@Moose72 have you ever had a second opinion from a MD or DO pdoc? I know pnurses are well trained and many are very good at what they do but they do not have the education level of a pdoc. Sometimes even pdocs get ito situations where they are stuck. Before I went on clozapine we tried everything I'd never tried, was likely to tolerate and that had a ghost of a chance of working. My pdoc consulted the ECT doctor who recommended something else and also talked to another pdoc, the head pdoc for the huge hospital where I go. I think the idea was for me to see him but then they decided clozapine was my best bet after giving lithium one last chance. I think my pdoc wanted to be absolutely sure clozapine was needed and would be good for me. Happily I never had even the slightest change in my CBC in 9 years of monitoring and it does work.

When I was first diagnosed I was in a clinical trial for lamictal. I started seeing my pdoc immediately after the trial and have been with her since. I had a hard time tolerating lamictal without vomiting every day and so my pdoc reached out the the head of the study who was an expert on lamictal and the drugs I was combining it with after the trial.

If a 2nd opinion is possible it might be a good idea. Feeling stuck in a long episode is awful. You deserve an ending and back to stability.

It just sounds like another set of eyes and ears might be beneficial at this point.