Professor Lizette Rabe lost her son, a brilliant medical student in his fourth year, to depression. Here she writes an open letter to the UCT student community after the death of Professor Bongani Mayosi, Dean of the Faculty of Health Sciences.Dear students It was with the greatest sadness that I learnt of your unimaginable, unspeakable loss, and my heart goes out to all of you who have to try and make sense of this tragedy. As students, and especially as medical students, you will know that depression is a clinical, biological disease, and that as with other illnesses, it can develop into a fatal, final stage. I am so sorry that you as a student community, and especially Professor Mayosi's nearest and dearest, will also now have to grieve the loss of yet another victim of "this terrible disease", as author Virginia Woolf wrote in her last letter to her husband before walking into the river Ouse. You would probably know that psychologists talk about "compounded grief", or "complicated grief" – grief that has been compounded by many other factors, and a death as a result of suicide certainly is "compounded", or "complicated" grief.Humankind's cruelest diseaseThe core of my message to you is this: Professor Mayosi, as a beloved husband, father, son, brother, or cousin, as Dean of your Faculty, as role model, as top researcher, as a super human being, did not make a decision to kill himself. No, he was the victim of humankind's cruelest disease. Yet we – due to socio-cultural-religious reasons, and the fact that science is also still grappling with psychiatric diseases – still cannot understand that it is a cruel disease that robbed him of his life, and with it, him from you. In an attempt to make sense of something that seems not to make sense, I know you have professionals to help counsel you to work through this tragedy. It is also important to understand that the person who has lost his life did not desert you, and that you should not feel anger towards him. If anything, you should feel anger towards "this terrible disease". Depression is an illness, not a weakness.But what then is left for us to do after such a devastating loss? I think, in the name of Professor Mayosi, all of us can help to contribute to help raise awareness of depression as a biological disease – and realise that it can viciously claim victims, seemingly anywhere, any time.I also hope that one positive outcome is that this tragedy, and Professor Mayosi's legacy, can be used as an opportunity to educate society, especially our student community, about the importance of mental health, specifically regarding depression, a biological illness with mental and physical symptoms. By keeping quiet, we perpetuate the stigma and the silence around mental diseases and, as we know too well, they too can have fatal consequences.Depression is a biological disease caused by a chemical imbalance in the brain, and indeed, it can lead to a fatal malfunctioning of our most important organ. By acknowledging mental health issues and speaking openly – and normally – about them, you, as a young generation and community of students, can become a new generation to understand that illnesses above the neck should not be treated differently to those below the neck, and that they should also be diagnosed and treated by a specialist, as with other serious diseases.Depression increasing at alarming rateAlso, mental health issues will not go away by remaining silent. Indeed, depression is increasing at an alarming rate. UNESCO's World Health Organisation (WHO) has identified depression as currently the third biggest disease globally. By 2020 – in barely two years' time – it predicts depression to be the second biggest, and by 2030 the biggest. It is clear that we need public awareness and public education to understand that without mental health, there can be no health. It is for that reason that the WHO has dedicated 10 October to Mental Health Awareness Day. On 10 September, World Suicide Prevention Day is observed. Yet, as much as we need to raise awareness around the prevention of suicide, we simultaneously also need to focus on the causes of suicide. It is too late to intervene in the terminal stage of an illness. That is why the focus should be on depression awareness. For ages, our societies – mostly as a result of religious and cultural dogma – have seen suicide in isolation of its causal illness because of ignorance about mental diseases, whereas modern science and research today see suicide as the terminal phase of a fatal, biological disease.I therefore hope that Professor Mayosi's legacy will also be one of helping us to understand mental health better – especially among your generation. If any one of you experience the symptoms of depression, or any related condition, such as anxiety disorder, that do not delay in seeking treatment from a clinical psychologist, on a psychological level, to learn coping mechanisms, and possibly, if the disease is more serious, also a psychiatrist, on a medical level, with medication to balance the chemical malfunctioning of the brain. Sadly, we know Professor Mayosi is one of 23 South Africans who lose their lives on a daily basis to suicide, with 230 more attempts per day. Worldwide almost 350 million people suffer from clinical depression, with almost a million per year who lose their lives to suicide. According to research suicide has increased with 38% between 2000 and 2012 in Africa, with a peak among the youth. Globally, it is estimated that there are 27 non-fatal attempts for every adult who dies of