I can relate to the cycle (all the way up, all the back down) you describe. It is hard. I feel for you.

I don't want this to sound un-kind, but what you are doing does not seem to be working. I'm with you on the exercise, nutrition, etc. I want everyday to be a day I don't need to take medication. I'm not there yet though.

For a long time I kept telling MDs it wasn't bipolar it was stress, it was I worked night shift, it was a vitamin or thyroid or whatever else I could come up with. It was inflammation, not severe depression.

When I cried the whole appointment when I went to a promptcare type place bc my PCP couldn't get me in that day (that time I was on the inflammation kick), he humored me and ran some labs (they were fine), put his hand on my shoulder and said "you're really depressed, don't give up". I started forcing myself to exercise most days after that even though could barely get out of bed. It was one of the most painful few months of my life. The pain is not quantifiable.

Give meds a try. It's ok to tell MD you don't really want to take them, and that you want small doses. You can always add more. Or change things. Different things work for different people. You have a medical condition and I bet would tell another person with a medical condition that it's ok to take meds. I struggle with that, a lot, but it's what I'd tell someone else.

Definately keep up all the behavioral stuff, you are doing awesome to be doing all of that. It will always help you and gives a good sense of accomplishment and strength/control.

I hope that might help a little. You are NOT alone.