I am sorry you are struggling and think it is great that you are here on PC getting involved. Lots of smart, experienced people here to interact with.

I have at times been considered a treatment-resistant bp1 person. I've never been on thorazine or Vraylar. But the others, I have. Like I am sure you have, I've also been on more antidepressants than I can truthfully recall off the top of my head, but I have never experienced the kind of ideation you describe just after starting a new antidepressant. I am wondering what those antidepressants have been, because some of them are very, very different than others. Cymbalta is not at all like Wellbutrin. And those two are not at all like an MAO inhibitor. So, if you are responding like this to very different types of medications, I have to confess that I find that sort of baffling. Sorry.

Which brings me back to MAO inhibitors. Have you ever tried one? I took Emsam for quite awhile. I had high hopes. But I don't think it did a thing for me. Something to consider, though. What about Lamictal? Or lithium? Or Tegretol? Or Depakote? I've been on all, but the one that helped my depression the most by far was lithium. And it's not really supposed to be that great for depression. But for me, it saved my life. That's why you can't just rely on what the conventional wisdom is if you have sever bp1 depression--in my opinion. With the exception of Provigil, none of those fancy new medicines have done a darn thing for me.

So, I also, as it turns out, spend a lot of time dealing with SI. It has gotten much better since I joined PC (thank you PC people!!). I don'[t feel as alone and isolated and I feel like I am not quite so much of a freak. That said, it's still a problem. You can see my meds below. We re-started Abilify last week and added an emergency sleep Rx for Zyprexa, because I do not sleep and because I got psychotic last week. My psychiatrist is brilliant. I cannot take Lamictal because I got Stevens-Johnson and wound up in the burn unit many moons ago. I am very worried about my SI because I do have prior attempts, one of them extremely serious. Anyhow, my pdoc says we will have to look hard at Clozaril if this SI continues. I hate that idea. I do. But I don't want this suicide stuff to take my life at some vulnerable moment. So, I might do it. we'll see. The other option is ECT. That, I would do without hesitating. I have no problem with ECT. I'd do it tomorrow, if he thought we should.

Anyhow, I am so sorry you are struggling. Bad depression is just brutal. There are several ECT threads here at PC. Maybe check them out and see what you think. Or, start your own. Maybe read about Clozaril. Or lithium, or any of the other mood stabilizers. You know, just because a drug is old, does not mean it isn't fantastic for some people. I'll take lithium over Latuda any day of the week.

Sending you positive vibes and thinking of you. Hang in there. Don't give up. Things will get better. You just need to find the right game plan. I am sure you will.