I really recommend seeing the best possible doctor and often that means the best possible hospital. I drive 2.5 hours each way to see my pdoc and have benefited greatly from her being at a top hospital. She wasn't originally and I wound up at the hospital because she moved there but it has worked out to be the best thing that could have happened. You don't necessarily need to change pdocs, but the 2nd opinion from an expert can be enlightening.

I was in one of the clinical trials for lamictal, actually one trying to see if in combination with lithium and depakote if it might help resolve rapid cycling. (Lithium and depakote do and they thought lamictal would make sense to further help since it helps with depression. As far as I know the study did not show this at all.). I think getting everything possible out of lamictal is a good idea as it is a relatively "easy" drug, at least compared to most of the AAPs.

Unfortunately it just can take time to get it right. It took me 14 years to get the best control I've had and where we aren't constantly adjusting meds to my mood. That's extreme but it does take patience that is really hard to find when you feel like you are constantly waiting.