I've read a good deal about Lamictal as it was recently prescribed for me. I researched before my pdoc even suggested it. If you look up dosing guidelines, you should titrate up as SLOW as possible, ie. the 25mg per 5-7 days. You should also do it that way so that you can monitor your symptoms or relief to see if you can get therapeutic results at a lower dose.

It also seems like you're on a mighty cocktail of meds. Tegretol did nothing for me, and I've heard from several psychiatrists that it's really not effective as a mood stabilizer. Also, Tegretol and Lamictal serve nearly identical purposes, but Lamictal has shown to have much better results.

I too live in a somewhat rural (ie. not very medically inclined) area. There are only 3 pdocs in my county and 2 are retiring. I drive an hour to see my pdoc, with whom I have a history. I also drive an hour in the opposite direction to see my therapist. Good mental health care is hard to find.