For some, winter means log fires, a glass of red wine, soup and a good book. For others, though, winter means hitting the blues.

Be glad you don't live in the Northern Hemisphere, where the lack of daylight in winter can lead to a depressive disorder called seasonal affective disorder (SAD).

But living in the Southern Hemisphere as we do doesn't mean that we cannot suffer from depression. Approximately one in 50 children, one in 20 teenagers, one in four women and one in 10 men suffer from major depression. People of all races and socio-economic classes are affected equally, according to the Mental Health Information Centre of South Africa.

Thanks to new medication and a better understanding of the biochemistry of depression, appropriate treatment (psychological counselling combined with the correct antidepressant) can lead to relief of symptoms in approximately 80% of those suffering from depression, and up to 60% may recover fully. However, only one third of all people suffering from depression seek help, says Dr Dan Stein, psychiatrist and head of the Medical Research Council (MRC) for Anxiety and Stress disorders at Tygerberg Hospital.

A person may suffer from Major Depression if his/her lows last longer than two weeks, are not caused by another disease or the loss of a loved one, and affect her/his general functioning and behaviour. Depression may affect all spheres of your life (your work, your relationships, your sport), your body (eg low energy, sexual dysfunction), thoughts (difficulty concentrating, indecisiveness) and feelings (depression, irritability).

Depression is caused by a disturbance in the balance of the brain chemicals serotonin, noradrenalin and dopamine. Sufferers cannot simply ‘pull themselves together’ or ‘snap out of it’. They really need treatment. The biochemical disturbances can be precipitated by genetic factors, life-changing events, the taking of recreational drugs (such as alcohol and Ecstasy), and shifts in hormones secreted by the thyroid (the cause of up to 15% of depression) or adrenal glands, and changes in female hormones. Illnesses such as Alzheimers, epilepsy, multiple sclerosis (MS), glandular fever, hepatitis, HIV/Aids and cancer can also lead to chemical imbalances in the brain.

Are you depressed? Fill in the quiz, based on the criteria for depression published in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

In the past two weeks have any of the following symptoms been present?

1.	Do you feel sad or depressed most of the day, nearly every day?	Yes	No
2.	Do you show a diminished interest in activities, most of the day, nearly every day?	Yes	No
3.	Have you experienced significant weight loss or weight gain, of loss/increase of appetite?	Yes	No
4.	Do you experience difficulty falling or staying asleep? Has your quality of sleep decreased or do you need more sleep?	Yes	No
5.	Do you feel restless nearly every day, or have your movements slowed down?	Yes	No
6.	Do you feel tired or low in energy nearly every day?	Yes	No
7.	Do you experience feelings of worthlessness or extreme guilt?	Yes	No
8.	Do you have difficulty in concentrating or making decisions?	Yes	No
9.	Do you have recurrent thoughts of death and suicide?	Yes	No

If you have answered 'yes' to the first two questions, and then to three of the rest, you may be clinically depressed and are advised to go and see your doctor.

Useful contact numbers
SA Depression and Anxiety Group (011) 783-1474.
MRC Unit for Anxiety and Stress disorders (021) 938-9229.

- (Health24)

Read more:
Depression Centre
Real-life story: Small's breakdown – are you at risk too?

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