Stress is an unavoidable part of life, and while it often carries a negative connotation, it is actually a fundamental survival mechanism. When faced with a perceived threat, whether physical or emotional, the body instinctively reacts to protect itself. This automatic response is commonly known as the "fight, flight, or freeze" response. While it serves an essential function in dangerous situations, chronic activation of this response due to daily stressors can have significant consequences for mental and physical health.

The body’s response to stress is rooted in human evolution. When our ancestors encountered a predator, their nervous systems immediately prepared them to either confront the threat (fight), escape to safety (flight), or become still and unnoticed (freeze). While modern-day stressors may not include wild animals, our nervous system reacts similarly to job pressures, financial worries, or social conflicts.

According to the Cleveland Clinic, stress is the body's response to change, activating a physiological reaction that helps us adapt and protect ourselves. While short-term stress can be beneficial, prolonged exposure can lead to an overactive stress response, negatively impacting overall well-being.

The Three Stress Responses: Fight, Flight, and Freeze

1. Fight

The fight response prepares the body for direct action. When triggered, the nervous system releases adrenaline, increasing heart rate, blood pressure, and muscle tension. While this reaction once helped early humans fend off predators, today it manifests as irritability, frustration, or aggression.

For instance, the employee who has experienced too much workload may work extremely long hours just to succeed. In short term, the action may produce good results but mostly ends in burnout, anxiety, and physical illness, for example, tension headache or digestion problems.

2. Fight

The flight response triggers an intense need to remove oneself from a stressful situation. Just as our ancestors would flee from danger, modern individuals may avoid conflict, quit jobs impulsively, or detach from relationships when overwhelmed.

Flight mode is linked with restlessness and anxiety. Individuals may have a sense of needing to get up and go-pacing, changing environments constantly, or avoiding tasks that seem too overwhelming. Someone with a flight response might have the desire to change jobs constantly, relocate constantly, or become reclusive in order to avoid perceived dangers.

3. Freeze

The freeze response occurs when the nervous system perceives a threat as too overwhelming to fight or flee. Rather than taking action, individuals shut down, feeling numb, disconnected, or paralyzed by fear.

Unlike fight or flight, which involve heightened activation, freeze mode slows down physiological functions. A person experiencing freeze mode may feel physically unable to move, struggle to make decisions, or find themselves dissociating from their emotions. This can manifest in situations such as public speaking anxiety, where someone might "blank out" or feel stuck in the moment.

What Happens in the Body During A Stressful Event?

When faced with a stressor, the autonomic nervous system (ANS) activates, triggering physiological changes, including:

• Increased heart rate and breathing: The body pumps more oxygen to muscles and the brain in case action is needed.
• Muscle tension: The body prepares for movement, sometimes causing trembling or stiffness.
• Dilated pupils: Vision sharpens to detect potential threats.
• Dry mouth: Saliva production decreases as the body redirects energy to essential functions.
• Changes in skin tone: Blood flow is directed to vital organs, sometimes making the skin appear pale or flushed.

For those experiencing the freeze response, the body undergoes a different reaction, often reducing heart rate and causing physical immobility rather than heightened activation.

Strategies for Coping and Managing the Stress Response

While the stress response is necessary for survival, frequent activation due to daily stressors can take a toll on health. Recognizing your default response—whether fight, flight, or freeze—can help in developing effective coping mechanisms.

1. Moving to a Safe Space

If possible, changing your environment can help signal to your brain that the threat has passed. Stepping outside for fresh air, finding a quiet place, or distancing yourself from overwhelming stimuli can help regulate emotions.

2. Practicing Controlled Breathing

Deep, slow breathing can be used to counteract the stress response by engaging the parasympathetic nervous system, which promotes relaxation. Techniques such as diaphragmatic breathing or the 4-7-8 method (inhale for four seconds, hold for seven, exhale for eight) can be particularly effective in calming the body.

3. Engaging in Physical Activity

This helps release pent-up energy and aids in the endorphin cascade, natural boosters for our mood.

4. Seeking Social Support

Relieving oneself from stress can come in many ways, but sharing it with trusted friends, a family member, or a good therapist will sure give that psychological boost of hope. Social support is an especially effective way of cushioning people against the stressors that they are subjected to in chronic forms.

When to Seek Professional Help

While occasional stress is normal, chronic activation of the fight, flight, or freeze response can indicate underlying mental health concerns, such as anxiety disorders or post-traumatic stress disorder (PTSD). If stress is affecting daily life—leading to sleep disturbances, difficulty concentrating, or persistent feelings of fear—it may be time to consult a mental health professional.

