Have you ever felt like you're doing everything for everyone — but losing yourself in the process? Author Julie Chavez joins us to discuss her memoir Everyone But Myself, a candid exploration of anxiety, burnout, and the emotional toll of spreading yourself thin. Along with Dr. Bisi Alli, we unpack the realities many women face when constantly caring for others, the importance of seeking help, and how therapy, medication and self-compassion can lead to healing. This heartfelt conversation is a reminder that prioritizing your own well-being isn’t selfish — it’s essential.
Have you ever felt like you're doing everything for everyone — but losing yourself in the process? Author Julie Chavez joins us to discuss her memoir Everyone But Myself, a candid exploration of anxiety, burnout, and the emotional toll of spreading yourself thin. Along with Dr. Bisi Alli, we unpack the realities many women face when constantly caring for others, the importance of seeking help, and how therapy, medication and self-compassion can lead to healing. This heartfelt conversation is a reminder that prioritizing your own well-being isn’t selfish — it’s essential.
This episode was made possible by generous support from Ken Stevens.
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Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books. Our topic today is anxiety and depression, especially in a woman who does too much. Our book is “Everyone But Myself: A Memoir” by Julie Chavez. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.
My guests today are Julie Chavez, who is the author of the “USA Today” bestselling memoir “Everyone But Myself.” And her writing has been featured in “Real Simple” magazine and the “New York Post.” Julie is a former elementary school librarian, living in Northern California with her husband and sons. She organizes her books by color. Julie, welcome to the show.
Julie Chavez
Thanks so much for having me. I'm thrilled to be here.
Dr. Denise Millstine
And we're so excited that you're here to talk about your book. Our expert guest today is Dr. Bisi Alli, who is the principal at Wellness Medicine, a practice focused on whole person care. She is a dual board-certified physician in internal medicine and lifestyle medicine. In addition to her clinical work, Dr. Alli serves as an associate clinical professor of medicine at Creighton University and an assistant professor of medicine at the University of Arizona College of Medicine Phoenix. Dr. Alli is also the author of “Tayo and the Super Produce Pals at the Grocery Store!” a dynamic children's book that encourages kids and adults to embrace plant powered choices. Bisi, welcome to the show.
Dr. Bisi Alli
So good to see you, Denise, and lovely to meet you, Julie.
Julie Chavez
You as well. I'm happy to be here with you.
Dr. Denise Millstine
“Everyone But Myself” is Julie's memoir of her anxiety that followed and was intertwined with a period of her life where she cared nonstop for others, her job, her kids, volunteering. Signing up for all of it until it finally took a toll on her mental health and she had to face and address what was happening. Okay, let's talk about women who are overextended and have associated mood disorders.
Julie, this is a memoir, so we know your inspiration for the story, but what prompted you to turn it into a book?
Julie Chavez
The main impetus for the book was after coming out of that time, which was about a year, and I chronicle this in the book, but I met with my principal, and she had been a really instrumental voice in helping me hold on to things, but also let go of some of the right things that needed to go. And I sat down in her office and I had been writing just a blog, you know, that basically was read by my mom and sister for years and maybe a few friends.
So I had been writing that for years, and she knew I was a writer, and I told her in this meeting, so it was sort of a full circle moment. I'm back a year later. I'm not sobbing. I'm not threatening to quit. So I said to her, I think that what happened to me is something that happens to a lot of women, and I'm so grateful for the advice that you gave me in that time.
And she said, well, that's what you should write your book about. Because she had always said, you should write a book, and I didn't know the topic. So I think the main thing was I really believed this was a story that didn't just belong to me. And I think that there's also a piece for women who are overextended.
There's so much expected of us, and we tend to grade on a curve when it comes to our suffering, especially what we're feeling. And so there is always an element of…this isn't that bad? Or I could have it worse, which is all valid and true, but it doesn't diminish our experience and the necessity to pay attention to what's actually happening for us. So it was mostly in the end, I thought, okay, if this can make one person feel less alone, then it will have been worth the exercise.
