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One of the most common mental illnesses experienced in the United States today, it is estimated that 6.7% of all American adults have experienced at least one major depressive episode in just the last year. With the prevalence of this disorder, the odds are that you or someone you love is currently living this difficult reality.

If you suspect that someone you love may be struggling with depression, there are a number of signs and symptoms that you can watch for. This includes both emotional signs, as seen with what they are saying or how they interact with you, but also physical signs. Everything in our body is connected. Therefore, this level of emotional pain can actually manifest itself in a clearly physical way.

Here are 9 physical signs of extreme sadness or depression:

#1 – Back Pain

When you are facing times of heightened stress, the first part of the body that often shows this is your back. Lower back pain, in particular, is often a manifestation of emotional pain, especially when it can’t be solved with conventional treatments like medication or massage. The only way to relax your back and free yourself from the pain is to address the root cause.

#2 – Chest Pain

While this isn’t a symptom you should just shrug off as being caused by sadness, as it could indicate something more serious, if you have been experiencing chest pain with no medical explanation, studies reveal that it may actually be caused by your depression.

#3 – Fatigue

This isn’t the kind of quiet that can be solved with a good night’s sleep or taking a short nap. Instead, you are physically, mentally and emotionally exhausted all the time. This makes it difficult to even get up and face the world, leaving you desiring nothing more than to just remain in bed.

#4 – Sleeping Disorders

As we just discussed, you may very well be feeling extreme exhaustion all day, every day, however, this doesn’t guarantee that you can then get a good night’s sleep. In fact, many people who struggle with extreme sadness and depression find that their sleeping patterns are greatly impacted. This manifests in 1 of 2 ways – either you sleep all day for hours on end, but wake up still tired, ready to return to bed from the moment you wake up, or you struggle with insomnia.

#5 – Dragging Your Feet

Regardless of how quickly you may have moved before the sadness set in, that sense of purpose is lost in your movements now. Instead, it has been replaced with a slow, labored gait coupled with dragging your feet as if you really don’t want to go wherever you are headed. There may be some truth to that statement, as your exhaustion leaves you wishing you could just stay home in bed.

#6 – Irritability

Imagine that you are living every day with the negative thoughts of depression and sadness running through your mind. Struggling to even get through your daily activities won’t leave much energy to put up with things that you see as ‘trivial’. This can lead to feelings of irritability and frustration.

#7 – Changes in Appetite

Much like the changes in sleep habit previously discussed, this can manifest in one of two very different ways. You may find yourself turning to food for comfort, eating constantly but ultimately finding no relief in this habit. This may lead to an increase in weight. Meanwhile, on the other hand, you may find yourself struggling with no appetite at all, causing a sudden drop in weight.

#8 – Slow or Distracted Speech

Overwhelmed with your feelings of sadness or depression, you have difficulty maintaining focus on any one topic long enough to even maintain a conversation. Instead, the combination of your foggy mind, fatigue, and lack of interest in the world around you leads to what others describe as a slow, dragged out speech pattern.

#9 – Unrelenting Headache

Believed to be one of the first symptoms that most people will experience, this is a combination of the constant negative thoughts invading our minds with the pressure created from extreme stress. This is a headache that seems to come on with no notice or explanation and doesn’t respond to any treatment attempts.