If I'm being honest antipsychotics are the best management for mania. They act more like a balancer and helps smooth out highs and lows. Especially when you have Borderline and Bipolar. A step down would be a mood stabilizer, but choosing that route you may receive a higher dose as well as other meds to manage other symptoms that the mood stabilizer can't. Mania isn't something I've been able to stave off without medication. Can you tell me your biggest concern with Anti psychotics?

I am hormonally intersex , anti psychotics cause extreme menestral pain due to this, or messes with my hormones to where I cannot have children until Im off of them for months before trying to conceive, im on BC due to my hormonal imbalances and that also affects the antipsychotics ability to help, also the side affects are so severe such as my hair falling out, extreme cramps which cause inability to move enough to go from my bed to my bathroom much less down stairs to eat, the ones i've been on so far have not worked and so my doctor said the one next would be lithium or xanax , and my mania gets so extreme and my hormones are so out of wack that ketamine treatment doesn't help, which makes me extremely hesitant on anything else as that is such a strong medication if that doesn't touch me will anything ?

Im afab transmasc nonbinary, the medicine I use is called Vraylar, and I've had no problems with my hormones. I also have PCOS and have a nexplanon implant. It's important to do trial by error, that's how I found my meds. May not be the same for you due to you having a different case, but the medicine I took helped a lot. I truly hope you can find something that works for you💕

thank you for the info!! ❤️

I would try lamictal or something like that

i've been on lamictal

I’ve got bi polar, bipolar depression I’ve tried almost all meds but nothing seems to work as best as seraquil it’s the best med and isn’t a risky med also. I’ve been on it for like 3-4 years

i have bipolar as well, but with mania more so than depression and seroquil hasn't helped in the past