I also needed clozapine to stop ultra-rapid cycling. I'm now rapid cycling but even that is less extreme. Unfortunately clozapine is supposed to be used as a last resort and you need to have failed a number of APs (my pdoc had me fail all that were reasonable for me to try, meaning I didn't do many typicals as I had bad/dangerous reactions to typicals and she only had me try a few) before they'll put you on it because it can rarely cause very serious side effects. Also you have to show you can be responsible about blood draws, weekly for 6 months, every other for 6 months and monthly until you come off it. So in my case I knew for several years I would probably need it someday but worked my way through other meds first before going on it in February.

My advice would be to consider ditching the Lexapro and see if another AD works for you. SSRIs are evil in my experience. Although they also didn't work for me so there's also that. I found ADs that were more sedating more helpful: imipramine (which also had the benefit of letting me really tightly adjust the dose with cycling using 10 mg pills), remeron (mirtazapine), can't remember what else I took long-term. I was not on ADs for a good while when I was newly diagnosed; they wanted to get me as stable as possible on other meds first and then added ADs when the other combinations didn't work.

I also wonder if Stattera is really your friend; I was on provigil/nuvigil but not until we knew well how I was responding to my baseline meds and could know it wasn't causing cycling.

Gabapentin helps me a good bit too. I take 800 mg at night now; in the hospital I was on 300 mg twice a day and 1200 mg at night. You can take a ton of the stuff and I find it calming. When I need a PRN I usually choose my PRN dose of it over my PRN Klonopin.

Abilify can be activating too. I found that activating was in general bad. That was true until I went on the MAOI AD many years into treatment and it is activating but can be balanced with my very sedating AP fairly easily which wasn't true for other activating ADs.

Have you considered getting a 2nd opinion from a really top doctor? You'd have McLean there in Boston which is supposed to be about the best psych hospital (and I'm sure they have OP) in the US and I'm sure there are other very good doctors. That was something I did early on and it REALLY made a difference. When I realized I was bipolar and my pdoc at the time was clueless about it I got into a doctor near me who is one of the top experts in bipolar in the world. I did a clinical trial with him and got a good start with meds plus a lot of education with him and then transitioned to my current pdoc who is very good with hard to treat cases and sees many BP patients who are hard to treat. She's also a pharmacist which just makes her better at her job. I've been with her 13 years now, diagnosed 14 years. SEeing a REALLY good dr. would be my #1 advice I think.

Sorry if this is too much; I'm trying to look back and think of what I would have wanted to know even a few years ago. My cycling was really not controlled consistently until this year so having any control is very new to me. It's very hard to live that way.