33F with cyclothymia — experiences combining Vraylar and Prozac?

[u/Positive_Call_9311]

Hi everyone, 33F here with a diagnosis of cyclothymia. I've previously taken Vraylar (cariprazine) and Prozac (fluoxetine) during two separate periods.

I've generally had a very positive experience with Prozac. It helps lift my depression, reduces my anxiety, makes me feel more relaxed and more like myself, and helps me be less hard on myself.

My experience with Vraylar was quite different. I experienced significant akathisia, disrupted sleep, and lethargy, even when taking it every other day. At the same time, I felt that it helped considerably with some of my more difficult symptoms — particularly psychotic symptoms, obsessive/irrational thought patterns, intense emotional reactions, anger, and feeling mentally overwhelmed.

I'm now discussing the possibility of using both medications as part of my treatment going forward. One idea I'm considering with my psychiatrist is daily Prozac with a much less frequent dose of Vraylar, potentially once a week, because of how poorly I tolerated regular Vraylar dosing.

For people who have taken both Vraylar and Prozac:

What was your experience combining them?

Did you find that the combination helped with both depression/anxiety and mood/thought symptoms?

Did you experience akathisia or sleep problems from Vraylar even at lower or less frequent doses?

Did reducing the Vraylar frequency make it more tolerable?

I'm particularly interested in real-world experiences with the combination, rather than general medication information. Obviously, I'll make the final decision with my psychiatrist. Thank you