Dr. Denise Millstine
That is so powerful and I wholeheartedly agree. As someone a little older than you, but as a mom of children, that it's so easy for women to overextend themselves and to, like you say in the book, to sign up for things you didn't even know you needed to sign up for, or you didn't need to sign up for being the person who keeps score at the baseball game, for example. And so I think this will resonate, whether it's not baseball scorekeeping, but with a lot of women and moms. So thank you for being brave and putting this story out.
Bisi, tell us your reaction to the book and also what it's like to be a physician who's an author.
Dr. Bisi Alli
So congratulations, Julie. I think you really did capture that concept. You just said it so perfectly. The story belongs to others as well. And I do see that as the crux of how women are both socialized and also is a superpower if we look at it as a strength as well. And so I'm really grateful that you really creatively weaved such a very vulnerable story and also your growth through that.
I'm grateful that you're also a mom of boys. I'm a mom of boys. I think we're all mom boys. And so it's neat, too, because they're also learning from how you stepped into prioritizing yourself uniquely. And they learn from that, too. So that's wonderful.
And thanks for the question and also for acknowledgment of the book. Yes. I've been in practice for about 15 years. I've actually always wanted to write a book. And so a children's book at that. As a child, it's always been a passion of mine that we figure out how to uplift the most vulnerable of populations. Basically, in watching my son grow, I was inspired by how we have been able to approach plant powered eating, which is just a fun way to say fruits, vegetables, beans, legumes and all the good stuff, nuts, seeds…Is because it really informs health over the lifespan. And so it's a children's story book. I'm really excited that hopefully will capture many adults in that too. And, thank you for acknowledging it.
Dr. Denise Millstine
Absolutely. Well, congratulations on the book. It's wonderful and we know that often we make food choices because of what we feed our children. We have a whole episode on plant-based eating, Episode #26 with Jane and Anne Esselstyn, so listeners should go check that out.
Okay, Julie, beginning of the book, you have this very raw, very authentic depiction of your panic attack. Can you tell our listeners what happened, what that was like, and share that?
Julie Chavez
Absolutely. So I had never really understood anxiety as something that was more than worrying, right? I think I always had an idea of what maybe that looked like. And so to experience that was really powerful for me. So I had had immunotherapy along with my kids, we’re all allergy people who were living death by cats. So we went for treatment, and I had a systemic reaction to one of my injections, which is a thing that happens.
So it's not necessarily that, but I was so convinced when that happened that I was going to die. I was just terrified of leaving my boys. They were so young at the time, and it really shook me, but I didn't take any time to address it.
So, you know, you fast forward eight months and then suddenly I'm sitting at the baseball game and I just had a thought that maybe I have permanently damaged my system with this decision. And as someone who tends to be a perfectionist, I really have to watch out for that line of thinking that adverse experiences are a result of poor choices. And so that was exactly where I was, where I thought, I have made a bad decision, and it is going to result in the end of my life.
My husband was traveling at the time. I was exhausted, both boys were playing sports, and modern sports are enough to make me want to just absolutely run and live in a cave. So I think it was just all of these things that came together. But I'm sitting at the baseball game thinking, oh my gosh, like I started to have itchy eyes. But then it was the thought that overlaid that experience that really ratcheted everything up, where I just thought, okay, I'm not going to be able to get out of this.
The thoughts were really what drove the attack. And so just consistently experiencing that spiral upward. So I came home, took a shower, took every allergy medicine I could to try and stop the reaction. And I just thought, okay, I just basically need to live through the night. And I think the thing that stands out to me even now is when you're in a healthy place, the window of tolerance is so much wider.
It just feels like there's more of an ability to adapt and to deal with things. And what had happened was I was so narrow at that point, I just couldn't cope. All it took was one thing being sort of out of place, and then it was like it opened the floodgates. So I was lying in my bed, couldn't stop crying, was monitoring my breathing. It was just, you know, I look back on myself with such compassion for that night. So that was really probably my largest attack. And then I had had some preceding ones that were sort of little bumps in the road. And then after that, it became something that I had to identify and work with.
