I took my son off of all medications with the help of the doctor who realized he was on the autism spectrum and NOT bipolar. And my son had been on heavy duty medications (Lithium/Seroquel) for three years. It didn't feel right to me that he needed mood stabilizers when he had never seemed like a moody kid. Spacey and quirky, yes. Moody, no. I can't speak for anyone else, and I don't recommend that you necessarily do what I did. But this is my opinion.
Doctors aren't infallible. in my opinion some doctors medicate WAY too much. I had a limit--two medications for my kid and for me. Period. If a medication didn't help, I didn't want my child on it. Helping meant I could see a positive difference without the child being doped up. I apply this also to myself. When my son got aggressive on stimulants (which don't need weaning) I took him off myself. Same with his one day of Prozac. One pill made him so psychotic he thought he could fly and started jumping off his desk at school. I got my first and only phone call from school about this child that day, they were scared for him. Me too. I never gave him another Prozac pill and I'm not sorry. Although this sounds scary, psychiatrists are pretty much doing some guessing when they put our kids on psychiatric drugs. "We'll see if Depakote works--if it doesn't, well, we'll see if a stimulant works--like Ritalin." They don't mean harm, but I think sometimes they do harm. My son never needed medications at all, yet he was put on them. I have terrible mood problems and going through the medications-go-round, until we found the right medication, was horrible for me (but, in my case, necessary). At the same time, being an adult, I wasn't going to allow myself to be so doped up, like on five medications, that I was unable to see through the fog. At times one particular medication would make me so "foggy" that I'd make psychiatrist wean me off. Again, I've never been sorry. Lithium did that to me. As did Tegretal. Frankly, my trial on Ritalin made me ten times worse, so I quit taking it. in my opinion we have to stop thinking of doctors as gods. They are human. Some are way better than others. Some do medicate too much. Some don't medicate enough. All are fallible.
I trust "mom gut" over doctors any day. If you think a medication combination is not helping your child, this is what I'd do. First I'd think, "So why is he taking this anyways? He's not better." Then I'd find another psychiatrist, with hopefully a reputation amongst mothers as helping their kids (other parents are good referrals) as sometimes pediatricians refer you to their best friends or cousins who need patients (worked at a hospital and talked to lots of nurses). Obviously, something is "off" if the child is punching himself in the face. You may want to try a carefully monitored "medication wash" (you may need the hospital for this) and to start over. My own psychiatrist will not make multiple changes in medications. He knows you can't tell if a medication is working or hurting if you make more than one change. If you do, then there's no telling WHAT could be causing good or bad changes in behavior. Also, I have a motto (several, actually), but one is "if it ain't helping, why take it?" You know if your child is better or worse. The doctor doesn't live with your child. Your psychiatrist works for YOU and can be fired. You have every right to tell him what you want for your child. If he takes offense, then in my opinion his bedside manner is poor for a psychiatrist. He should welcome parent input. Psychiatry isn't an exact science.
I am not a fan of tons of medication for every single symptom. Usually, from what I read and in my layman's opinion, too much medication causes as many problems as none. You have a right to participate fully in the treatment of your child.
Ok, off the soap box