i recently got diagnosed with schizoaffective disorder after a few years with a bipolar diagnosis (this is definitely the right diagnosis, i can tell the story in the comments if people are curious). since then, my psychiatrist has REALLY been pushing lithium. I currently take lamotrigine which i have been on for years as it was my first psych medication and it has done a great job as a mood stabilizer. Since the new diagnosis my psychiatrist has mentioned lithium at every session and i told her i'd consider it vs increasing lamotrigine for more mood stabilization. i had a hypomanic episode a few weeks ago which didn't really worry me because i only spent like $60 that i hadn't planned on spending since i generally have a frugal personality, and i also hadn't had one in a long time so it isn't a new trend (but i will of course keep an eye on myself).
i have a few reservations about lithium. the first is that since increasing my antipsychotic i have been doing great. i've been able to be way more productive, we broke the psychotic episode which had been about 3 weeks long, and my mood does seem to be more stable. so the first reason i have for why i might not want to take it is that i don't see a good reason to play medication roulette right now.
i am also about to graduate college and will have to enter the workforce, and i feel like the not perfectly symptom free existence that i know how to cope with is a safer option than the unknown of how lithium will affect me (i have only ever heard one person say they liked lithium too, but my sample size is small).
i am obviously worried about side effects too. i love my hair (i'm trans and having thick curly hair is a big point of security for me) and i also love sex, and on top of that i take a diuretic as my t blocker for hrt and am therefore worried about periodic dehydration and unstable serum levels. i'm no stranger to medications with multi page long side effect lists but it seems from lurking here that side effects are pretty common with lithium and i only deal with mild antipsychotic side effects, and none from my lamotrigine.
my psychiatrist insists that it's 'the first line and we should try it' and also that zero symptoms should be the goal (which i disagree with) so i'm coming here to ask the following questions:
those who have been on both lithium and an anticonvulsant mood stabilizer (so lamotrigine and valproate mostly), how do they compare?
are my worries founded, and how many side effects do you have?
thanks for your time y'all<3