And I think the term panic attack, too. It took me so long to understand that that's what had happened, because I think no matter what, we have a paradigm for those sorts of experiences, especially if they haven't belonged to us previously, where we're identifying it. And if you're categorizer, then you can kind of get stuck. It's good for me now to look at it and see that that was where I was. But yeah, I was just drowning in panic.
Dr. Denise Millstine
I really love what you just said about your window being wider when you're in a healthier place. That made me think of telling my mother when my kids were little that I live on the margin. It's like I can't take one more thing because I can feel myself, like really pushing myself to my edge. And I think that's such a beautiful way that you said if you're in a healthy place, then this fear of a reaction, an allergy, is maybe something that doesn't escalate, that doesn't explode. But because you were so stretched, then you didn't have that resilience in and you didn't have your footing to be able to, even if intellectually you knew I'm blowing this up. You just couldn't stop it. It just exploded on you.
Bisi, as a general internist, you treat a lot, a lot of people who have generalized anxiety disorder and have had panic attacks. I think what Julie's describing is something that was provoked by this traumatic experience, now that had happened before, but it was reminiscent of that. Are you seeing panic attacks that are provoked in this way and also unprovoked, just come out of the blue. How do you see that in your practice?
Dr. Bisi Alli
Very much very similarly to the way Julie described. The other thing I want to point out is that and you just brought this up, Julie, how you were intentional in not assuming that this was what it was. It's very hard to characterize. And so I liked in the book that you also highlight that you went to get help. Because unfortunately, women do have a higher risk for cardiovascular disease and often very non textbook presentations compared to men. And so the very important thing you did was you got help to characterize what you were dealing with. And it's the same.
So once we've exclude all those scary factors right then addressing the provocative factors. And I also noticed in the book that you mentioned that you have a history of migraines, which about 80% are triggered by stress. So we see these profiles very commonly where a lot of the underlying factors are around stress, which can induce anxiety, which can also induce depression. So the fact that you were so aware at least to be able to go get help is huge.
Julie Chavez
Well, and I feel very fortunate in that because that's you're exactly right. There are so many people who labor under that and then don't have the means or the experience to know that they need support in that. So that's a good point.
Dr. Denise Millstine
Julie, you did get help and I want to talk about that. But actually the very next day you went to work. And you were, nobody can see this because this is an audio podcast, but “fine.” You showed up, you did what you needed to do, you felt yourself reading to the kids as a school librarian and literally dictating to yourself what the next step had to be like. Read those words, turn the next page. Read those words to just get through your day. But you very much, at least as it's depicted in the book, had this “I'm fine face.” Nothing is wrong here. What was that like?
Julie Chavez
You know, it's so interesting you say that because after the book came out, I had a lot of coworkers who came up to me at the time and said, I had no idea that was happening. And I remember saying, yeah, that's kind of the point, unfortunately for this.
But it was kind of a mild like my subconscious was almost doing everything for me. It felt so split. You know, if integration is what we really want in our lives, both externally with our families and the people we love, all of that kind of integration. But for ourselves to be integrated, all these disparate parts of me, that they work together. It was like I had pulled one off and that one was going to do this business over here, and this one was just going to be busy panicking. I mean, and it really was like, let me turn this page, but I'm feeling just. And it was so physical.
I think that was the thing that surprised me most about the panic attack and the resulting experiences was how much I felt like I had been plugged into a socket. So for me it was very amping. But yeah, I hid a lot and it wasn't intentional. I think it really was survival in my mind. Like, well, we just don't have time for this. I mean, people have to get to practices and things are happening.
During my recovery. It was interesting because the momentum can be very helpful because there is something to be said for doing it before you feel like doing it right. I get up, I make my bed, I drink enough water. To Bisi’s point, I eat foods that are fuel and not live on Snickers, so no shade to Snickers.
Dr. Denise Millstine
It really satisfies. But yeah, it's not so good for your health. It's not in Bisi's book.
