I've been on effexor for 7 Yeats and still going so I'm no help there... But you mention being on topamax and having mania.....I am in the process of getting off of topamax (I started the beginning of June). It has given me the worst side effects ever. It made me manic...repeat my sentences over and over without realizing..couldn't get my words to come out right, I feel stupid half the time. This last time the doctor increased my dose from 150mg to 200mg daily..that lasted 4 days and I called the doctor and said I was done with it. I this med made me very outspoken and blunt. And makes me cuss A LOT ( I rarely cussed before). Just thought I'd mention the topamax part. Good luck! :-)