Ok, I wrote this and it deleted it. So trying again.

I had my insurance book out beside me trying to figure things out for myself. It's missing part of the page where my cat tore it but here's what I can come up with that you've not tried: trileptal, tegretol, zyprexa, Fanapt, Fazaclo (never heard of this but it's in the book), Latuda, Orap, risperdal. You've not been on the older APs, some of which are really effective. My list includes haldol, perphenazine, loxapine, fluphenazine, chlorpromazine. There's also, to quote my pdoc "Always Clozaril". It's very effective but a last resort b/c it requires a ton of bloodwork because it can make your white blood cell count drop. I've also tried keppra (but haven't heard of that being used) years ago and know someone who benefits from zonegran.

I'm not going through all the ADs because you need more than that. However, I highly recommend MAOIs when depression isn't responding to other stuff. You have to follow a diet that is low in tyramine which isn't that hard to follow and there are meds that interact so you have to wear a medic alert. But they are very, very effective. I'm on Emsam which is actually a patch. On the lowest dose you don't even have dietary restrictions.It doesn't burn out like so many ADs do and it worked fast and incredibly well. You aren't on an AD so going on would be easy (if you're on an AD you have to come off that first and it is horrible). I didn't respond to meds all that much for 6 years and then I responded some to Seroquel combined with high dose Depakote. In the 7th year I went on the MAOI and increased my Seroquel dose to counter the stimulation from the MAOI (you might have to have something sedating with it because they are stimulating, related somehow to amphetamines). And I was stable from then until physical health issues destroyed everything.

I understand that you don't trust meds to work and that you are so frustrated. Just to let you know that there is hope, here is my list of what I tried before becoming stable. Monday I'll probably start a new drug which will be cocktail 65. Since 1997 I have taken: paxil, zoloft, remeron, trazodone, xanax, ativan, klonopin, valium, ambien, ambien CR, sonata, lunesta, rozerman, elavil, wellbutrin, effexor, celexa, prozac, depakote, lithium, lamictal, keppra, geodon, abilify, risperdal, provigil, nuvigil, imirpmaine, trileptal, hydroxyzine, seroquel, seroquel XR, fish oil, emsam, zyprexa, gabapentin, topirimate, Latuda. And a placebo in a clinical trial. Most of those were tried in multiple combinations as well so have been tried a few times and nearly all were tried at numerous doses. And after all that I did finally find the right meds. Even though I'm no longer stable and doing well since getting the right meds I've had 2 bad episodes and one that responded immediately to a med change in the last 4 years. It used to be that I had 3-4 bad episodes per year and since my episodes are long it was pretty constant. I never had little episodes or good mania/hypomania.

So you can be on a lot of meds and still get stable. It takes patience I didn't have but it can happen. I live in the middle of nowhere too and while it didn't start this way (there have been several moves) I drive to a city to see a good psychiatrist. It's totally worth it. I know that's not always an option but if you can I highly recommend seeing the best person you can find. When you are hard to treat you need someone who sees lots of hard to treat patients.

Hope this works this time!