What to do when in need of an antipsychotic but also can't stand APs?

They alllllll suck. Or at least everything I've tried.

Risperdal didn't give me akathisia, but I also thought I was breaking into an apartment in Lowell, MA one minute, drinking beer with my sister in Manchester, NH the next (I don't have a sister), lost in the woods in Maine another, but I saw a woman who led me to a cabin and when I got in there I got scared because it was obviously someone else's and there were like 10 rifles, on a boat, lost in a pink maze, trying to go outside the hospital (I was IP at the time, but the unit looked way different and very green) but they all left without me and I felt incredibly betrayed and abandoned, it was raining cocaine and ants, and god knows what else. I had no clue I was actually inpatient.

Invega didn't give me akathisia, but it did give me an anaphylactic reaction

Zyprexa didn't give me akathisia, but it makes me do nothing but eat. And then I feel guilty for eating so I throw up. Not looking forward to bringing back my ED.

Seroquel didn't give me akathisia, but it did jack.

Clozapine didn't give me akathisia, but I don't think I have time to get bloodwork to start it, and I also want to be awake more than 8 hours a day.

Fanapt didn't give me akathisia, but it also made me fall like twice a day while I took it.

Literally everything else I tried (thorazine, fluphenazine, haldol, geodon, abilify, latuda, saphris, and vraylar) gave me akathisia, and I've had so much akathisia that I will NOT tolerate anymore. Every time I get it, it gets worse.

Have to get on something this week and get it working ASAP before I risk flipping out every time I leave the house. Hell, even if I don't leave. Ideas?

You mentioned Zyprexa. I took that and gained weight, so I switched to Abilify. But, I found the Zyprexa worked well for me.

I hope your pdoc can find a solution for you.

Could you take a lower dose of Zyprexa and exercise?

What about Lybalvi?

There is a brand new class coming out in September called karxt

Could it be possible that you need one of these antipsychotics, yet take another drug to counterarrest the side effects of the antipsychotic? There are many, many drugs out there that help with the side effects of APs. For example, there are particular medicines that help with akathisia. I don't know of many medicines that counterract weight gain or anything like that unfortunately. I am currently taking lurasidone which helps my psychosis a lot (pretty sure that's Latuda in the U.S.), but I saw that you mentioned that one gave you akathisia. Have you mentioned any of this to your prescriber? Perhaps that person could help orient you around which antipsychotic to take if you express your concerns. And also, maybe they can suggest an adjunct medicine to help with the side effects from the AP.

Cogentin + any AP = urinary retention
Propranolol sometimes makes me pass out (low blood pressure)
I refuse to take scheduled benzos. Even if I did manage to get prescribed them, I would just hoard them.

Are there any other treatments for AP induced akathisia? I did take PRN haldol for a bit since this post and even a few days of 10mg/day caused it to come back, and I still have it days after stopping it. I'm starting to think if I keep taking this stuff it's going to become permanent and if I don't want to live now, wait 'til then.

I hear you on the akathisia, I have had it and it's not fun. I think what made it go away for me was the fact that I take venlafaxine and mirtazapine (both antidepressants). I think mirtazapine in particular has a very calming effect. You might even be able to take 15 mg of it (a low dose), and be okay with that. Of course, I don't know whether you also have depressive symptoms, and if that would work or not, but it might be worth bringing up to your prescriber. Haldol is particularly notorious for akathisia, I think.

I almost never have "pure" depressive symptoms, it's 9/10 times agitated/mixed depression.

I really don't want to take a med with its own issues to deal with a med with a lot of issues though. My psychosis only comes in manic and depressive episodes, so I guess I'll just only take what they watch me take(they did put me on quetiapine) and get a B52 in the ER (ativan's ok IM and having no supply of my own), transfer, and d/c whenever it comes to that, and go back to the beginning.

I also take mirtazapine and find its calming effect takes away my SI.