Written by Dylan Watkins

Dylan has been a GP in Totnes for the last 20 years. As a Junior Doctor he undertook training in paediatrics and psychiatry as well as other specialities before deciding to be a family doctor.

What do they say the big life stresses are?

Moving house, having a child, divorce, bereavement, losing a job… people commonly quote them but it is hard to pin down actually which ones are worst… there seem so many.…

This book is for people likely to have experienced several of these; often within a very short timescale. Most of us can ride out stresses for a while, living on adrenaline and optimism; but it inevitably grinds down your resilience after a while.

You can be so busy telling yourself you are OK in a situation, that you don’t recognise the tightness in the chest, the tremor and sweaty palms or the butterflies in the stomach for what they are.

Separation doesn’t just happen in isolation. It is usually the unhappy consequence of a process that has been evolving for some time.

The first for most I think is the life stress of having kids. Having a family can be unbelievably stressful. The kids are of course our greatest joy and delight too but the strain that parenting can put on a relationship is a great risk.

The second is then the separation. If you’ve got to the point where that is the best option then you have usually tried various means of compromise and getting along: perhaps been to Relate or a counsellor. By the time you get to separation this has been going on a while and you will invariably be suffering the strain of a stressful situation.

Third then is negotiating terms with your ex-partner: the house; financial and access rights.

Fourth is moving house. It happens so much in any separation and is hugely disruptive in your lives but stressful emotionally too.

How do you recognise that you are stressed though?

It isn’t like being stressed for an exam- that, I think, you feel as a stressed brain. In life-stresses the body often reveals the stress more than the mind.

You can be so busy telling yourself you are OK in a situation, that you don’t recognise the tightness in the chest, the tremor and sweaty palms or the butterflies in the stomach for what they are.

Disturbed sleep begins to kick in and tiredness with it. Fatigue just exacerbates the response to the stresses you are under. You can see that once stress begins to get hold it can be an out of control ride without some sort of help.

The pressures can tip over into depression. Depression being more than just some sad, bleak thoughts; but something deeper and more pervasive.

The Royal College of Psychiatrists has made a list of typical symptoms someone with clinical depression might suffer:

  • feel unhappy most of the time (but may feel a little better in the evenings)
  • lose interest in life and can’t enjoy anything
  • find it harder to make decisions
  • can’t cope with things that you used to
  • feel utterly tired
  • feel restless and agitated
  • lose appetite and weight (some people find they do the reverse and put on weight)
  • take 1-2 hours to get off to sleep, and then wake up earlier than usual
  • lose interest in sex
  • lose your self-confidence
  • feel useless, inadequate and hopeless
  • avoid other people
  • feel irritable
  • feel worse at a particular time each day, usually in the morning
  • think of suicide.

I think it is a pretty good list. If you scan down the list going “Yes, yep, that one too…” then it really is time to consider getting some advice.

As a GP people come to discuss their problems with me at all sorts of points along this line…

I couldn’t say if it is right or wrong to go to the GP earlier or later. We are all individuals with different backgrounds and we each, individually, seek help when we need to. I know GPs say they are busy – but you are the patient and if you recognise stress in yourself then starting talking about it sooner rather than later with your GP is probably best.

We don’t judge anyone, ever, for coming in feeling the effects of stress, so get talking sooner in the process. A high proportion of GPs have been divorced or separated- so they can usually empathise pretty well: and if they haven’t themselves been through it they will likely have a colleague who has.

You might worry you are being weak, succumbing to these feelings.

There is that nice little aphorism I’ve seen on Facebook:  “Depression is not a sign of weakness. It’s a sign that you have been strong for too long”. The strong person reacts to stress by redoubling their efforts, pushing themselves way beyond the limits for which their body or mind is designed.

It doesn’t have to be the GP that you talk to of course. Anyone who is a good listener can be great to offload to. There is something more though, I think, to be gained from talking with someone trained to listen and help you find your way forward. Whether that is a counsellor, doctor or priest… doesn’t matter.

I know what I do as a GP though. I will try to understand the problem and get its context. I will try to gauge where on the scale of anxiety or depression or stress scale my patient is at that point. I will then attempt to tailor my suggestions to the individual: in terms of helping them understand where they are at emotionally and understand how this might have come about. I’m not trying to be a marriage guidance counsellor, but might try to ascertain what my patient really wants as an outcome and to try to see if it feels achievable.

GPs can signpost patient’s on to support: counselling especially. If the stress symptoms are stronger then most places now in the UK have easy access to psychological therapies; especially Cognitive Behavioural Therapy- CBT. This is often accessible by self-referral. Check your GPs website or search for “CBT self referral” in your local area.

Often I do prescribe some sort of medication. Sleeping pills seem most helpful in the short term. Getting some sleep can be terribly regenerative. SSRI antidepressant drugs are demonised in the press sometimes, but in my experience really can bolster your emotional state. I don’t like to prescribe them long term, but find that using them for a spell when the stresses are most high can make a real difference. They counteract anxiety as well as lifting mood a little. In my experience they can begin to work within just a day or two. They seem to have very few side effects, especially when used for shorter spells.

For severe anxiety there is diazepam. I don’t tend to prescribe it a whole lot but it can be used for situational stress. (Mostly for fear of flying or going in an MRI scanner) My worry with diazepam is that it may cloud the mind or judgement more than the SSRI pills so perhaps not best if you are stressed about attending court or similar.




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