Ask the doctor - stress symptoms

Click here for the main 'Ask the doctor' page

Recently I've been under a lot of stress, and I’ve been getting palpitations and headaches. My GP has given me a clean bill of health and I don’t want to make a fuss, but I’m worried because I still feel awful.
I can’t help wondering if your physical symptoms and the stress you’re under are more closely linked than you realise. Our bodies react to acute stress by releasing hormones that, many thousands of years ago, gave our ancestors an evolutionary advantage. One of them, adrenaline, primes us for ‘fight or flight’ – the response that allows us to stand and face predators or escape. High levels of adrenaline cause the symptoms we associate with anxiety – dry mouth, racing heart and shortness of breath – but being in a constant state of high alert can also cause other physical symptoms. A condition called Generalised Anxiety Disorder (GAD) often manifests as physical symptoms – including chest pain and headaches – as well as abdominal pain and palpitations. GAD is thought to affect up to one in 20 people, but we may dismiss the symptoms as ‘stress’, or downplay them because we’re worried about burdening our loved ones. Other symptoms include tiredness, feeling on edge or irritable, and problems concentrating and sleeping. The mainstay of treatment for GAD is Cognitive Behavioural Therapy (CBT), which aims to help us to challenge negative and unhelpful patterns of thought that trigger or perpetuate symptoms. There are some medications that can control the symptoms while you’re taking them, but won’t tackle the underlying thought processes. That’s why it’s essential to use the techniques you’ll be taught in CBT to help in the long term.
Dr Sarah Jarvis, Good Housekeeping (Apr 12)
See all of our advice on coping with stress

Six months ago, I was in a car crash and banged my head quite badly. My memory was affected at the time, but I was told it would get better. Instead, it seems to be getting worse – and I’m short-tempered, snappy and keep forgetting things. What’s wrong?
There are several possibilities. You may be suffering from post-traumatic stress disorder (PTSD) as a result of your accident. Although it’s more commonly associated with soldiers who’ve seen active service, PTSD can happen after all sorts of trauma. It classically involves flashbacks to the event, but after a head injury people will often have amnesia about the accident itself, so don’t experience these. It’s also possible that you may be depressed – this can affect concentration and memory as well as mood – or have post-concussion syndrome. Relatively minor brain injury can have surprisingly severe effects, which become more apparent as people try to resume their ‘normal’ lives. Talk things through with your GP – if your symptoms are affecting you a lot, a consultant neurologist specialising in brain injuries could help.
Dr Sarah Jarvis, Good Housekeeping (Nov 11)

My sister's been diagnosed with mild depression. Her GP says she doesn’t need antidepressants, but she’s also been told her case isn’t severe enough to get counselling on the NHS. Is it worth her trying online services?
Depression is very common, and the NHS has made a huge investment in talking therapies through a programme called IAPT (Improving Access to Psychological Therapies). Some of these treatments are face to face, but there never seem to be enough for everyone who might benefit. I direct many patients with milder depression to Computerised Cognitive Behavioural Therapy (CBT), which can be extremely helpful for people who have the motivation to sit down and go through the exercises it advises. Particularly useful websites include www.moodgym.anu.edu.au and www.livinglifetothefull.com. They help you to understand, and counter, the negative thought processes that can result in a vicious cycle of depression. I’m also not surprised that antidepressant tablets aren’t suitable for your sister. Medication doesn’t work for everyone – and many patients will need to try more than one treatment before they find one that works for them. Tablets also don’t give you the tools you need to prevent further episodes like CBT does. Antidepressants are designed to control the symptoms of depression, not treat the cause. One thing worth suggesting to your sister, though, is getting regular exercise, as this has been shown to be a highly effective treatment for mild depression. This is partly because it raises the natural body levels of endorphins, a feelgood hormone. However, it can be hard to get motivated to start exercising if you’re depressed, so why not do yourself some good at the same time and offer to exercise with her?
Dr Sarah Jarvis, Good Housekeeping (Sept 11)

I suffer from depression and have been in hospital several times. I’ve spoken to counsellors but I can’t open up to them. Where else can I go for help when I’m down?
One in five people in the UK suffers from depression at some time, so you are not alone. If you find it easier to talk anonymously, you may find the SANE community, at www.sane.org.uk, helpful. Samaritans (0845 790 9090) provides 24-hour emotional support and Saneline (0845 767 8000, from 6pm to 11pm daily) can provide information and crisis support. NHS Direct (0845 46 47) can also offer medical advice at any time. In an emergency, you can visit your local A&E and ask to see the duty psychiatrist.
Dr Sarah Brewer, Prima (May 11)