Julie Chavez
It's not in the plant powered family. So we're going to go with other things. But I think basically just the physical side of it and you know, all of these pieces that kind of come together and feeling like I was so depleted, but that I still had to keep showing up. But that momentum did help to some extent because I was doing these things to move me forward.
But also that momentum can be a trick, especially for women like you were saying earlier, Bisi. We're socialized to show up to people, place to show up for others. And so then it just delayed my ability to look at what I was feeling and experiencing and say, this is not okay. I think that's why I had to get to that full crisis point in order to ask for help.
Dr. Denise Millstine
I think one of the really interesting points that you bring up, Julie, and Bisi, I'm hoping your comment on it, was summarized in this quote. “The trick about mental health is that when you discover or admit you need support, all the tools you would use to find that support have vanished. You're hopelessly tired, fatigued by even the slightest roadblock.”
And you talk about, you know the energy it takes to pick up the phone and try to get an appointment, and to deal with the roadblocks that might come up in the health system. Bisi, can you talk about that for people who are considering seeking help for mood disorder.
Dr. Bisi Alli
I think that is a very good characterization. And also one of the unfortunate side effects of untreated anxiety and depression. And so the piece where you have people who love you and are around you, who observe changes, and maybe what you're prioritizing or who can speak up and say, this seems a little bit different than I've seen you handle in the past, especially as you describe that window of having a platform to stand on when you feel well versus when you're tired, you haven't eaten, and so forth, or really when the mood disorders are uncontrolled.
And so this concept around burnout really is typified by emotional exhaustion, that sense of detachment, which you're describing and then reduce personal accomplishment. That's the definition. And that's what we saw in the book. So really the key though is finding an ally. You described your relationship with your husband so beautifully. Your relationship with your sister was really funny and it was really lovely too.
And so having those allies that we can support and can support us, but really letting them know that, hey, things are a little bit hard this week. I need your help to give me some feedback and guidance. This is what's been working. If you have that capacity to say this is, I would like your input too. If it doesn't seem like I'm at a place where I'm handling it by myself. So I really like that understanding those peer supports and having them in place in advance, that's really key.
Just a quick plug to the opposite of the “S” candy bar that you guys just said. If you put a date with your favorite nut or seed butter on there, I'm telling you it tastes the same. So yes, so you had to try it, texture, taste is good and high in fiber, high in protein and good for that mood boost. So just something to consider.
Dr. Denise Millstine
That recipe will be in the show notes.
Julie Chavez
Well, I know what I'm doing later. Thanks for planning it for me. This is great.
Dr. Denise Millstine
Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
So Julie, Bisi is talking about the support system that you very intentionally turned to and had in your personal life, but you also decided that it was time to seek professional help for what you were navigating, and your first thought was to go and see your gynecologist. This is reasonable. You thought she's a woman. She'll understand me. You worked with her through your pregnancies, and you really liked her.
So, of course, Dr. Alli and I were cringing when we read this as primary care physicians, we were like, why, why didn't you call it primary care? We'll get to that. Can you share with the audience, like, why did you make that choice? Maybe so that somebody could consider, is that the right direction for me to go? And how did it turn out?
Julie Chavez
Yeah, I think that what is interesting about it. So this was actually a newer gynecologist that I went to see. So the gynecologist that I had in Seattle, which is where my boys were born, she was amazing. She had gone back to medical school when her girls were in high school, and she just had that wonderful balance of life experience and technical expertise, and she was amazing.
And this isn't as much in the book. I do touch on it, but when Nolan, my older son, was born, I was underwater for a while and I really struggled. And I remember going in and just sobbing at a six-week appointment because I struggled with the upheaval that a baby causes.
I know that's shocking for everyone here, but apparently they really jam things up, is what I've been told.
So it was wonderful. But I went in and I remember Mando was with me, and Dr. Wells looked at Mando and said, let's talk about how we're going to get her some help. And it was this amazing relief of just like, okay, the adults are going to take care of it. This is going to be great, but truly feeling cared for. And so that was the experience that stuck with me. And so that is why I thought, oh, I think when we find care, we want to repeat it. We want to rinse and repeat. So that was exactly what I was thinking.
