for 4 years, mostly stable, with horrible metabolic side effects (prediabetes, severe sleep apnea, non-alcoholic fatty liver disease, abdominal adiplosity), but those started to get gradually reversed when I added Ozempic, Topamax, Provigil to the mix. I also upgraded from regular Zyprexa to Lybalvi, although I am not sure it conferred any benefit, since I still was ravenously hungry on it and still needed Ozempic, Topamax, Provigil to reduce the insanely strong hunger caused by Zyprexa.

Unfortunately, Zyprexa also makes it hard for me to think strategically, which is a big problem at my current management job. Just recently I stopped Zyprexa (Lybalvi, to be exact, which is Zyprexa plus another ingredient) for two days and during those two days I had two very simple good ideas about something at work and these ideas should have come to me much earlier: they should have long been obvious to me. So it is as if I were blocked from access to obviously good ideas, not some unusually good, some genius ideas, on Zyprexa. I want to fight for my job, for the opportunity to be successful, and Zyprexa is in the way.

Also on Zyprexa I have no sexual thoughts, even though I am mechanically able to reach clitoral orgasm. This antisexual effect of Zyprexa has accumulated over time: it has not always been that bad, but over the past year it has been. Again, during 2 days off Zyprexa recently, sexual thoughts started coming to me. Similarly, in April 2022, I tried Asenapine instead of Zyprexa and instantly had wonderful sexual thoughts. Unfortunately I stopped sleeping and had to go back to Zyprexa in order to get sleep.

Lastly, I used to write creatively and on Zyprexa I just cannot. I can jot down some plans, skeletons for future writing but I cannot get into the flow of the actual writing process and I cannot generate metaphor. During the recent 2 days of Zyprexa, internal writing process resumed and my memories become three dimensional and very interesting, as before. On Zyprexa, the world is sort of flat. In November 2021, I tried Vraylar and again the internal writing process resumed, was wonderful and I came up with highly metaphoric speech, had highly sexual thought content, but then stopped sleeping, realized that this would devolve into mania and begrudgingly went back to Zyprexa.

The only modern Antipsychotic I have not tried is Latuda. I will try it, but have low hopes, since I am afraid it will send me into mania and/or anxiety.

My psychiatrist recommends trying old antipsychotics. I have tried low doses of Haldol and Thorazine and they are not enough to make me sleep. By myself, without medications, I am completely unable to sleep and this has been going on for 10 years if not more. I have not tried higher doses of Haldol and Thorazine.

Maybe there are other first generation agents (FGAs) to try. For several years I was afraid of FGAs but now I am willing to try anything because I see that I have exhausted the options with modern antipsychotics.

Sorry for lengthy prose and hopeful that I will hear from people who have been courageous enough to try old medications. Note that I have tried Lithium, Tegretol, Lamictal, Depakote, so those options are a no go for me.