Gatsby,

With medications you must weigh the pros and the cons.  The greatest negative is the result or impact of not being stable.  The second thing that needs to some consideration is the damage mood swings do to the brain.  Maybe you have heard about the lesions identified in the brains of individuals with bipolar disorder.  These are not due to medication they are the result of neuronal death, due to the effects of mood swings.

Now about the cursed lithium you have shyed away from.  First, I believe you know that all of the other choices for a mood stabilizer are antiepileptic drugs.  Of all of the mood stabilizers, lithium is is in the middle range for cognitive effects.  Lithium is also a neuroprotectant by increasing brain derived neurotrophic factor (BDNF).  I believe there are two of the the AED's that may also provide some neuroprotection.  Lithum has been studied the most, due to its long term use for mood disorder.  Lithium also has some effect on depression, making it a true mood stabilizer.  Better results have been seen when lithium is used along with an antidepressant in the treatment of depressive episodes.

Some people tolerate lithium well and have few side effects.  When a person begins a medication certain side effects are noticed and diminsh with time.  There are potential side effects that are monitored by blood tests, tested for at the same time lithium levels are tested.  I cannot give you any statistics on these but some people present with a decrease in thyroid hormone, so TSH, and T4 levels are monitored and the creatinine level is tested to monitor kidney function.  Kidney function is monitored because of the possible risk of developing diabetes insipidus.  This disorder results in the increase of water being removed from the body and more often than not reverses itself after lithium is discontinued.  These are not common side effects, tough they are monitored by psychiatrists due to the potential negative effects.

There is nothing wrong with the "gold standard" it has helped many lead more rewarding and productive lives.  I have taken it for more than two decades.  There is an artcle on this site regarding the action of lithium and if you follow the link there are a few more related articles you may read.

Another interesting feature to taking lithium is that researchers have found increases in gray matter, in the areas of the brain that control emotion.  There is much not known about the action of psychotropic medications but lithium is one of the best studied, known, and tested medications.