I recently read an article about a supplement, Relora, which is supposed to be good for anxiety and stress, giving a feeling of energy and wellbeing. What would you advise?
Several herbal remedies can improve anxiety and stress. Among the most widely used are valerian, which is calming, and rhodiola, which is energising. The supplement you mentioned contains magnolia and phellodendron, which are said to reduce levels of stress hormones. If you are also feeling low, a supplement containing 5-HTP helps to lift mood as well as reducing stress, anxiety and improving sleep.
Dr Sarah Brewer, Prima (Apr 11)

I’ve been suffering from severe mood swings over the last year; I’m happy one minute, then in the depths of despair the next. I feel too embarrassed to see the doctor, but is something wrong with me?
Depression is common and affects at least one in five people at some time in their life. Having a depressive illness is no more your fault than having a physical illness and it is vitally important that you seek help from your doctor. Sometimes, large mood swings between euphoria and blackness are due to a condition called bipolar disorder (also known as manic depression). Your doctor will advise on whether you need antidepressant drugs or referral to a psychiatrist. You will feel better about having depression, and about seeking help, once you know more about the condition. Information is available from Depression Alliance at depressionalliance.org and Mind mind.org.uk or call 0845 766 0163.
Dr Sarah Brewer, Prima (Mar 11) 

My sister has always liked everything to be neat, but now she won’t let me and my family visit, even for coffee, in case we mess her home up. My son thinks she has OCD – what exactly is this and how can I get her some help?
Obsessive compulsive disorder, or OCD, is diagnosed if you have unpleasant, intrusive thoughts (a fear of illness from germs, being blamed for harm coming to your family, a fear of being robbed, etc) coupled with a compulsion to prevent this harm (through washing, cleaning or tidying, or rituals such as extreme versions of superstitious behaviour). It can be hard to say where ‘natural’ tidiness or cleanliness ends and OCD begins. But given how much it’s affecting her ability to socialise, it sounds as if your sister may have OCD. It will need tact to broach the subject, but you may find that she’ll be glad you did, as OCD can be very isolating. Explain that help is available through her GP in the form of cognitive behavioural therapy (CBT), possibly in combination with medication.
Dr Sarah Jarvis, Good Housekeeping (Jan 11)

I'm 52, and in recent months my memory seems to be getting dramatically worse. I am under a lot of stress at work, and I'm worried
this might be contributing to it. I think I need to talk to my GP, but what tests should I ask for?
We all forget things from time to time, but in certain situations it can get much worse. Ironically, the stress you're under may be the cause of your forgetfulness. Among the most common causes of poor memory are stress, anxiety, depression and tiredness. And if your memory lapses are making you more stressed, this can lead to a vicious cycle. Certain medical conditions and medicines can a ect your memory, too. An underactive thyroid can slow down the working of your brain as well as the rest of your body, and may also cause tiredness, weight gain and intolerance to cold. Any medicine that makes you tired (some painkillers, antidepressants, epilepsy medication and treatments for nerve pain, for instance) can affect your concentration. Anaemia and chronic problems with your liver or kidneys can a ect your energy levels, and hence your memory. Do talk to your GP about it - he may check for these conditions and should be able to reassure you. You may also want to investigate ways to help you relax, such as yoga classes or meditation.
Dr Sarah Jarvis, Good Housekeeping (Jul 10)

I'm worried about my 55-year-old sister. Her memory is getting worse and she often uses words in the wrong context. Do you think this is the first sign of something serious?
Memory loss becomes increasingly common as we get older. In some people, however, it becomes progressively worse. If you also notice other signs, such as difficulty performing familiar tasks, disorientation (not knowing where she is for example), decreased judgment, loss of initiative or changes in personality, mood or behaviour, it is important to talk to your doctor. You can also seek confidential advice through the Alzheimer's Society's website at alzheimers.org.uk or by calling 0845 300 0336.
Dr Sarah Brewer, Prima (Jun 10)

I've cared for my mother, who has severe arthritis, for years and now she's developing early dementia. I want to encourage her to do as much for herself as she can. But how do I find out more about what services I might need?
You're not alone - there are about 6 million carers in the UK, with about 5,500 joining the group of unsung heroes every day. Your first ports of call are your and her GP - GPs now offer an annual assessment of carers' needs, but only if they know you are one! Your mother should be eligible for a Social Services assessment that can ascertain her present needs, but constraints on services often make it hard for them to plan ahead. There are many voluntary organisations that provide advice, local support groups and help for people in your position. Boots has just launched a new website, with comprehensive details and advice about everything from carer/dependent support and end-of-life care to lasting powers of attorney, which allow you to take legal responsibility for your mother's affairs if she's not capable. Visit boots.com and search for Caring Made Easier.
Dr Sarah Jarvis, Good Housekeeping (Oct 09) 

The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit netdoctor.co.uk