I know the quandary you are in with regards to med changes happening too slowly. I have gotten so frustrated with my pdoc before. And not finding stability doesn't help either.
2 weeks ago I was spiraling into such major depression I just wanted out. I phoned my pdoc who got really worried and wanted me to go to hospital. She had scared me a few weeks prior by saying that by now, and on the med combo, I shouldn't be having such bad depression, and if it still was not better we'd have to discuss ECT. Anyway, I slept it off and harrassed a few close friends for support and got through it.
Back to the real crux - I was then considering i needed to be in hospital to be safe, but I could not afford to go off work at that time (Too much work and exams round the corner too). While I didn't go, and managed to get thro the episode, I still get angry at myself for allowing my work to get in the way of my health and sanity. If I hadn't been working, I would have gone to hospital.
Your idea of a fresh start sounds radicle, but possibly necessary - it's a lot fairer on a new pdoc, especially if you really like and trust him, to start on a clean slate. But it's not easy for you. And I definitely wouldn't imagine it to be possible as an outpatient.

I'm on Sodium Valporate, and if I don't start stabilising soon, I need to change to Lamictin - not sure if this can be done while I continue working, or if going cold turkey and starting on the new meds as an inpatient is better.