I have many patients who do great on 60-90 mg of Adderall per day and have for up to 13 years.  Anybody like yourself who is not doing well needs to make changes.  You need to start with a re-evaluation with a physician.

One simple option may be to change to the new Vyvanse and possibly just one/day (70mg).

Many of my patients require Tenex with Adderall.  Patients on Vyvanse are much less likely to need it.

One of the most important things I learned in training in the ‘60s – if what you are doing isn’t working, do something else, even if it is wrong it gets you unstuck.

Some important lifestyle issues to consider include:   quality sleep, exercise, bright light every day, good diet, omega 3 fatty acids, and possibly Cerefolin, and personality issues.  If you need medication work with your doctor until you find “the right medication at the right dose” for you.

It partly depends on what you’re taking the medications for.  Uncomplicated panic disorder without agoraphobia has the highest rate of complete remission.  Severe obsessive compulsive disorder, agoraphobia, or social anxiety disorder may require some long term medication to maintain remission.  Generalized anxiety without serious depression may respond fully to CBT.  A lot will depend on how good the CBT is and how hard you are willing to work on it.  For OCD I recommend Brainlock by Jeffrey Schwartz.  For panic disorder proper breathing is essential.  The following link has instructions for proper breathing. 

www.askdrjones.com/wp-content/uploads/2006/06/Anxiety_Handout.pdf

For social anxiety stimulants are frequently helpful.

Serious adverse rashes can occur with Lamictil but it is rare.  Most reactions are mild - they go away when the Lamictal is stopped and many people tolerate Lamictal okay when it is restarted.  If a week or more goes by before skin clears you have to start back at 25mg or even lower.

Severe reactions are rare but can include anything above the neck such as swollen lymph nodes,  lesions in the mucous membranes in the mouth, or under the eyelids.  Then it is not considered safe to try taking it again.

I can’t tell how severe your reaction was but on the face is worrisome and "vasculitis" doesn’t sound good.  You should probably discuss this reaction with a dermatologist before trying Lamictal again.    

I have just posted an article on preschoolers and ADHD:

www.askdrjones.com/2007/09/06/behavioral-treatment-for-adhd-in-preschoolers/

Most research in preschoolers is with methylphenidate even though it is only FDA approved down to the age of 6.  The patch works fine if cut in half.  Be aware that after six weeks of daily use blood levels may go up and the dose may need to be reduced further. 

Depakene even in the best form, Depakote ER, can have adverse effects on hormones - it would be one of my last choices.  Lamictal is the best tolerated mood stabilizer if it doesn’t cause a serious rash (very uncommon).    The main problem with Lamictal is that it has to  be built up slowly so it would need to be overlapped with Depakote or something else.  In general for most patients Lamictal is a much better medication.

If she is on birth control pills - which is not recommended for women with mood disorders - Lamictal doses need to be higher.  The NuvaRing is the best form of birth control in my opinion if needed.  

Meridia (sibutramine) is FDA approved for weight loss.  It combines the effects of antidepressants like Effexor (at doses of 225mg or higher) or Cymbalta with dopamine effects like stimulants.  One possible side effect is increased blood pressure.

Years ago I tried Meridia for several patients and most of them didn’t like it enough to stay on it.  If you are looking for a medication that helps with depression and weight loss then I would recommend Wellbutrin.  www.askdrjones.com/2005/12/29/how-to-take-wellbutrin/  If you are mostly interested in the mood/anxiety effects I would recommend Effexor XL at least 225mg per day possibly in combination with Wellbutrin.  This would closely duplicate the effects of Meridia.  An alternative that might even be better would be Effexor and Vyvanse.