I wouldn't call you highly medicated (look at my signature). You are on a good dose of lithium but lithium is about blood levels not dose and if you need that much to get the levels then you need that much.

I think it is always a combination of coping skills and meds, although when I am really bad therapy is more just talking until meds kick in. Although this time around honestly therapy has helped more than meds although even my therapist would say it isn't exactly fixing things. It has let me get some horrible depression thoughts out and that's more than the meds can do.

I really can't separate them but I do know you are not "highly medicated" and that lithium plus an AD may not be enough. You may still need another mood stabilizer to help keep you level (lithium doesn't work as well for both ends) and maybe you are on too much AD for the amount of stabilizer you have (for example I was on 300 mg of Seroquel when I went on Emsam which is pretty activating; I needed 600 mg of Seroquel immediately after starting Emsam to keep me from being manic).

It's completely a balancing act and to me both have to work together.