Thank you for the concern everyone, it really means a lot to me. And sorry for the late reply.

I agree that the meds right now are not sufficient. I had been tapering off most of my meds in preparation for ECT, and was actually planning to stop Lamictal as well pretty soon. I don't know that that would make a difference anyway because it doesn't seem to be helping much. But as those of you who have been reading my ECT thread know, it now looks like it's going to be a few months before I can get into the hospital for ECT. I'm seeing my Pdoc tomorrow and I really really really hope he can expedite things somehow, because ECT is where I have my hopes set for a "real" solution. But if the wait can't be reduced then I guess maybe I can't avoid some temporary meds.

I do feel like things have been going steadily downhill for a long time, and I feel like it's accelerating now. I have been having trouble recognizing whether this is a mixed state or not, but since so many people here mention it I'm starting to think maybe it's true. I've been on the fence about asking for my crisis team because I feel like I would be wasting their time. I don't know if the lack of support thing is just in my head. Maybe it is, because I keep feeling like everyone hates me and I honestly can't imagine why anyone wouldn't. Even my therapist, I really look forward to seeing her but as soon as I leave her office I feel like she's thinking "phew, I'm glad that creep is gone for the week." I feel like she'd rather be rid of me but is just too polite to say anything.

I've been afraid to take more drastic measures because I don't want it to affect my job. I keep struggling to produce some tangible result every week so they don't notice what's going on. But since these symptoms are already affecting my job, maybe it would be better to try and get extra help. I don't know.