My Patients Has A History Of Bipolar Depression With Psychic

My patients has a history of bipolar depression with psychic features. She been on taking Depakote 1000 mg at HS, vraylar 6 mg for over 3 weeks and Lithium 300 mg BID. Her lithium was toxic and we discontinued it. She began exhibiting several oral facial movements and tremors that was socially disfiguring she is more depressed. We had reduced the the vraylar to 4.6 mg. She had a mild hx of parkinson's and was taking sinemet 10/100 BID. We increased the Sinemet to 10/100 TID and started B6 2 tabs BID. Her symptoms contiue to persit. Do you recommend discontinuing the vraylar? What suggestion might you provide?