And I do think maybe too, there's a little bit of confusion right now, especially as we're talking more about perimenopause in our culture. I think people are not sure who to go to right to. I go to a primary care or do I go to a gynecologist and they kind of get passed around.
So this gynecologist that I went to here in California was lovely. She actually gave me a really good piece of advice that I still hold on to now. So it wasn't all for naught. But when I went in with this anxiety, I think her response was, maybe. I don't know if more clinical would be the word. I'm not even sure what the response was. It felt like she was responding out of her experience and it wasn't aligned to mine. So it did not go well.
She told me to quit my job. Whether that could have been a route is another question. It's almost beside the point, but it was just the fact that she was willing to give specific advice like that that really could have derailed quite a bit for me, as opposed to, I think, what I was expecting was kind of the care that I described that I had received so much earlier, where it's someone that says, I see you, I hear you, this is valid.
I think that's a huge thing, is just that idea for someone to say what you're feeling is normal and expected under these circumstances. And here's the next step we're going to take. As opposed to, oh, you just need to quit your job. Because she was right that I was doing too much, but she was wrong in which lever I needed to pull because there were deeper issues to that, too. I could have quit my job and the anxiety could have continued.
So I think that was where she and I were a mismatch. And thankfully, I still had enough of a tether to my gut that I could say, okay, that doesn't sound quite right. I'm going to try again. So it wasn't you know, it's funny looking back, but it was also another out-of-body experience on top of my other out-of-body experiences I was having where she actually wrote me a permission slip. I wish I had kept it. I don't know what I did with it, probably threw it away. But she said, here's your permission slip to quit your job. And I just thought, what do I do with this?
Dr. Bisi Alli
Are you sure it wasn’t a check?
Julie Chavez
That would have been great. You know, if it was, I really hope I didn't throw that away. There's some good and bad in there, just with anything. I mean, we're all people and just trying to find our way home. But Bisi, I'd be interested to hear, let's say I came into your office. I mean, how do you handle that? Or what do you see that you would do differently? Probably a few things.
Dr. Bisi Alli
Identify on both sides. And I'll tell you what I learned over time to grow into a physician who meets people where they are. And I'll explain the caveats, of course. But most people, when they're coming to you for advice, are capable of deciding their next step. What they're looking forward to your examples, are validation and empathy. And so when we lead with that first we get better results. And when someone wants more, they usually will let you know. Well I want to know what you want. What would you say. What would you do. What do most patients do.
And that's actually really important because as we teach our medical students and our residents, we also echo these important points, which is that the ways of paternalistic medicine, where this person says they have this diagnosis, we're doing it this way, is really way of the past. We present people with options they choose. They learn more about the risks, the benefits, alternatives. They're guided with enough information so that they can make informed and educated decisions. Without that unfortunately, you get frustration. You get people who don't feel like they are supported in their clinical setting and unfortunately, you get poorer outcomes.
So I agree with you that finding the best match is key, and also giving some grace, because the best of us may or may not be aware that that's how the information came across. And so it's okay to say, you know what I see is that you responded with a suggestion. What I am concerned about is I'm not a place where I'm even thinking about quitting my job. What I would like, what I'm looking for is actually just guidance about, is this normal or what other patients do, or what kind of next step should we be considering, so I can make a best decision for me?
And that's the caveat that I'd like to make, because we go to so much school. We're supposed to provide what's evidence based and expert. Our intention, the best of us, is not to harm the patient or give bad advice. The feedback, though, like you just gave through this example, hopefully will help others know how to respond to their patients, first with empathy and then the evidence-based information so that they can make informed decisions.
Dr. Denise Millstine
I want to emphasize a couple things you said in that, Bisi, which is that this paternalistic, this is the phrase we give to paternalistic approach to medicine is really old school. So this is you go to a medical professional’s office and they tell you what to do next, which in this example is quit your job. It's not necessarily bad advice in its details. It's wrong, but it's not bad advice to say, hey Julie, it's too much. You need to pull back on something. And I think what you're encouraging listeners to consider, Bisi, is that if you are in a dynamic where you're showing up in an office and being told, here's what you do next.
