Hi jtassar. I'm sorry you're struggling now and have had to deal with psychiatrists that were less than ideal. We've all been there and many here still are.

I'm sure you've heard the trite "What works for one doesn't work for another." I've also found that some medications don't work well enough at some points, but do at others.

Your medication combo looks reasonable, to me, but a tweak or single change may make a difference. I'd be hesitant to make a complete overhaul right now, especially considering the Coronavirus 19. Frankly, your mix isn't that different than mine other than your Lithium and my Lamictal. Tegretol and Trileptal have many similarities.

What is the worst aspect of your bipolar disorder right now? Mania? Depression? Mixed state? That is important. If mania, maybe another antipsychotic could help? Or a second one? I've been on more than one antipsychotic at a time, in the past. If you have mania, I would be sure any changes wouldn't affect your sleep negatively. If you're depressed, maybe you need something slightly activating (Lamictal?).

I have struggled with bad anxiety issues in the past, and still have minor ones, on occasion, but not OCD. As for other medications for that, I have no suggestions. I will suggest learning some powerhouse anxiety fighting coping skills and practicing (and practicing) to master some. For depersonalization/derealization, grounding techniques. Remember that no medication(s) alone usually does/do 100%. You need the therapeutic tools and the healthiest low stress lifestyle possible, too. Not just for anxiety disorders, but also for bipolar. I'm extremely serious about this! I know. If your therapist isn't stressing this, they are not doing their job well. I assume you have a therapist in addition to a psychiatrist.