Brief Answer:
Consultation

Detailed Answer:
Hi XXXXXXX and thanks very much for your premium question.

Bipolar depression is indeed a very difficult illness to live with, as you know. As you also know, it can be very hard to treat. Let me give you my thoughts about how I approach bipolar depression with medications, and how this may apply to you. Yes, there is hope for you! Many patients of mine get better, absolutely.

Bipolar depression is typically treated with three classes of drugs: antidepressants, mood stabilizers, and atypical neuroleptics. For you, the antidepressants are Zoloft and Wellbutrin, the mood stabilizers are Lamictal and Neurontin, and the atypical neuroleptic is Latuda. So far, so good. Now, predicting which combination of these medications will be helpful can be very difficult. Most of this is trial and error. It sounds like things are going okay on this regimen. Some things could be tweaked.

First, sometimes in these cases it can be helpful to get genetic analysis to determine how you metabolize certain drugs. This is usually covered by insurance. This will tell you if you metabolize these drugs quickly or slowly -- and this can make a big difference, as the blood levels are different for everyone and may need to be adjusted.

Second, Latuda could be increased. I often have patients as high as 160mg daily. Alternately, there are many medications in this class that could replace it. It sounds like Abilify didn't work out, but other options include Saphris, Seroquel, and Risperdal. Latuda is an excellent medicine, so before switching I would go higher on the dose.

Finally, consider doing couples therapy with your husband. Therapy is often very, very useful in providing a safe space to work on otherwise contentious issues. I provide individual therapy on this website at my private link below, if you are interested.

I hope this information was helpful to you.

My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States. For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: XXXX

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Brief Answer:
Follow-up

Detailed Answer:
I'm glad to hear you're interested in a more comprehensive evaluation. I accept private patients all the time on this website. My private link is this:

XXXX

By using this link, you can ask me questions directly, and I will consider you my private patient. The cost is $35 per topic.

I deeply respect people like you who take an active role in learning about psychiatry and about their illnesses. I will take your input very seriously. I believe we should work together towards a common goal of helping you feel better. It would be my honor to work with you.

To answer your question about your son, I recommend he switch antidepressants. Zoloft is a good choice, but he is on a high dose and it is still not working. If he were my patient, I would try a new antidepressant, possibly Lexapro. Often, trying a new antidepressant will make people feel vastly better.

Reach out to me at my private link, and make sure to fill out a complete medical history. I look forward to being your private doctor, working together with you for your health.

Dr. Sheppe

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