Unless you've asked to be told, what do I do next? There should be some interaction. There should be a shared decision making going on in that conversation so that you don't have to be like Julie leaving the office with this prescription to quit her job in her hand. And, at least in my mind, Julie kind of losing it in the car because now you're wondering, is this really the answer? Do I really need to quit this job that I love, that feeds my soul, that I've invested in? In addition to all of the questions of, is this the best financial move for my family and all of that. So I think that's really powerful to think about how important it is to be part of the decision of what's next.
Julie, you were surprised that you then made an appointment with your primary care practice. You went to see a PA with whom you'd had some good interactions in the past. And he said, I know you think this is anxiety, but I think it's actually depression. And that surprised you, but resonated. Will you tell our listeners about that?
Julie Chavez
So I had been depressed in high school. I had gone through a season of depression in high school, had seen a therapist during that time, and I remember feeling very flattened. And so it didn't feel the same to me. So when I went to see my PA, who, like you said, I had had positive experiences with, but they were more with the boys with their needs and that's why we had switched.
And so when I went in, I explained what's happening and he said, I think you're depressed. You're in a loop where you're feeling anxious and you're used to knowing what to do to get yourself out of a slump. And he was exactly right. I mean has a fair amount of insight into how my inner workings go. And so for me to be out of my depth with myself really did make me feel just so alone and disconnected. And so I think he was identifying that to not only the anxiety I was experiencing, but just this sort of bone deep exhaustion that really was related to burnout and all of these other things.
It's funny now, it's so easy to see the trajectory, but then it really was like, oh my gosh, when he said that, I think you're depressed. It really was just, oh, okay, this makes sense to me because everything feels hard and insurmountable, but I'm still getting it done because I'm in a different season of life where people need me.
I think language is just one of our best tools. And Bisi, like you were saying, listening and starting with empathy and I think anytime we can have words to an experience, not necessarily a label, but just to be able to say, this is what I'm experiencing, that it is actually happening because I think there is also a piece of mental health conditions where you do a little self-gaslighting.
So I'm thinking, am I really experiencing this this way? Is this happening? So to have something sometimes for someone to say, I've never been happier to be told you're depressed.
So that was a freeing moment for me where it really was okay. And I think once you have that language, that's the first step too. Now I can move forward with that and it's not going to be a smooth path, but I think that was another reason I had originally gone to the gynecologist, because I was harboring a hope that it was some weird hormone or thyroid thing, and they'd be like, here's your tiny pill. And I would go back to feeling like myself. So yeah, that was a powerful experience for me.
Dr. Denise Millstine
And that kind of harkens back to something you said earlier in the episode, which was that we grade suffering on a curve. Right? Because you, for all outside appearances, had this perfect life. You had a job you loved, two healthy kids, a marriage that was strong and loving, a roof over your head, all of it. And I think often women who are stretched thin feel like they don't have permission to be struggling, because there are very often people whose lives are harder in different ways. And so that's very authentic and real.
Bisi, I am hoping you'll comment on what Julie just said. Was that so she didn't recognize this was depression, and part of that was that it looked very different from the depression she had had earlier in her life. And we see yet another depiction of depression in her husband Mando, whose sister passes away, which of course, he is grieving. What she says is depression is an ill-fitting garment that looks different on anyone. On me, it looked anxious and flighty. Mando’s sadness manifested itself physically. Can you talk about how depression can look like what we would typically call physical illness.
Dr. Bisi Alli
So first, just a quick overview, in that was such a beautiful description, very well characterized. So depression. There's a mnemonic that we use in medical school, but it works for the general public as well. And it's SIGECAPS, stands for sleep disturbance, loss of interest, guilt or feelings of worthlessness, loss of energy, concentration problems, appetite changes, psychomotor agitation or retardation, which is at the extreme of it, where we just can't get out of bed or we can't do anything, and then suicidal thoughts and death.
