I’m a GP – the eight symptoms you should never dismiss as ‘just stress’

Living with chronic stress is consistently linked to poorer health outcomes, from heart problems to chronic inflammation and a less efficient immune system. It can manifest as a prolonged sense of feeling overwhelmed, under pressure, and burnt out – and wreaks havoc on our minds and bodies. If you’re juggling a busy schedule and family commitments, it can be too easy to dismiss everything as “just stress”, when the mental and physical impact may warrant further discussion with a healthcare professional. “Headaches, dizziness, muscle tension, poor sleep and stomach problems are among common physical symptoms people may experience during periods of stress,” says professor Victoria Tzortziou Brown, president of the Royal College of GPs. “A GP’s role is to make sure we are not missing an underlying medical condition,” Tzortziou Brown continues. “Some symptoms should always be assessed, regardless of whether you are feeling stressed.” For example, unexplained weight loss, a new lump, blood in your stools, persistent chest pain or unexplained shortness of breath, she says, should never be ignored. Shorts Stress can lead to some palpable physical and emotional symptoms, adds Dr Zamiel Hussain, GP and founder of AccessGP. “When the body remains in a prolonged state of alert, it can affect concentration, appetite, digestion, heart rate and sexual function.” “Chronic, continued stress can leave people feeling exhausted, irritable, overwhelmed or mentally foggy, alongside these physical symptoms.” Hussain shares the eight common symptoms typically associated with chronic stress that may require further exploration with a professional. Tiredness, fatigue and brain fog A short period of tiredness during a demanding week is common. Seek help when fatigue lasts for a few weeks, is unexplained, does not improve with sleep, or is making it difficult to function normally. These symptoms may impact the extent of your social interactions, for example, or contribute to irritability, too. Fatigue and poor concentration can be caused by stress and disrupted sleep, but they can also occur with anaemia, iron deficiency, thyroid problems, diabetes, infections, medication side effects and a range of other conditions. A GP will usually ask about sleep, mood, diet, menstrual cycles where relevant, medication, alcohol, snoring and any additional symptoms. Depending on your medical history, investigations may include a full blood count and ferritin to look for anaemia or iron deficiency, thyroid tests and/or kidney function tests. Sleep disturbance Stress can make it difficult to switch off, fall asleep or remain asleep. As a result, poor sleep can worsen concentration, emotional resilience and physical fatigue, creating a cycle that can be difficult to break. Our immune system can be impacted by sleep, too, which then further compounds the effect stress has on our overall wellbeing. If you are regularly having problems sleeping, it has not improved with changes to your routine or sleep habits, and is significantly affecting your daytime functioning, it’s reasonable to take this up with your GP. This could uncover anxiety, depression, medication effects, restless legs, hormonal symptoms or sleep apnoea. Someone who snores loudly, wakes choking or gasping, has witnessed pauses in their breathing or remains excessively sleepy during the day should mention this, as these can be features of sleep apnoea and may require a sleep assessment. Addressing sleep is multifactorial and needs a holistic assessment spanning sleep hygiene habits through to caffeine intake. Treatment is not necessarily a sleeping tablet. Identifying the cause and considering approaches such as cognitive behavioural therapy for insomnia is often more useful in the long term. Low mood, feeling overwhelmed or losing motivation There is an important distinction between feeling temporarily overwhelmed and developing a mental health condition. It is certainly worth speaking to a GP when low mood has lasted around two weeks or more, when someone has lost interest or pleasure in the things they normally enjoy, or when their motivation and functioning have noticeably declined. Other warning signs include withdrawing from people, feeling hopeless or worthless, struggling to care for yourself, or increasingly relying on alcohol or other substances to cope. Someone does not need to wait two weeks if they feel they are already struggling significantly. Any thoughts of self-harm, suicide or being unable to remain safe require urgent support. Appetite and unexplained weight changes Stress can reduce appetite, although some people eat more when under pressure. The key distinction is between a short-lived change with an obvious explanation and continuing, unintentional weight loss. Weight that continues to fall without changes to diet or exercise should be assessed rather than automatically attributed to stress. A doctor may review mood, digestion, medication and other symptoms. Blood tests or further investigation may be needed depending on the overall picture. ‘Chronic, continued stress can leave people feeling exhausted, irritable, overwhelmed or mentally foggy, alongside these physical symptoms’, says Dr Hussain (Photo: Richard Drury) Loss of sex drive Sex drive is often one of the first things to change when someone is exhausted, anxious or emotionally overloaded. When the body and mind are focused on simply getting through the day, intimacy understandably moves down the priority list. A temporary reduction in libido during a difficult period is common. It is worth discussing with your GP when the change persists, is causing distress or is affecting a relationship. The conversation should not focus solely on hormone levels. Sleep, mood, relationship difficulties, medication, alcohol, menopause, hormonal contraception and physical health can all play a part. Exploring symptoms can help guide whether further investigation is needed. For example, erectile difficulties, pain during sex, menstrual changes, menopausal symptoms or marked fatigue may justify a broader assessment or certain blood tests. Bloating and IBS-like digestive symptoms The gut and nervous system are intricately connected. Stress can worsen abdominal discomfort, bloating, diarrhoea, constipation and established irritable bowel syndrome. However, new or persistent bowel symptoms should not automatically be labelled as stress or IBS without considering other causes. Abdominal symptoms should always be explored by a professional before we can safely attribute them to stress or anxiety. It is particularly important to see a health professional if symptoms repeatedly wake someone at night, there is blood in the stool, unexplained weight loss, a persistent abdominal swelling or lump, prolonged diarrhoea, or the symptoms are continuing or becoming more severe. Palpitations and panic attacks Stress and anxiety can activate the body’s “fight or flight” response, making the heart beat faster or feel more forceful. Panic attacks may also cause sweating, shaking, breathlessness, chest discomfort and dizziness. However, palpitations should not automatically be attributed to anxiety. New, recurrent or unusual episodes deserve a thorough assessment, which may range from checking the pulse and blood pressure to an ECG, blood tests or longer heart monitoring, depending on the history. Palpitations with chest pain, significant breathlessness, fainting or near-fainting require urgent medical assessment. Recurrent panic attacks are also worth discussing with a GP, as anxiety and panic disorder are treatable. Tension headaches Headaches are a common manifestation of new or ongoing stress. See your doctor if they are happening several times a week, are severe, are changing in character or are not improving with simple measures. A sudden exceptionally severe headache, or a headache associated with weakness, confusion, loss of vision, collapse, fever or significant neck stiffness, requires urgent assessment rather than being put down to stress. What to do if these symptoms are affecting you and you suspect it’s more than “just stress” “Sometimes reassurance and a recovery plan are appropriate. Sometimes blood tests, examinations, investigations or referrals are needed. In other cases, the consultation may identify anxiety, depression, insomnia or burnout that would benefit from talking therapy, medication, time away from work or workplace adjustments,’ says Dr Hussain. “My advice is not to wait until you can prove that something is seriously wrong. If symptoms are persistent, affecting your ability to function or making you worried, that is already a good basis for a conversation with your doctor.”