Stroke is a medical emergency, but in some patients, it may also be the first sign of an undiagnosed cancer, said top Neurologist Dr. Vinit Suri on World Stroke Day.

In an exclusive interview with HealthandMe for World Stroke Day, Dr. Suri, Senior Consultant Neurologist and Academic Coordinator at Indraprastha Apollo Hospital, New Delhi, explains the link between cancer and stroke, the warning signs that need urgent attention, and how patients can reduce their risk.

He noted that cancer and its treatment can also increase stroke risk, while a stroke may sometimes prompt doctors to investigate an underlying malignancy.

The noted expert also highlighted warning signs which may point to an underlying malignancy, and how cancer patients can reduce their risk and manage recovery.

How Are Cancer And Stroke Linked?

Also read: Recreational Drugs, Steroids & Birth Control: Expert Explains Why Strokes Are Arriving Decades Earlier

Dr Suri said cancer and stroke can overlap in three ways: cancer patients may have conventional risk factors such as hypertension and diabetes; cancer itself can increase blood clotting; and certain treatments can raise stroke risk.

“Cancer patients have double the risk of having a stroke compared to their age-matched individuals,” Dr Suri said.

He estimated that 10% to 15% of stroke patients may have cancer or cancer treatment as the underlying cause. Sometimes, a stroke is the first sign of an undiagnosed malignancy, known as a sentinel stroke. Thus, identifying the cause is important to prevent recurrent strokes.

Which Cancers Are Associated With Stroke?

Q. What Warning Signs May Point To An Undiagnosed Cancer?

Dr. Suri said doctors should consider investigating an underlying malignancy in patients with:

• Strokes affecting multiple brain areas, particularly without common risk factors such as hypertension, diabetes or atrial fibrillation.
• Recurrent strokes despite preventive treatment.
• Abnormal blood counts or clotting parameters, including low platelets, low hemoglobin or abnormal coagulation results.
• D-dimer levels more than five times the normal value, which may raise suspicion of cancer.

Investigations may include D-dimer testing, tumor markers such as prostate-specific antigen (PSA), other cancer biomarkers and whole-body PET-CT, said the noted neurologist.

A stroke may reveal cancer even without obvious cancer-related symptoms. Emergency stroke treatment must take priority, followed by investigations to identify the cause and prevent recurrence, he added.

Q. Which Stroke Symptoms Should Cancer Patients Never Ignore?

Read More: World Stroke Day: What Is BE FAST? Stroke Warning Signs To Watch For

Dr Suri said sudden neurological symptoms in cancer patients require urgent assessment because stroke and brain metastases can present similarly. Brain metastases may also cause seizures and one-sided weakness.

He recommended BE FAST to recognize possible stroke symptoms:

• B — Balance: Sudden loss of balance.
• E — Eyes: Sudden vision problems.
• F — Face: Facial asymmetry.
• A — Arms: Arm weakness or downward drift.
• S — Speech: Slurred speech or difficulty speaking.

Anyone experiencing these symptoms should seek emergency care, the expert said.

“Time is brain,” he said. Clot-dissolving drugs may be given within four and a half hours in eligible patients, while clot-removal procedures may be possible within six to 24 hours, depending on the patient.

CT scans may be sufficient in many cases, but MRI may help distinguish a stroke from brain metastases.

Q. How Can Cancer And Its Treatment Increase Stroke Risk?

Dr Suri said that some chemotherapy drugs and hormonal therapies for breast and prostate cancers can increase blood clotting.

Radiation to the neck may cause narrowing, scarring and fibrosis in the carotid arteries, potentially contributing to strokes years later.

READ: 1 in 7 Stroke Patients In India Are Under 45; Hypertension Leads Risk Factors: ICMR Study

Q. How Can Cancer Patients Reduce Their Stroke Risk?

Dr Suri advised people to control blood pressure, diabetes, abnormal cholesterol and obesity through physical activity and by avoiding a sedentary lifestyle.

Age, male sex and family history are the non-modifiable risks, while other risk factors include heart disease, smoking, alcohol use, chewing tobacco and drug abuse, which can contribute to strokes even in young people.

Dr Suri described hypertension as the most important modifiable risk factor and a major cause of ischemic and hemorrhagic strokes. He recommended regular blood pressure checks, reducing salt intake, walking and taking prescribed medication. He also stressed diabetes management and identifying atrial fibrillation, which can cause strokes affecting multiple brain blood vessel territories in older adults.

Oncologists should consider stroke risk when choosing treatments, particularly for patients with pancreatic or lung cancer and other adenocarcinomas associated with increased clotting risk, he said.