suicide. Importantly, in our country suicide is one of the biggest causes of death among the youth. I know you might think, "What does all these statistics have to do with you", but I do hope they will help to put your tragedy in perspective, and help you understand depression and its fatal outcome better.How to empower the youth against depression?The question is: What can be done to empower especially you as the youth with knowledge about a scary biological disease that is mentally and physically debilitating – and that can lead to someone's death without anyone realising someone's brain is malfunctioning in a fatal way?It must be clear that depression is not about being disappointed, sad or just to "feel down". It is a clinical disease which needs professional, medical help. It therefore is necessary to recognise symptoms, acknowledge that one needs help, and then to get the help. To do nothing will not make it go away. On the contrary, it will become worse. If they were symptoms of another illness, one would much sooner see a doctor. Why not also for depression?Another way to help break the stigma around depression is in the way we speak about the disease. Language evolves, and to break the taboo and stigma, we need to rethink the words we use. We can begin to speak about depression in the same way we speak about any other disease. The same applies to those who have lost their lives to depression: to refer to them with the same respect and dignity that we use for those who have lost their lives to any other disease. In that way we can contribute to break the silence and the stigma around the illness and encourage others to be open about it. It is argued that the verb should not be to "commit" suicide, because that indicates a wilful, rational act, while suicide as a result of depression, a clinical illness, cannot be a wilful act, but the result of a terminally ill, irrational brain because of the absence of life-giving neuro-transmitters. The preferred phrase should be that someone has died of suicide, as we now know that in the majority of suicides, more than 90%, the cause is a chemical imbalance in the brain, causing a fatal depression episode. Only a rational, healthy brain can "commit" something. However, the most humane phrase is to say the person has died of depression. In that way the illness that has caused the death is acknowledged, as well as the victim's indescribable suffering. Of course other suicides, such as suicide bombers, complicate death as a result of a fatal depression. It has been suggested that these people should rather be called homicide bombers, because their goal is to kill as many as possible innocent people. Also: What about those who first kill one or more before killing themselves? A Roman Catholic priest who regularly writes on suicide, Father Ron Rolheiser, calling for a more humane approach to those who have lost their lives to humanity's most cruel disease, says indeed, they are the ones who commit suicide, as they commit those deeds with premeditation of first killing one or more others before destroying themselves. With regards to depression, this "terrible disease", I want to urge you all to hold on to hope – indeed, to become Ambassadors of Hope. But first we should break the silence and the stigma around the illness. We can all become an agent of change to prevent that depression, a psychologically and physically paralysing illness, destroys more individuals and families. Together we can fight the illness of despair. Together we can all become Ambassadors of Hope.With sincerest condolencesLizette Rabe- Professor Lizette Rabe founded the Ithemba Foundation – ithemba means hope – to raise awareness of depression as biological disease and to support research into depression. The Hope Hike and the Hope Bike is held in October, the WHO's Mental Health Awareness Month. The Hope Hike is a 3, 5 or 10 km fun walk or trial run, and the Hope Bike a 25 km mountain bike route. This year the Cape event will be held on 14 October on the Blaauwklippen Estate and the Northern event on 28 October at Van Gaalen's, Skeerpoort. More information here. Find help and information here:Lifeline 24 hour crisis line: 0861 322 322SADAG helpline: 0800 567 567/ or sms 31393World Health OrganisationSA Federation for Mental Health Recognise these symptomsRegarding symptoms, it is important to realise that you probably have depression if you feel for longer than two weeks sad, anxious or "empty"; when you have difficulty concentrating or to remember; when you are indecisive; when you feel tired and without energy, worthless, hopeless, negative, irritable and desperate; if you cannot sleep, or sleep badly, or sleep too much; feel irritated and restless; when nothing is interesting anymore, and you eat too much or too little. You may even already experience involuntary thoughts about suicide. You should immediately make an appointment with your GP. Become an ambassador of hopeBecome an ambassador of hope and wear a "sky-blue for hope" depression awareness ribbon. Make one yourself, or order one from the Ithemba Foundation, an NPC which raises awareness of depression as biological disease. Ithemba is the isiXhosa word for hope, because if depression is the illness of despair, we need to constantly build hope (www.ithembafoundation.org.za). With your sky-blue for hope ribbon – symbolising peace, tranquillity, calm, eternal HOPE – you can spread the word that there is hope, that depression is a treatable disease, that one can live a better life – that there must be more victors than victims.