Pdoc wants to cut down on meds

My current med list:
fluphenazine/Prolixin: 20mg/day with 1mg 2x/day PRN (for mania/psychosis)
cariprazine/Vraylar: 3mg/day (for negative sz symptoms/mood stability)
lamotrigine/Lamictal: 50mg/day (tapering back up to at least 200mg, definitely keeping this one for depression/mood stability)
topiramate/Topamax: 100mg/day (for appetite/weight control from olanzapine since I take it so often)
Prazosin/Minipress: 4mg/night and 1mg/AM (for PTSD sx)
diazepam/Valium: 5mg AM/10mg PM (for akathisia from Vraylar/fluphenazine)
olanzapine odt/Zyprexa Zydis: 5mg 2xday PRN (for psychosis/mania/insomnia/severe anxiety)
Symmetrel/Amantadine 200mg AM/100mg PM (for tremors from fluphenazine)
Ativan/lorazepam: 2mg PRN 2x day for akathisia/severe anxiety/insomnia

She wants to simplify my list that was just expanded in a residential program setting. She doesn't like me being on three antipsychotics, two anticonvulsants, and especially two benzos (she doesn't want me on any benzos but they're the only thing I can take for akathisia which I am very prone to and get severely). She's leaving it up to me to figure it out (basically said pick valium or ativan and choose other stuff to stop). I'm at a loss because everything does something good, but something bad too. I'm absolutely keeping the fluphenazine and the lamotrigine, that much I'm sure of.

Words of wisdom? Ideas? Insights?

Realistically you are on a lot of meds. I am too so I relate. But a few years ago, my psychiatrist and I decided to try reducing the number of meds I am on, and we successfully tapered me off one antidepressant and a benzo. Since coming off them, I've felt less sedated and have more energy so that was a bonus.

I'm a bit surprised that your Dr. wants to leave it up to you - that's pretty hands off. Can you talk to them and say you want to talk through the pros/cons of each med? If that's a no go, you might want to talk to your pharmacist about how the different meds may be affecting you - good and bad, and use that as a basis for decision making.

then my suggestion would be to only taper off one med at a time and go slow. That way you'll be able to notice and deal with any withdrawal effects or symptom worsening. This is how I did it, and my Dr. and I discovered that a 3rd med that I was also trying to reduce couldn't be safely reduced without the resumption of some really problematic symptoms and we decided that I was better off on the med.

Good luck with it.

I agree that you sound overmedicated. Maybe you can taper off one and then see how you feel. Then another, and so on.

Perhaps you can start with one of the antipsychotics, then go off the med you’re taking for the side effect of that med. then evaluate and see how you are doing before quitting more? But yeah hospitals are notorious for stacking on the meds.

I would advise to try Gabapentin to ameliorate akathisia. I am also prone to akathsia and Gabapentin works very well. I have been taking it without any side effects for 6 years. It is a much safer option than benzos.

Regarding the rest, I agree that it is not an elegant list but do not know what to advise.

Thanks guys

I think I'll cut out the Vraylar completely, use the Prolixin PRN instead of the Zyprexa PRN and drop the Topamax, and see if Gabapentin works, and if it does then drop both Ativan and Valium.

I was once also on three moodstabilizers, three antipsychotics, and two benzos, simultaneously. It was too much, and it was good that I was weaned off some. At least I can say that it turned out that as some were removed it showed them as less effective than I thought and/or side effects reduced or disappeared. One was a little more effective than thought, though that was also switched with general success. Eventually I was down to just two moodstabilizers and one antipsychotic, but over time. Not rapidly. Other additions/removals have since happened over the years.

I would strongly consider choosing just one benzo, as a start. I've never been on Valium. I generally like Ativan, but it's best as a prn for me. I did also take it for akathisia. It worked while adequately in my system, but when not, akathisia struck with a vegeance. Twice per day would have been better than once. Isn't Valium longer-lasting? If so, if you are fine with it side effect-wise, maybe that's better. However, I found long-lasting Klonopin less effective and made me tired during the day, unlike Ativan. Not sure how similar Klonopin and Valium are.

I never tried Vraylar, and know it's fairly new. If I knew it to be very effective and weight friendly I'd probably consider transitioning more to that and less of Zyprexa or Prolixin. Then eventually, maybe you wouldn't need the Topamax? Zyprexa was effective for my mania, but gave me akathisia and rapid weight gain. I never took Prolixin to guess which was less side effect friendly or efficacious. I am for any med that you can use as prn only or take some daily and some prn. My old psychiatrist used to use Seroquel that way, with good results.