Great question. I have been wondering that myself. Medication seems to be more of an art than a science. Since everybody is different, what pdoc really knows what will help in the end. Of course there is a lot of science behind their guesses its just that they really don't know how we as individuals will react. For example last terrible mixed state I was in all sorts of meds were thrown at me and in the end it was a stimulant that dragged me out of it. Who'd of thunk that? I'm glad my pdoc kept plugging away.

Sorry you are miserable. It is worth trying new meds as they might be the ones that help you. Mood stabilisers are a good start point as they can be instrumental in treating BP. Mixed states are hell. I hope you find some peace.