You need to get off that Effexor double quick, sweetie. I get from your post that these symptoms are current? If you have to drive 1 hour away, so be it! Your mental health is more important than an inconvenience. (Sorry, not yelling at you, just very passionate about people getting better!) Mania will destroy your life, money, career due to attitude and time missed, relationships, health and anything else you can think of. Whoever put you on Effexor only was not too smart IMO, unless you ONLY complained of depression and nothing else was asked or said. That is usually the case, we don't usually seek help until the depression comes, so I need to know that as well, OK?
Who do you video conference with? Pdoc or GP? You don't have to see the pdoc everytime you have a problem. You do need an office visit, thorough consult so he can note everything, and he should be asking lots of questions. Then, you only need to call him if you're having trouble, they don't make you come in every time, they know there is frequent adjustments needed. You should have been taken off the Effexor completely as soon as that started, the only thing is there are withdrawl symptoms and you have to tapered off carefully. Also, see only one doc (pdoc) for your BP, as it will be very confusing and basically impossible for you to get the correct treatment.
You are an ultra rapid cycler, made much worse with the Effexor. When you find the right cocktail of meds (much trial and error), it will slow way down, possibly stop, but I'm a rapid cycler, and still have minor swings kind of frequently. It's MUCH better than I was, tho LOL!
You're so welcome, think nothing of it, that's why I'm here and also the support is maybe more? It's a great place, I hope you will stay, too. Ask anything you want, anytime, you are going to have a billion questions, I still do!