I have treatment resistant bipolar disorder and I have found that the only way is trial and error. There is nothing especially designated for treatment resistant, well maybe save for Clozapine but it gave me immobilizing depression at tiny doses, so I could not tolerate it. But Clozapine is the only med that officially has the status of being the last resort medicine, in part because you need to be on continuous blood work monitoring to fill your prescriptions, so it is a high maintenance treatment which physicians avoid if they can. But Clozapine has literally allowed many people, bipolar and schizophrenics, to lead full lives whereas before they could not get help from anything else. So my first question to you is, have you tried Clozapine? And more generally, what have you tried already? Can you list what you have tried, in what combinations, at what doses, for how long, and with what results? I even have a spreadsheet where it all is listed and I actually plan to move this information to a Notion page that I can share with my doctors because Notion displays data in a much more user-friendly format than a spreadsheet.

I see your signature with current prescriptions, but it does not give visibility into what you have tried and abandoned, and why.

I am surprised that it is with antipsychotics that you experienced that they "last a short amount of time". Usually, it is antidepressants that first work but then stop working. I had it happen to me on Trazodone, an old antidepressant used in low doses for sleep. It stopped working for sleep altogether after several years and raising the dose did nothing to resurrect its effectiveness. Many people experience that ADs stop working for them as, well, ADs. I have a friend with MDD who has had if happen multiple times on various medications, including Wellbutrin that you are taking. But APs, if they work, usually tend to be more stable with their effectiveness than ADs. But of course everyone is different and we all have our idiosyncratic responses to medications.

So please provide your history with medications and we will see what remains unexplored. And in terms of symptomatology, where are you, how do you cycle... what, essentially, are you treating?