i have been on Lithium for about 1 1/2 years and i can honestly say that it has changed my life tremendously. I am also on effexor xr and they both take care of the manic and deperssion. oh and i tried getting on Topamax, but felt like i was loosing it. got off of that shit real quick.
Topomax can cause psychosis, but the new PR on it deletes reference to psychosis.
Effexor is always a stimulant first. Most anti-depressant rx from it is a natural reaction to the stimulant structure of the molecule. You can only get the XR version cos the other stuff could cause hypomania and lead to suicidal ideation and really wacky shit.
lithium does not make u happy; it just plays with your sodium-potassium levels and other marvelous shit. it does not relieve anxiety or reduce paranoia.
i have a friend who threw away her lithium and said the seroquel made her sleepy even at the lowest dose.
and right now she needs a OTC sedative for her paranoia.

me being the herbalist, i recommend damiana 370 mg 1-3 capsules 1-3 times a day as anti-psychotic with ginseng to relieve depression and valerian (1-3 capsules before bed) for sedative properties. YMMV