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Overall I've been pretty stable for the past couple of months and havn't had any Mania or severe depression and I am feel more stable. I still am struggling with some mild depression and anxiety and times where I feel gone from the world around me. Anybody have any creative ideas on how to deal with this. Thank you

Current meds 

Effexor XR 150mg 

Depakote ER 2000mg

Latuda 100mg

Trazodone 100mg

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I'd go with increasing Latuda to 120mg. Latuda can help with bipolar depression too. I forget what the highest dose is for effexor but if you can increase it you should. 

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It would help to know what the diagnosis is. Have you tried raising the Effexor ?

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Diagnosis 

Bipolar 1 with psychotic features rapid cycling 

Generalized Anxiety Disorder 

OCD 

Borderline Personality Disorder 

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I'd personally try raising the Latuda to 120 mg or even max it out at 160 mg.

Increasing Effexor XR to 225 mg may induce mania or even psychosis, but with your cocktail, you kind of have some protection against that, so that would be my next step if it were me.

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Posted (edited)

Idea 1. Add low dose (~1mg) risperidone to augment the antidepressant properties of the Effexor (risperidone in very low dose can enhance the depression and anxiety relief from SSRI's and SNRI's)

idea 2. lower Depakote and add in 300-450mg of lithium. That high of a dose of Depakote might be contributing to depression and the lithium could give you a lift because it works on mania AND depression while Depakote just mania and low dose lithium needs much less if any monitoring.

idea 3. add a tiny bit of Adderall (5-10mg) for depression relief and clarity of thought/focus

Also, relating to low dose lithium, this is worth checking out.  https://www.ncbi.nlm.nih.gov/pubmed/22796912

Edited by Sephiroth999

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