I am a 35 yo female with a history of anorexia and bulimia and self harm (all resolved), but more recently of bipolar type 1. I had ECT in the past due to refractory depression, in which I had 3 serious suicide attempts, including a nearly successful hanging. I had 6 sessions of unilateral ECT, until, on the last session, I completely lost all of my memory for a few days. They cancelled all future sessions. It had been working beautifully. I eventually achieved euthymia around November and have been completely fine until recently. The depression is coming back. My psychiatrist bumped up my Lamictal and my lithium, but nothing is helping. The hole is just getting deeper. I am on 40mg Celexa, 300 mg Lamictal, 2,100 mg lithium, 180 mg Geodon, 60 mg propranolol, and 30 mg Adderall XR, with 200 mg trazodone prn sleep. I do not want to become chronically suicidal again because with each attempt, my technique has improved. I do not wish to leave my husband and children. My psychiatrist is a 3rd year resident without much experience. When I asked her if ECT could be an option again for me, she had no answer and when I asked about vagus nerve stimulation, she said she had no experience with it. This can't be the best it gets and I refuse to spend my life institutionalized. Could ECT be tried again or is VNS a good next option?