I agree with u/sciurus - the most effective anti-depressant I have used is dextroamphetamine, it worked almost immediately relieving depression and promoting motivation. Next to that the was phenelzine (MAOA and MAOB), selegiline doesn't even compare to phenelzine, though I've not tried the selegiline dermal patch. Unfortunately both these medication induced hypomania and I was taken off them, however in those days I wasn't taking Lithium or Quetiapine which I believe would help attenuate the problem.

Wellbutrin/Bupropion worked well for me too, though I began to get headaches and have visual problems and stopped it. Where I live I can't get any stimulant medication due being Bipolar and these medication are off-label, but I would try Modafinil if it was available but so far that's not an option.

Everything else I tried over the decades - SSRI's SNRI's even amitriptyline (TCA) had no benefit and was a waste of time.

What works for me now and keeps me very stable is a ketogenic diet with ~80% fat daily, mainly monounsaturated fat (EVOO), its not a choice I made easily but with the problems I've experienced with the medical system I decided to explore as many alternative options as possible. Lithium Carbonate worked too, but there was no compromise on the 1.2g daily and I eventually suffered toxicity and was taken off it. I take Quetiapine now, which has caused Insulin Resistance and I find I can minimise my daily dose while I'm on keto. I also take a little Lithium Orotate which seems to work quite well in combination. I'm not particularly energetic or motivated and coffee helps a little here but not like a proper stimulant would, so I think a time release amphetamine would do the trick to maximise functioning.

Regarding upregulation, cycling is probably your best bet 5 days on 2 days off, that's how I'd do it. Also, I've had some good results lately on 1 - 2g of EPA, which seems to work synergistically with bulletproof coffee, though I suspect that's purely subjective.