Well, in my neck of the woods lithium is still prescribed first. I am (one of the few according to you) that it works for. Plus, I take Dilantin for my seizures with no problems. Depakote whacked me out. Both my daughters take lithium with no problem. Lithium has worked well for years, I'm just not sure where you are getting your information. And the side effects are NOT as bad as living with bi-polar disorder, in my case. Of course, I may be an idiot, but I do know about bi-polar disorder since I've lived with it since my teens.
And this is just my humble opinion as always....
Info is from husbands psychiatrist, sister's psychiatrist, good friend's psychiatrist, VA Hospital psychiatrist - among others. Lithium - did NOT work or had awful side effects for 5 people I know personally. They are all now on different med cocktails which contain (or have contained) prozac, abilify, lamictal, depakote, [SIZE=-1]bupropion, effexor, cymbalta,[/SIZE] mirtazapine, desipramine. Risperdol and zyprexa are anti psychotics that are often used instead of lithium. Some of the other drugs that are more sedative and anti anxiety and less anti psychotic that are often part of the cocktail are trazodone, clonazepam and seroquel. The Drs I have talked to still use Lithium for some patients (the ones who tolerate it well) but also turn to lamitictal, tegretol or epilim. The stimulants Adderall, provigil and ritalin are also used in combo with other drugs for some patients - my husband included.
There are a huge range of drugs to chose from and since every person is different and has different chemistry and a different variety of bi-polar, lithium is no longer a one-drug-fits-all-bipolar treatment. Lithium is one of the OLDEST and most universally successful treatments for bi-polar disorder but the side effects, drug interactions and severe sedative/fuzzy brain results it gave people I know made it impossible for them to maintain a job and a normal productive life while taking it - plus, it's success in controlling the mood swings and other symptoms was just not that great for them.
It made my hubby so sick (physically) and fuzzy-headed he said he'd rather have the bi-polar if he had a choice between it and living on lithium. My sister was on it and said it was about as helpful as taking a Nyquil. Dear manic friend took it for years but it eventually stopped working for her and she is now on Abilfy and Seroquel, Vietnam Vet friend with PTSD, severe depression, bi-polar and ADD also could not tolerate lithium AT ALL (The VA ALWAYS starts treatment with lithium) and now takes a combo of lamictal and adderall with seroquel for anxiety attacks.
I live surrounded by people who are medicated bi-polar/PTSD/ADD and NONE of them are currently taking lithium. And each of them has a very different TYPE of bi-polar - when un-medicated they range from from severely depressed with debilitating anxiety and panic attacks to severely manic to the point of psychosis. Every point on the spectrum and NONE are currently on the same meds (although some share some meds). Husbands Dr is an expert on psychiatric drugs and deals with children and addicts as well as more standard patients and he does not use lithium very often in his treatment of patients any more - he said there are so many alternatives that are now even better at controlling the bi-polar without leaving patients totally "flat" and without any normal appropriate feelings of excitement, joy and sadness. He says that many bi-polar people would not keep taking Lithium because it removed their creativity and passion and inspiration. They were not cycling, but also weren't "living" (in their opinion) either. IN HIS OPINION the newer drugs and cocktails allow people to experience the normal range of appropriate moods that "normal" people feel while controlling the inappropriate highs and lows and the constant cycling for no reason.
"YOUR MILEAGE MAY VARY" -- Everyone is different and I am happy for those who get treatment and live a great life no matter what the drugs.
My Opinion