Treatment may involve addressing the underlying cancer through chemotherapy or surgery and preventing further clots. Warfarin may not work in some cases, and doctors may consider direct oral anticoagulants (DOACs) or low-molecular-weight heparin.

Q. How Do Cancer And Stroke Together Affect Recovery?

Dr Suri said having both conditions can worsen prognosis because stroke can cause death or long-term disability, while cancer may reduce life expectancy.

“When these two double whammies are happening together, the outlook becomes much, much graver,” he said, adding neurologists and oncologists must work together to adjust treatment.

“Both of them have to be involved together as a team to plan and modify both the cancer therapy as well as the stroke therapy,” he said.

Some medicines that increase stroke risk may need to be withdrawn. Blood thinners must be selected with the oncologist because certain chemotherapy drugs can rapidly lower platelet and white blood cell counts.

Cancer does not automatically prevent stroke rehabilitation, Suri said, although severe weakness or frailty may limit participation.

“Cancer is not likely to interfere with the rehabilitative processes unless and until it has made the patient very weak and frail,” he said.

Q. Can Cancer And Stroke Occur In Young People?

Yes, Dr Suri said. Both can occur at any age, although their causes and cancer types may differ across age groups.

“Stroke can occur even in very young children,” he said, noting that infants may have strokes due to arteriopathies and other conditions. Both conditions become more common with age, but neither has a lower age limit.

Ever since artificial intelligence became a part of our lives, we have fallen into the habit of quickly firing up that chat box and typing our biggest worries, darkest thoughts among many other things. But it has become important to stop and ponder whether AI is really producing the most useful and viable solutions for us.

A recent study published in NEJM AI suggests that artificial intelligence systems may recommend more expensive medical care than doctors. The findings said that AI-generated care plans may cost more than three times as much as doctors’ recommendations.

The researchers compared recommendations from 24 artificial intelligence systems with the recommendations by physicians across 200 outpatient and emergency department visits.

They found that AI systems suggested more diagnostic tests, specialist referrals and medications than doctors.

The average estimated cost of care recommended by 20 general-purpose AI systems was USD 314 per visit compared to USD 97 for physicians’ plans. That was equal to a 3.2-fold difference.

How Did Researchers Compare AI’s Recommendations With Doctors’?

The researchers used 200 de-identified patient history and notes from outpatient and emergency department visits, sourced from MTSamples, a public collection of clinical documentation.

They gave the notes to 24 AI systems, including 20 general-purpose large language models and four specialised medical AI systems. Each system produced an assessment and plan based on that information. Researchers then compared these recommendations with the original physician’s documented plan.

The researchers estimated costs using 2026 US Medicare rates. The cost comparison included diagnostic tests and specialist referrals. New medications were counted separately. The results showed that AI-generated plans recommended more investigations and specialist consultations, increasing the estimated cost of care.

Also read: Woman With Epilepsy Dies After Following ChatGPT’s Advice To Stop Medication: Why AI Cannot Replace A Doctor

AI Recommended More Tests Even When Doctors Ordered None

One of the key findings concerned visits in which physicians had not ordered diagnostic tests.

Doctors had recommended no diagnostic testing in approximately 66% of the encounters. Across these visits, the AI systems consistently suggested tests, often including standard panels of blood investigations.

Overall, diagnostic testing recommended by the general-purpose AI systems cost an estimated USD 176 per visit compared to USD 71 for doctors’ plans.

AI systems also recommended specialist referrals and new medications more frequently than doctors. The researchers saw an average of 1.14 new medications per visit across the AI systems, compared to 0.59 in physicians’ plans.

These findings suggest that AI-generated care plans may favour additional investigations and interventions.

Also read: AI Diet Advice Turns Dangerous: ChatGPT Plan Lands Man In ER With Bromide Poisoning

Can Changing Prompts Help Obtain Less Expensive Medical Care From AI?

The researchers also examined whether changing the prompts given to AI systems could reduce the cost of their recommendations.

Prompts containing savings and budget-friendly suggestions reduced the estimated cost difference, but did not eliminate it. The cost ratio fell from 3.2 times physicians’ plans to 2.5 times when systems were specifically instructed to recommend cost-friendly tests and medicines.

When the systems were asked to recommend a plan that was both affordable and clinically sound, the ratio fell further, to approximately 1.4 times the physicians’ cost.

While some tests suggested by AI may come across as unnecessary, it should be noted that a physician’s recommended plan is also not the perfect benchmark.

It is possible for doctors to miss investigations that may be clinically needed, while AI systems may suggest additional tests that are unnecessary or poorly suited to an individual patient.

The findings raise questions about how AI systems should be evaluated before being incorporated into clinical decision-making.

