I have a bipolar patient with high risk of destabalization. Has trialed various doses of Trazodone and Seroquel and still cant sleep but is also acutely manic. Overweight and does not want a medication that causes weight gain. Olanzapine made her too groggy. I could have switched that to lybalvi to avoid the metaboloc risk but becomes to groggy. Hydroxyzine does nothing. We do not do controlled substances. Patient is on lamictal 200 and trazodone 150mg and latuda 20 which has significantly helped with depression and anxiety (would have but panic attacks not approved for mania. Should i go ahead and add abilify to acutely stabalize her? Recommendations? Insurance does not cover vraylar