I didn't really think you were toxic - yet, but it would be a good idea to see where you are, since you are having trouble. I absolutely hated that; it never completely went away for me at therapeutic dose. Depakote was much cleaner and was very a very effective stabilizer; only problem was significant weight gain and I lost most of the hair in front, around forehead and temples in a span of two months!!! Needless to say, I stopped. The last stabilizer I tried was Trileptal and once I got through the bad dizziness and vomiting (started at too high a dose), for a couple of days, it was stellar! Very effective on mania, absolutely no side effects for me. It does not have the weight gain that the others have, no congitive slowing (I take all mine at night with Seroquel - knocks me on my ass and sleep like a baby!). No blood work, either. It's a newer twist on Tegretol. I'm sure Dana can explain more. If you can't tolerate the lithium, you do have choices. Not all side effects happen to everyone, so experimentation is a good thing to find the right one for you.
You know that lithium will dehydrate you very quickly if you don't constantly drink water, right? Usually it makes people so thirsty, they don't have a choice!! Dehydration can also contribute to the cognitive slowing, if bad enough, of course not to that extent by itself, but please do drink enough water (I still carry a bottle of water everywhere, habit I started many years ago a a result of lithium tx).
Oh, good that you aren't a clinical nurse right now, LOL! I know it sucks doing paperwork, tho!
Keep us informed, OK? I hope you are doing well otherwise. Are you sleeping? Does your doc have you on anything else?
Talk to you later,