is my effexor causing my mixed episodes and hypomanic episodes?

hello all,
I'll try not to make this too long... I started on Effexor 300 mg 6 years ago and that pulled me out of my psychotic depression err(mixed episode as I call it now) really fast. Only I was manic for about good 6 months after that(at the time i had no idea, all I know is i felt great and did whatever I wanted whenever I wanted{although I did get into some trouble, I managed to find my way back}!!!) over the next 4 years I was functional with hypomanic episodes(again at the time I just thought I was feeling really good!) flash forward to 2 years ago I fell into deep depression then swung up to manic episode with hypersexuality, racing, intrusive negative thoughts...the whole 9 yards basically-all within a week. Went to a new pdoc immediately(my general dr kept refilling my prescriptions of effexor over the years prior) and she diagnosed me with bipolar affective disorder, put me on 1 mg risperdal, then ramped up to a whopping 1.5 mg(being sarcastic). I was pretty stable up until 3 weeks ago when I hit a low again and within the same week swung up into mania and did things i wish i didn't do(i know I know...the usual!) and now I am dealing with the fallout, I'm depressed, anxious, having actual panic attacks, racing thoughts, i was suicidal the other day but now I am doing better today. I am just wondering if I should be asking for something to replace my effexor with? The effexor has always worked for my depression and anxiety up until the past couple of years, yet I am wondering if that is what is making me cycle so often. I have no idea what meds I should doing or discussing with my pdoc at my appt on wed. I obviously am going to discuss my symptoms, but at this point, I am afraid she is just going to want to ramp up my risperdal to 2.5 or 3. I have been on 2mg up from 1.5 of risperdal for the past 2 and a half weeks. I see a pdoc from the county and she is kind of difficult to work with as she limits dialogue and tries to get me out of the office right away without changing too many things about my meds because it is more work for her. I know it is sad and pathetic but she is my only option because I dont have any insurance. I hope my questions make sense....I am just really nervous and want to do what is best for me. From what I have heard and read, ssris aren't the best for those with bipolar disorder and I want to get my cycling under control. I feel that being on one is potentially making my situation worse. any advice would be greatly appreciated...what meds should I look into considering to discuss with her? what do you guys think?

The Effexor could certainly be contributing to the mania and cycling. I had the same problem before my diagnosis with Paxil, and even after I came off of it, I continued to cycle through all nine months of a pregnancy (can you say "manic hypersexuality"? In the same week I realized I was bipolar...and pregnant. ) Not sure how high a dose you're on with the Effexor, but that might be able to be lowered, or your pdoc could add a med like Lamictal. Lamictal has been shown to help with rapid cycling and also has antidepressant qualities. You may even be able to come off the Effexor and take Lamictal instead, along with the Risperdal. Lamictal is available in a generic (lamotrigine), so the cost shouldn't be too much. Another antidepressant option that has a lower incidence of triggering mania and cycling is Wellbutrin, also available in a generic, so that might be another option.

Definitely talk to your doctor about it. You may need to put your foot down and not let her rush you out the door.

Most ADs I've taken contributed to hypo/mania and rapid cycling at some point or other - Effexor, Zoloft, and Prozac (which was the worst, bar none). Wellbutrin has been pretty good for me, for a very long time, but I'm adding Lamictal now in hopes that it will even things out a little.

Lamotrigine is cheap, my copay is $3 for 60 25mg tabs (20% of retail cost). Bupropion XL is not quite as cheap but not breaking the bank; my copay is closer to $25 for 90 150mg tabs (again, 20% of retail because it's a generic.)

Definitely pdocs have realized that anti-depressants can cause manic behavior in people. In fact, the diagnosis of bipolar disorder increased significantly once anti-depressants became popular.....

I am on a low dose of Wellbutrin one time a day and a low dose of Trazadone at night (to help me sleep). Otherwise---a mood stabilizer and an anti-anxiety drug. I used to be on several antidepressants taken more frequently, but was taken off of them once the connection with mania was made.

Cymbalta made me MANIC for the first time ever in my life. I was flying high for weeks. When I went from 30mg to 60mg I felt horrible. My heart was pounding out of my chest and I couldn't sleep at all for days. Cymbalta is an SNRI and in the same class as Effexor. I had tried Effexor when I was younger but I could not take it due to extreme puking! I am currently on lexapro and lamictal and my horrible depressions and crying spells have subsided.