Wander, I second Rainbow in that if you really are treatment-resistant, then a logical next step is to try Clozapine. But by the US standards, you are not at a point when you can be pronounced treatment-resistant.

You take: "Lithium, Lamictal, Seroquel and Clonazepam".

Clonazepam you take because otherwise you go into withdrawal pains and not because you really need it, so we can discount it.

Seroquel: you take a tiny sleep medicine dose of 25 mg that scores of people who are not mentally ill take because they need a sleep medicine. This is not a psychiatric dose - for Seroquel to be an anti-psychotic/anti-manic agent, it needs to be prescribed at a higher dose, think 300 mg and above. So we can discount it as well.

This leaves you taking Lamictal and Lithium, which is a very common and usually effective combo wherein Lamictal protects from the bottom and Lithium protects from the top. Many people, including on this board, are quite happy on this combo. But it is not a "last resort" combo - rather, it has become one of the first combos to be tried. So your treatment does not make the impression that your clinicians have exhausted other options with you.

I used to be considered treatment-resistant and was put on Clozapine, but it made me depressed to the point of physically motionless, even at the lowest possible dose and even in the presence of Wellbutrin. So I thought that I would need to try ECT. But I happened on Zyprexa and Zyprexa saved the day. The addition of Topamax not only stopped the weight gain from Zyprexa, but also added protection from racing thoughts, giving me calmness that I had last experienced prior to the disorder. I am really happy with this combo. I also take Gabapentin which improves the quality of sleep (Zyprexa takes care of quantity of sleep). So you can see from my signature just how many medicines were tried and discarded, but ultimately a good combo was found via trial and error. I had long periods of disability in the past but now am working full time in a high stress occupation. What I am trying to say that there is no science to the selection of psychiatric meds - it is trial and error - and it seems that you have not exhausted your options.

There were recently publications that Clozapine, given its superior efficacy, is not being used as nearly as widely as it deserves. People suffer while they can be helped. My reaction to Clozapine was an outlying case - it helps many people who take it without making them severely depressed.