And then the piece about how it looks different for everyone, is very critical, especially in diagnosing from the clinical side, and then also for patients to feel validated and have a name to something so they can feel like they can move forward to a next step of what will help.
And so the piece, when it gets to the extreme where people are literally unable to move or function, and usually it's two weeks or more of these symptoms, we are definitely at a point where we need to seek often inpatient support at that. A lot of patients are requiring, in addition to all the lifestyle measures like optimizing sleep, diet, exercise, prioritizing things that bring joy and comfort.
They also may need medication at that point. They may also benefit from more invasive therapies like, extreme side, electric shock therapy. But the key, though is it has to be in partnership in having someone that can also support the patient. And that could be a friend, that could be a coworker or a colleague, family member. But the key is that.
Dr. Denise Millstine
Yeah, no, I think it's great. And I really appreciate that you gave all of those characteristics because it's so true that mood disorder can look different in different people at different times. And I really hope part of the work that we're doing at this podcast is to help people recognize, you know, in Mando's case, it was sinusitis and pink eye. People don't typically think of that as a manifestation of a mood disorder. But indeed, his was worse or not getting better because of what he was navigating with his sister’s passing.
Julie, there were two more elements of your treatment that I want to talk about. I'm hoping you'll talk about how important it was to find a therapist who was helpful for you. And then Bisi, I do want you to talk about the medications that Julie was prescribed, particularly the SSRI’s or selective serotonin reuptake inhibitors. But first, Julie and therapy.
Julie Chavez
Yeah I think the therapy was such a key. Well I know it was a key. I mean I had kind of this two pronged approach, right? I'm prescribed medication and then it was go to therapy. And that was a lifeline for me. I think it was so key because a lot of what happened for me was, and this is still true to this day, my anxiety lays on top of my feelings.
So if I am really struggling with something emotionally, or if I'm feeling like my son just left for college last week. So this summer has been a lot of feelings. But a lot of times I will feel anxious and then I realize, wait, this means I need to feel something. It's either angry or sad or whatever. And a lot of times I have to consciously think, how do I stop what I'm doing? Because I will overdo to outrun those feelings.
So these are all patterns. I think that's the most important thing that I learned in therapy. Is that the way that your mind works, some of it is set, of course, but so much is malleable. And so many of these mental habits that we have are small, but they can sink us or keep us afloat. And it is sometimes a very thin margin.
So being able to develop identification of those, right, like, oh gosh, I'm in a bad thought pattern here, I need to interrupt this. And then having tools to do that is a lifelong skill that I will continue to work at. And I use even now, where it just is so powerful to be able to befriend yourself as who you are today, and also hold space and hope for the direction you're going.
So I think for me, that's what therapy brought, was concrete tools and a place to be unapologetically sad, mad, yap about whatever. Because I think that's the other thing, is that I noticed this with my family. I do a lot of listening, but it's very rare sometimes that people are like, mom, how are you? And that's not really their job, so they don't need to be emotionally responsible for me. I have to be responsible for me. And in our modern context, therapy really allows for that. I think in so many ways. Bisi, tell me about my medications.
Dr. Bisi Alli
I want to add quickly, because I think it's not always made known to the general public, that uncontrolled anxiety can beget depression, and there is co-morbid meaning both can coexist at the same time depression and anxiety. And so when we talk about anxiety that can look like restlessness, fatigue, also difficulty concentrating, muscle tension, irritability, difficulty with sleep. So you can see there's some overlap with depression. And then that's typically that idea of like constant worry can beget, panic disorders. There's different contexts too. Some people get social anxiety disorder. But these typically are in existence for at least six months. So different than depression symptoms.
The other thing I wanted to point out is that when we talk about medication options and there are so many, but the most common is the category that you are prescribed, which is the selective serotonin reuptake inhibitors. Just a fancy way of saying that, unfortunately, there can be changes in the balance of those chemicals in the brain in particular. There is serotonin in the gut as well, which will come in handy shortly. When I talk about that side effects.
