Those first and second paragraphs were written like a veteran. A been there, done that. Me, too.
I can see why none of us have been brave enough to respond so far. I’m not either, but somebody should.
I really get your concern. I’m on such a host of medications. I often think about how to drop one or two. Of the meds you’re on, I’ve tried Trokendi (and failed it pretty quickly - I just performed an ill advised act of rebellion and dumped topomax) and Botox. I’ve also tried and failed Effexor, though that took 15 months (Thoughts from the Dark Side). Right now I’m sort of stable on Botox though results can be mixed from session to session. Sometimes I feel like a normal person, others I’m reminded how very untrue that is.
I can say I was never even sort of regimented on Effexor. I just can’t stick to a schedule. Still, I really didn’t feel these big shifts you’re talking about. Or maybe I did but they were in the middle of the night. I also quit 37.5mg cold turkey. Three weeks of increased MAV and I was back to baseline. Though the serotonin function didn’t completely return to my normal level of dysfunction for months. It’s not a fun detox, but it’s doable.
Have you considered weaning off whichever med you like the least to make sure you still need it before adding in something new? It’s possible the largest part of your gain may be due to just one or two of the meds.