Ddizzy,

It does take time for medication to reach therapeutic levels, but I would have thought that after 4 weeks you would have seen some improvement in your symptoms.

I know when I experienced psychosis and was hearing voices, an anti-psychotic called abilify was added to my lamotrigine and nortriptaline. This seemed to stop the psychosis and moderated my depression and mania. I have never used lithium so I cannot comment on that.

I have been stable for 3+ years now so don't give up. You will eventually find the cocktail that works for you.