While it's tempting to pretend it's not there, stress has a way of making itself known. Some people can even feel physical pain -- problems with indigestion, heartburn or headaches, said Dr. Cecil Wilson, an internist in Winter Park, Fla., and board member of the American Medical Association.

There are more subtle signs, too. You're more easily irritated; you feel like you're always behind, he said. Some people may find that it's difficult to sleep -- or they sleep more than they normally would.

As stress mounts, the risk for depression rises. Depression has many forms, Wilson said. You might get up in the morning and just as soon not face the day. You feel overwhelmed with it all and are continually feeling low.

Recognizing that stress is getting out of hand is the first step to change, Wilson said. But even more important is identifying the sources of anxiety, and taking action.

First, say to yourself 'Is it my environment?' You might look around and say, 'Things aren't going well at home with my kids,' or 'I've got an elderly parent I'm concerned about,' Wilson advised.

The workplace can also be a huge source of pressure and anxiety, and often the easiest to change. If you simply have too much work to handle, ask the boss for help, Wilson said. If that's no solution, switching jobs may be the only way to ease the stress load, he said.

The body has its own ready-made stress-buster, Wilson pointed out -- a good workout. We all know that regular exercise is great for a variety of reasons, to ease tension and relax.

Then there's even something as obvious as going on vacation, a weekend away from stressors, he added.

Many Americans swear by meditation, prayer, T'ai Chi -- even a midday nap.

Then there are diversions that seem like they relieve stress, but really compound it. People under stress often drink more than they otherwise would, Wilson said. But that extra drink or two can lead to many more, until drinking becomes a habit that's hard to break. It's the same thing for smoking -- people may smoke more, thinking it curbs stress, but it doesn't, he said.

Amid the hurly-burly of middle-age, it may also be important to step back and realize that a certain level of tension will always surround us.

We hear a lot about high anxiety today, but I'm not sure we live in a more stressful world, Wilson said. Life has always been stressful.