I have found that I have had to change meds due to break through episodes and depending how the moods occur. Most often I go manic then mixed and have had been prescribed depakote and seroquel or more recently saphris to put the brakes on the manic/mixed. ..then I crash into depression and have been prescribed an antidepressant (have tried Latuda couldn't deal with the nausea esp since I was throwing up the other meds that were necessary)...once I stabilize for several months I usually will go back to lamictal and saphris for maintenance. I take it as a given that I am going to change meds depending on what state I am in my illness.