You mentioned the kindling effect of the SSRI. I was misdiagnosed as MDD for years, and was on most of the SSRIs/SNRIs at one point or another. They helped with the depression, but didn't do a thing for the manic side of things. I don't know whether or not I experienced kindling, but after about a decade of antidepressants I was diagnosed BP.

The BP diagnosis has been both a blessing and a curse. I never wanted the diagnosis or the stigma that goes along with it, but it helps to at least know what's going on and to have a path for treatment. After years of med trials, living in different places and having different doctors, I was finally put on the combination of Depakote, Latuda, and Lamictal. We tried Depakote monotherapy and that quieted the mania, but it didn't do a thing for the depression. When Latuda and Lamictal were added, I pulled out of the depression within days. They're kind of my "savior" meds. Eventually I started to have liver problems and the Depakote was removed, but staying on the Latuda and Lamictal have been enough to keep me stable. I hope it remains that way.

Best of luck on your journey. You're right that the Lamictal titration takes time to reach a therapeutic dose - I hope it does well for you. Thanks for your detailed introduction, it's good to know people's background and experiences leading to the present state of affairs. Like you, I'm "high-functioning" and don't want to lose that edge as time goes on and meds change.