The therapeutic and toxic levels for lithium are very close together so it's hard to find the right dosage and get relief w/o getting severe side effects. I hit the therapeutic level once over last 10 yrs and my muscles stopped working and couldn't walk. Otherwise it does nothing for me.

There are studies that show that 20% of BP patients experience mania when taking an AD. (Search the web for legit studies.)

Most ADs cause severe agitation for me or hypomania. Especially SSRIs. But effexor is doing a decent job for me now.

And bottom line is psychiatrists don't know a great deal about mood disorders or how psychotropics work in the brain. All they have on meds is empirical evidence at most.