Special K have you had blood work recently to ensure that the lithium levels are in the therapeutic range? Meds are 60% of the equation for me, but there are other things I need to do to manage the bp effectively like eating well, exercising, keeping a schedule, sleep regularly, therapy etc.

I was on lithium, but I have BP II and have never experienced mania, so I found it kept me too down (I was on 2 anti-d's when I was on lithium and I still fluctuated between mild and major depression). I am now on lamictal and wellbutrn and that works well for me, but again I suffer more from depression.

There are definitely many options of med combos. Lithium is very inexpensive and tends to work better for controlling the highs, but everyone responds differently to meds. You may want to meet with a psychopharmacologist (this is a psychiatrist that specializes in psychopharmacolgy). You will likely need a referral. I haven't met with one privately, but when I was hospitalized we had a group lead by one that would discuss our concerns with side effects, best med combos etc. It may be worth a try.