I'm somewhere between bipolar 2 and cyclothymia, have ocd (pure as well) and depression and a pretty strong history of PTSD and traumatic loss. I take abilify for the depression/psychosis/and mania, but I've cut back a lot, and in a lot of cases don't really need it as much in terms of depression. The abilify definitely makes my ocd worse, and I've tried Caplyta bit had a weird psychotic reaction and got all aggressive, twice, and made it hard to distinguish obsessions from reality, so personally, I wouldn't recommend it.
What helps:
* maybe swap our effexor for Prozac? Idk about effexor specifically, but a lot of anti-depressants can actually make mania more likely. Prozac is supposed to be best for bi-polar, AND helps with OCD for a lot of people. So, that alone may do a lot for you.
* Treat your PTSD, as hard as it sounds and seems, your biology changes with trauma and you'll generally be much less tolerant to stress and anxiety, and be more reactive to OCD obsessions. If you're anything like me then your obsessions are pretty tightly intertwined with your trauma, so ERP may be really difficult without being able to relive your traumas safely and effectively (daily Polyvagal exercises are a really great place to start, start small, the smaller and slower the better)
* I personally find that I'm also less prone to mania and psychotic episodes when I can relive and revisit my traumas safely, something about it just calms the nervous system
* Generally, there's virtually nothing that PTSD doesn't affect, and can even make your anxiety look like ADHD
* Your depression and anxiety will also get better as you treat your PTSD, so you should be able to cut back on your anti-depressants eventually (if you want), which should make it easier to live with OCD
* the bipolar 2, in my own experience, isn't actually quite as stubborn as my OCD, and can be managed pretty well when my relationships are in check, which can be done better as my OCD gets better, since I avoid almost everything when my OCD gets bad.
** TIP: Once you spend some time doing what you need (or choose) to treat your PTSD and just have the stubborn OCD and bipolar left, give Social Rhythm Therapy a try. It's not a complete cure, but it does really well for stabilizing mood and mania, which should make it a little easier to manage the rest of your OCD on a day to day and just live your life. There's some resources out there for it, but even just making a routine of your first and last social interactions for the day (like the going out and buying coffee at the same time everyday and saying good night to someone at the same time each night) does a lot for your biology.
** There's also a book specifically for Pure 'O' that may help. As well as other conditions, if you can't afford a therapist or simply need or want something structured. I'll show some pictures of other workbooks I've used, if it helps.
This may be a lot, but it's just kind of how things work for me, and I feel pretty certain that I know how you feel. I just don't have bad ADHD. I hope this helps.