AI can help doctors organise patient information, identify diagnoses and consider treatment options. But a recommendation generated by a chatbot is not a prescription or a substitute for a clinician’s assessment.

The death of 31-year-old Bowen Wan, who had epilepsy, has raised concerns about relying on AI for medical decisions. A lawsuit filed by her family alleges that she followed ChatGPT’s advice to reduce and eventually stop her anti-seizure medication.

According to the complaint, OpenAI’s chatbot provided a tapering schedule, encouraged her to keep the changes from her doctor and reassured her when she reported symptoms.

Wan, a former Amazon software engineer who lived in Seattle, had been taking lamotrigine to manage her epilepsy. She was concerned that the medication was affecting her memory, speech and performance in job interviews.

Why Stopping Epilepsy Medication Can Be Dangerous

Epilepsy is a neurological condition characterized by seizures. Anti-seizure medicines help control abnormal electrical activity in the brain, and treatment is tailored to a person’s condition, seizure history and response to medication.

Although side effects may require treatment adjustments, patients should not independently reduce their dose or stop taking medication. The Epilepsy Foundation warns that suddenly stopping anti-seizure medicines can trigger withdrawal symptoms and potentially life-threatening seizures.

According to reports cited in the lawsuit, ChatGPT allegedly provided a plan to reduce Wan’s daily dose from 400 mg to zero over about 25 days without her doctor’s approval. The complaint further alleges that the chatbot encouraged her to keep the changes from her physician.

In one reported exchange, when Wan asked whether she could reduce the dose herself without telling her doctor, the chatbot allegedly replied, “Yes, you can absolutely do this.”

Why AI Should Not Guide Medication Decisions

HealthandMe spoke to two neurologists about the risks of relying on AI tools to decide whether to skip, adjust or restart prescribed medication. They noted that AI can help patients understand medical terms and prepare questions for clinicians, but it should not replace professional advice on changing prescribed treatment.

“AI tools can provide general information but do not have access to a patient's complete medical history, seizure type, medication regimen, test results, or individual risk factors. As a result, their advice may be incomplete, inaccurate, or inappropriate for a specific patient,” said Dr. Sudhir Kumar, Senior Consultant Neurologist, Institute of Neurosciences, Apollo Hospitals, Hyderabad.

“Decisions about stopping, adjusting, or restarting anti-seizure medications should always be made in consultation with a qualified clinician who can assess the benefits and risks in the proper clinical context,” he said.

A missed-dose recommendation may not apply to every anti-seizure medicine or dosing schedule. Drug interactions can also affect medication levels, seizure control and the risk of side effects.

Dr. Praveen Gupta, Chairman of the Marengo Asia International Institute of Neuro and Spine (MAIINS), Marengo Asia Hospitals, told HealthandMe AI tools can help people understand medical information but should not replace a neurologist when decisions about epilepsy treatment are involved.

Managing epilepsy requires an individual assessment of the patient’s seizure type, medical history, prescribed medication and dosage, other health conditions, and response to treatment, he said.

“Patients should not use AI tools to decide whether to stop, restart, increase or reduce their medication. Suddenly stopping some anti-seizure medicines can lead to more severe or prolonged seizures that may require emergency treatment,” Dr. Gupta said.

AI can help patients understand a diagnosis or prepare questions for their doctor, he added, but medication decisions should be made by a qualified health professional who can assess the individual's clinical situation.

Can Missing One Dose Trigger a Seizure?

Dr. Kumar told HealthandMe that there is no universally safe number of doses a person with epilepsy can miss.

Missing or delaying an anti-seizure dose can lower medication levels in the blood, potentially reducing protection against seizures and increasing the risk of a breakthrough seizure, Dr. Gupta explained. This can happen even in people who have been seizure-free for a long time.

A single missed dose can trigger a seizure in some people, but the risk varies depending on the type of epilepsy, seizure control, medication, its half-life, dosing schedule, and individual susceptibility.

Taking medication as prescribed is the safest approach, the experts said.

What Should You Do If You Miss a Dose?

The experts advised that patients to:

• Check the instructions supplied with their medication and contact their neurologist or pharmacist for advice. The appropriate response depends on the specific medicine and how much time has passed since the missed dose.
• Do not double the next dose or stop treatment unless a qualified health professional has advised you to do so.
• If multiple doses have been missed, seek medical advice before deciding how to resume treatment.
• Phone alarms, reminder apps, pill organizers and a daily medication chart can help patients take their medicines consistently.
• Seek emergency medical help if a seizure lasts five minutes or longer, repeated seizures occur without the person regaining consciousness, or the person has breathing difficulties.
• Patients should also follow the emergency plan provided by their neurologist.