Dx hx: Bipolar II, BPD, OCD, severe BDD, GAD, ADHD, c-PTSD

Medications: Lamotrigine 100mg, dexedrine 20mg, trazodone 150mg, clonazepam 0.5 mg PRN

Hi all, I’ve been struggling with mental health on and off since I was 13. I’ve been in therapy since I was 18, have done DBT, EMDR, SSRIs, 3 inpatient admissions, and nothing helps. My biggest concerns currently are probably the BDD and c-PTSD. I’m actively suicidal, have a method, and have been “practicing” so that I’m successful once I’m ready.

Currently the 4 options that I have are:

1) Ketamine therapy for unresolved trauma

I was inpatient 2 months ago and the psych there said that meds will likely not benefit me but he thinks ketamine will have a 70-80% chance of improvement for me. The problem is he wasn’t able to get it approved in hospital because I don’t meet the full criteria for treatment-resistant depression or severe PTSD despite having features of both. I was referred for outpatient treatment, but it’ll cost me $3-7k and I’m already in debt. Also both of their psychiatrists are on leave right now and don’t know when they’ll be back, so I have to wait for an indefinite amount of time to even receive treatment.

2) Starting an antipsychotic

My regular psychiatrist suggested this despite me not having psychotic symptoms. I most likely would not take this route due to the side effects of weight gain, movement disorders, and constant fatigue.

3) ECT

My regular psychiatrist wants me to try ECT before he’ll refer me to a different doctor that does ketamine treatment and may be able to get it covered by insurance. I know that ECT can put depression into complete remission for many people. I’m also extremely wary of trying ECT due to the possible side effects of permanent memory loss and cognitive decline. I don’t have major depressive disorder so I’m not sure whether I’ll even benefit. If it doesn’t improve my mood and I’m left with permanent memory loss or cognitive dysfunction, I think I’ll have no choice but to end it at that point. It’ll affect my work and relationships.

4) Finding a new psychiatrist

Honestly I’ve been meaning to do this anyways as I’ve never really found him helpful. He’s very old-fashioned and any time I’ve needed a referral or letter, he’s made me write it myself and he signs it. If I don’t know what to write on the referral, he just won’t do it. Unfortunately getting a new psychiatrist has months-long waitlists, my coworker has been waiting 8 months and has not heard anything. I honestly don’t know if I have that long with the way things are going.

I honestly feel really stuck and hopeless at this point. The things that I’m able to access now can have horrible lasting effects, and the others will take months and ketamine will put me in a lot of debt. Any input would be appreciated!