And so these chemicals can become imbalanced for a variety of reasons. And so what we're doing is making it harder for the serotonin, which gets scooped back up for reuse instead of being taken away. It stays available by your brain for longer periods of time, and that can help with recreating that balance. And so the medications like SSRIs, they're fantastic. We usually see even short, small changes within a few weeks.
Typically we want people to be back in the office within two weeks of starting the prescription so we can assess for improvements, side effects, which we'll talk about in a minute. And then a small subcategory of patients will experience suicidal thoughts or ideation. So we definitely want to evaluate patients for that. And that can sometimes also give insight that we need more psychiatric input from a psychiatrist. But the key is that these medications work well. These are your Prozac, Zoloft, Lexapro, Paxil and Celexa.
The other thing is that these medications are actually used for both anxiety, depression, panic disorders, PTSD, and they just vary.
Sometimes in the dosage or what dose we start and how we titrate over time. So they're very well tolerated. They do sometimes present with GI side effects and that's because of those serotonin receptors that are also in the gut are getting stimulated. So people can have nausea, vomiting, diarrhea. Those are the big side effects. And they usually will go away over time if people can stick it out. But usually by six weeks, we can say for sure or with more certainty whether these medications are a good fit. And there are others of the class. These are just the best that we see the most improvement with for most patients.
Dr. Denise Millstine
That was so much information. Thank you so much for that. And I really love how in the practice that you do, you would never just give somebody a prescription for an SSRI and not talk about the other components of the treatment, which might include therapy, but certainly would also include what you're eating, how you're sleeping, how you're moving your body, all of that.
Julie, before we wrap up, I would love if you had any last pieces of advice for, say a woman who's listening to this, who is overextended, who is struggling with her mood, anything that you want to share to that person.
Julie Chavez
You know, I think that I would say, you know, it almost makes me emotional to think about it because so many women I know labor so hard. And they do it because they love their families and they love their people. And I think probably the thing I would say is that you are doing the best for the people you love if you are loving yourself.
And that looks like the practical ways that you love them, right? I make a sandwich for my boys. I do these things because I love them and the things I do for myself. Because I love myself, I exercise, I try and get vitamin D, I drink enough water, I do these basic things because life is hard and overwhelming, and it doesn't matter if yours is the most hard or the most overwhelming. Whatever you're feeling is valid, and what you don't deal with will deal with you later.
So there is that element of not a fear-based thinking, but you don't have to live that way and you don't want to. And ultimately no one benefits from that. So I think it's just that maybe you lavish attention on people, lavish a little bit on yourself and find space for that, not because it's necessarily a crisis, but because you don't want to get to that point.
Dr. Denise Millstine
Give yourself permission to say no. To take the rest. To really consider is, am I the only person who could be doing this? Are there other people in my circle who could be doing that as well?
Julie Chavez
Yes
Dr. Bisi Alli
And it's not all or none. I just want to give validation that if today is not the day, tomorrow can be. And so the mnemonic is NEST, so nurturing activities, eating plant-based or plant powered foods, exercising, sleeping, stress management and then timed mindful breaks. So build your nest like you did, Julie. That's phenomenal. Thank you for your book.
Julie Chavez
Thank you for reading and sharing that. I love that. I tell my son’s all the time. That was when I mentioned when no one was new, a new baby. That was something my mom told me. She said, Julie, every day is going to be different. You have to accept that. And that is something I still go back to, to exactly what you're saying, where every day is different and some days are tough, even in Australia. If you've read “Alexander and the Terrible, Horrible, No Good, Very Bad Day.”
Dr. Denise Millstine
Well, I think this has been a wonderful conversation, and I want to thank you both for being here with me, and I want to encourage listeners to go out and read “Everyone But Myself: A Memoir” by Julie Chavez. Thank you both.
Julie Chavez
Thank you.
Dr. Bisi Alli
Thank you.
Dr. Denise Millstine
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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