Hi Beth, I've done all the meds you have listed. The provigil was awesome until I got hives. The rest didn't do much. These are my present meds: Lamictal relieved the chronic depression and stopped the inner rage fire. It also gave me ego boundaries. Cymbalta stopped the pain of depression just like the advertisements. Effexor gives me steady energy to stay functional all day. ritalin gives me the ability to focus and channel the energy. Risperdal suppresses the free floating anxiety and obsessive thinking.   I posted a question about hormones affecting the bipolar cycling. You may want to check out pyroluria. It is genetic inability to utilize B6 and Zinc along with other issues. I started on B6 100 mg/day and now have upped it to 3x/day. What a huge difference. I was on abilify which was a gift from heaven. Every issue I had cleared up. I wasn't rescuing people, i really liked myself and others and the constant death and suicidal thoughts stopped. They just stopped!!! I was shocked to find I was making plans for the future. That I was even looking forward to the next day. I knew why people thought/think suicide isn't a good idea. Then I ended up with side effects and abilify needed to be stopped. The B6 doesn't give the full satisfaction of Abilify but it is a good viable alternative. The research on B6 shows it to be helpful for bipolar and schizophrenics. SAD is kicking in and I'm going to up the B6 to 4x/day. Well, I should say "we". my pdoc is monitoring this with me. Hope this helps. Judy