Zander's Inside Voice

I have two appointments tomorrow. One is with my psychiatric nurse practitioner who prescribes my meds. And within these last three months, my meds aren’t working as well as they used to. My attention span hasn’t been what it was on adderall previously. I haven’t had an increase in forever and the next increase puts me at the highest possible dose. I don’t know if I want to do that or just try something else. I’ve looked at other meds that work for ADHD and really like Vyvanse. Other than not knowing how to say it, it sounds like what I need. It’s a different type of stimulant that also helps with binge eating, which is another problem I deal with. I was excited about asking if I could try it until I discovered that my insurance requires it to be pre-approved. I looked at the form and it says you have to try all these other things first. At this point I have tried two of the three categories required. Maybe I will have to try the third first or maybe she can just let me try Vyvanse. The problem is that there is no generic, which is why insurance doesn’t want to cover it unless they absolutely have to. That blows my mind. If there’s something that a medical professional wants to give a patient that would work best for the patient, why would insurance interfere with that? Why does insurance interfere with everything anyway? Why does ANYTHING a doctor wants to do need to be pre-approved?

Also my nightmares are back. Well, not back, but I am having nightmares that are different. A couple nights I had this possessed water chasing me around and trying to pull me under and kill me. Thinking back to it and writing makes me feel ridiculous. I was being threatened by killer water?! But none of the nightmares ever make sense.My medication is supposed to stop the nightmares and it’s not anymore. It makes me not want to sleep and then I am tired the next day. I liked the clonidine at first but now that it’s not working, it’s like what’s the point in even taking anything. So I don’t know what she will tackle first. Increase clonidine, try Vyvanse or something else, or increase adderall? I guess all I need to do is be honest and see what she suggests we do. I will bring up Vyvanse as an option but that will force me to tell her about binge eating. I used to go to counseling where she is and she used to read my notes and blurt things out at me that I wasn’t prepared to be reminded of. I had opened up a lot to my therapist and shared things with her that I didn’t want anyone else to know. Like I get that she can see things I have talked about and that’s fine, but STOP asking me about those things unexpectedly. I mentioned it to my therapist once after it happened and either wrote something in my notes or changed how she wrote up what we talked about because it never happened again. I felt better once my therapist moved to another place and now I can keep this nurse practitioner out of those notes and control what she knows. That feels so much better to me. But she has never mentioned binge eating and I have never told her anything about it. Hopefully we can get somewhere tomorrow. Part of the reason I never mentioned it to her was because I didn’t realize there was medication that could help with it. I also thought it was an impulse problem or me just being a bad human.

The other appointment I have is therapy. I need to bring my list and dig a little deeper. I know that I have a tendency to not want to go deep if I don’t have to. But I don’t want to spend time and effort to just chat with a therapist. I need to be working on things like healing from trauma, talking about what I am scared of and what is holding me back from being who I want to be. As much as I want to get better and do all that, it scares me to be open again. My other therapist was a recent graduate and she would just get all this really intense stuff out in an hour and then I would be down for days, so sad and heartbroken. And that frightens me the most about being open again. I did tell her what used to happen all the time with the other therapist, so I know she will be careful about it. But at the same time, what if she doesn’t mean to and I am the one who is opening up too much.

Or do I just blame myself for everything, even when there is no way I could be responsible for something? Maybe I need to just repeat it is not my fault a million times per day until I finally stop defaulting to the idea that something, everything is my fault.