Ok, thanks, XXXXX XXXXX very helpful. For some of my patients, the presence of an antidepressant actually increases their anxiety because it gives them mixed energy - kind of like a hypomania but the mood is low or anxious instead of happy. So, the Cymbalta has to be carefully considered for decrease or even stopping altogether.
As mentioned above, Lyrica can make anxiety worse in some patients, so it should be considered. You are on a total of 12.5 mg of Zyprexa plus Seroquel 50 mg (for sleep) - 2 antipsychotics. Has either one alone been tried at higher doses? The Epilem is a good option, it can help both with the anxiety and the cyclothymia
SO, ideally I think your medications would look like this:
(1) Epilem at 1000 to 1500 mg, based upon what the blood level shows
(2) Remove the Cymbalta if it is felt to be making things worse
(3) Continue the Zanor until things are better and then come off of it.
(4) Possibly get off the Lyrica, but continue for now
(5) Optimize either the Zyprexa or the Seroquel, but choose one and get off the other.
Keep in mind, this is without the benefit of seeing you and knowing your story in person, so please take it with a grain of salt! But these ideas I think would be helpful to manage the anxiety, keep the mood steady, and get you on fewer meds.
Hope this helps!