250 is about a therapeutic dose. I would just tell them that your meds are not working and things are unstabile and that you need to get in for an adjustment.

In January I was on 300 mg Lamictal, was not well, SIing and drinking crazy. I ended up in the ER then committed to psych for 2 weeks. All that actually got done was increasing my dose to 400 mg and all the crazy has stopped and things are fine now.

If it's been going for awhile, and listening to you, you sound vexed, I'd wouldn't hesitate to call them. They work for you. To get in faster, I'd tell them I'm having thoughts to self harm but not wanting too. I've used that before. Good luck Hun!