Brief Answer: Need for supervised treatment. Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 69 year old female • Misdiagnosed for having bipolar disorder 15 years ago • Currently on: effexor 37.7 + lamictal 250 + seroquel 50 and trazadone 100 per day • Complaints of: extreme fatigue, irritability and anxiety on drug tapering by psychiatrist. Before understanding your case, it is important to know the reason for medicine dose changes. In your case it appear due to lack of sleep. Your sleep is improving after dose changes. Antidepressants can lead decrease sleep due to mood changes but same time it has withdrawal symptoms like you are experiencing. But in-spite of that, after examine you, if your psychiatrist want to taper them fast, I would not disagree with him/her. In my opinion you can delay/stop seroquel tapering but continue effexor and trazodone tapering as advised by your psychiatrist. For symptomatic relief for current symptoms you can be given on demand anti-anxiety medicine like Clonazepam. In diet take multivitamins (specially vitamin B complex). Avoid any stimulant or alcohol use (if present). I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards, http://bit.ly/Dr-Ashish-Mittal

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