Dear Friend,

You are on too low a dose for it to help with mania. And it doesn't help at all for mania if you take it 12 times over the course of a few months.
At that low dose it helps with sleep -- but only on the nights that you take it.

How long is you appointment with her?
What do you tell her?

Do you tell her that you have not been able to work?
Do you tell her what you do all day?
Did you tell her how many many years you have been in treatment for anxiety and how unsuccessful this treatment has been?

What's wrong with her? Is she listening? Are you both talking and listening to each other?

Get an appointment with her supervising MD/ Psychiatrist.
NPs cannot write scripts unless under the direct supervision of an MD.

Maybe you need to go to emergency services. Perhaps they have a comprehensive team that will work with you.

Mari