I have been thinking about this lately as well. Currently I am only taking lamotrigine and PRN lorazepam for sleep, and the main reason for that is exactly what's mentioned above, that I don't want to give up my physical health. I find I have to be really assertive about what meds I do/don't want to take because if I just go along with what psychiatrists say I'll be on five different meds in no time. They really don't think much of prescribing them.

I'm currently physically healthy, I have a good weight, I do a lot of sports, I work full time, and so on. I am not willing to give that up and risk diabetes or kidney damage or other nasty side effects. I've taken lithium and Seroquel in the past when my depression was extremely severe, and I might consider doing it again, but only for a set amount of time, not longer than a few months. Seroquel turned me into a zombie. Yes, maybe the depression was less severe, but at the same time I was too sedated to think and work properly, or to do sports, or even drive my kids to school in the morning. If I can't do that, I don't consider that a successful treatment.

I don't mind keeping up with the lamotrigine because it has no side effects for me (that I know of---I'm still hoping I might at some point be able to come off that as well). The thing that helped me break out of the worst of my depression was ECT, and I would do that again, too. It has no physical side effects and I haven't noticed any other adverse effects, either, except some short term memory loss that went away after a few months. People tend to see ECT as an invasive "last-resort" option, but for me it actually feels a lot less invasive in a sense than stuff like Seroquel, not to mention it's way more effective. I would prefer maintenance ECT over Seroquel any day. Right now I try to prevent relapse with lamotrigine, exercise, therapy, my work (which luckily I like a lot), and other non-medicinal stuff. It hasn't been perfect but my depression is a lot less severe since the ECT and I hope I can keep it that way with my current approach.

I'm going on a year since I finished ECT, and while the depression still lingers and gets worse from time to time, it's pretty much stayed at the level where it was when I finished ECT (which is way better than before), and most of the time the depression is just "average" now. Not fun, but tolerable. And I haven't had a full-blown relapse yet.