Spoke Definitions

Below are the definitions of each of the spokes of Peterz Weel.  Read through the description carefully and answer yes or no to the question at the end of each description:

General Practitioners

GPs are often the first point-of-contact for patients experiencing mental health problems. This includes patients who do not disclose their mental health problems. In addition, GPs are reported as the most common providers of mental health services.

Your GP is able to refer you to a Specialist such as a Psychiatrist and/or Psychologist. They can also prescribe medication if that is required.

Do you and your GP discuss your mental health concerns?


A psychiatrist is a specialist medical doctor who assesses and treats patients with mental health problems.  At its core, psychiatry involves listening carefully and sensitively to people’s most personal thoughts and feelings,  understanding their mental state, and working with them to identify and implement appropriate treatments including psychotherapy, psychotropic medication, social strategies and other interventions.

You can only see a Psychiatrist if you have been referred by your GP. It is recommended that if you have a severe Mental Illness such as Schizophrenia or Bipolar Disorder, you involve a Psychiatrist in your treatment plan.

Do you work closely with your psychiatrist to  … ?



Working with a psychologist and Psychological treatments help you by giving an opportunity to talk to a specially-trained health professional in order to understand your symptoms, and to help you adapt how you feel, think and act in response to them.

What do we know about psychological treatments?
•    You play a role in the therapy yourself
Psychological treatments help you to understand why you feel, think and act in ways which are distressing and affect your life, and to work towards changing these. This can be challenging but it means you play an important part in your own therapy, and this in itself is empowering.
•    Real change takes time to happen
Psychological treatments do not work quickly, but over a period of months will help you to learn new ways of thinking, behaving and even feeling. You may notice, for example, that you are better prepared to handle things that used to worry you or get you down. Eventually you may find the whole way you think of yourself and the way you perceive and respond to the world changes for the better.
•    Sometimes they work best combined with other treatments
Psychological treatments are often effective on their own for people with depression and anxiety disorders. Sometimes it is also useful to combine them with other treatments such as medication. For people, with psychotic illnesses such as schizophrenia and bipolar disorder, for example, ongoing rehabilitation, accommodation and employment support are often needed as well as medication.

Do you have a psychologist you can talk with?


Pharmacists have a strong primary health care role and, due to their accessibility, are often the first health professional contacted by a consumer with a health concern.

Pharmacists are frequently consulted for advice on psychotropic medications and their accessibility and frequent contact with mental health consumers and carers means they are ideally placed to play a greater role in the management of mental illness or conditions

Your Pharmacist will dispense the medication prescribed by your GP or Psychiatrist. They have an extensive knowledge of medication, it’s action, it’s compatibility with other medication, and any side effects.

Pharmacists get to see patients more frequently than GP’s and Psychiatrists as patients have their repeat prescriptions dispensed in between visits to their GP or Psychiatrist. This is a chance for both the patient and Pharmacist to track the progress of the patient.

Pharmacists now offer Professional Services to their patients, funded by Medicare. An Instore Medication Review or MedsCheck service is an example of this. This is an opportunity for a patient and their Pharmacist to sit in a counselling area within the Pharmacy, and discuss the patient’s medication and any issues regarding their mental health.

Peter has been involved in a pilot study conducted by Griffith University to improve the relationship and mental health outcome between Pharmacists and Mental Health patients. You can read more about this study when reading about what Peter does on the website.

Working closely with your GP and Pharmacist, will give you the best health outcome. Educating yourself about the different types of medication available and any associated side effects, will provide you with a faster road to recovery.

If you are experiencing difficulties remembering to take your medication or you’re having difficulty managing your prescriptions, repeats and doctor’s appointments, ask your Pharmacist about Dosage Administration Aids. These are packs that contain your medication for the week. The Pharmacy manages your prescriptions for you and packs up your tablets each week. You only need to keep your regular doctor’s appointments for check ups.

Medications used in Mood Disorders such as Anxiety, Depression and Bipolar Disorder will be discussed in the section about Medication on the website.

Are you managing your medication? Or would you prefer your Pharmacist to provide you with your medications packed on a weekly basis?

Support Group

A support group can provide a warm, non-judgmental atmosphere where members can talk about a particular mental health issue relevant to them as well as give support and encouragement to each other. Meetings provide an avenue for people to come together to share coping strategies, discuss feelings and make new friends.

Peter formed the Bipolar Support Group of the Sunshine Coast, over three years ago.

The aim of the Support Group is to give everyone an opportunity to share their feelings, offer comfort and support to other members, to share helpful coping skills or to simply observe and listen. The Group is based on the foundations of, Information, Interaction and Support. It is a confidential environment where members feel comfortable sharing their unique story. You can read more about the Bipolar Support Group when reading what Peter does on the website.

Are you a member of a support group?


Sleep is as essential for good health as oxygen, food and water. Most scientists agree that sleep is important for restoring physical and mental health. It refreshes the mind and repairs the body. Lack of sleep, or sleep deprivation, can cause fatigue, poor concentration and memory, mood disturbances, impaired judgement and reaction time, and poor physical coordination.

The body’s internal clock regulates when and how we sleep depending on the amount of light around us. When the sun sets, your brain releases hormones to make you sleepy. In the morning, exposure to daylight suppresses these hormones and releases brain chemicals to keep you awake.

Sleep and Bipolar Disorder have two very different relationships. When someone is in the Manic phase, they will have a reduced need for sleep and will try to survive on as least sleep as possible. During the Depressive stage, the polar opposite occurs. There is always an overwhelming feeling of tiredness and often, in this phase, there is a tendency to sleep excessively.

Are you getting enough sleep? Or are you sleeping too much?



Health benefits from regular exercise include the following:
1.    Improved sleep
2.    Increased interest in sex
3.    Better endurance
4.    Stress relief
5.    Improvement in mood
6.    Increased energy and stamina
7.    Reduced tiredness that can increase mental alertness
8.    Weight reduction
9.    Reduced cholesterol and improved cardiovascular fitness

Thirty minutes of exercise of moderate intensity, such as brisk walking for 3 days a week, is sufficient for these health benefits. Moreover, these 30 minutes need not to be continuous; three 10-minute walks are believed to be as equally useful as one 30-minute walk.

Are you getting at least 30 minutes of exercise at least three days a week?



Food can play a vital role in maintaining mental health as well as physical health. In general, eating a nourishing diet gives people an overall sense of well-being. There are also some specific nutritional strategies that can help improve mood, maintain healthy brain functioning and help people with depression, anxiety and related disorders.

Did you know you can be referred to a Dietician by your GP ? This is a Care Plan that is funded by Medicare and is a great opportunity to be educated about what food is right nutritionally for you.

Are you eating the right kinds of food?


A hobby is an interest or activity that we engage in outside our place of employment primarily because it brings us pleasure. We do it—whether gardening, baking, antiquing, traveling, painting, writing poetry, or tinkering with cars—because we want to. This is a welcome change from having to do the many things daily life requires of us.

Personal pursuits spark and satisfy our curiosity, get creative juices flowing, and exercise our problem solving skills. This is why people who enjoy hobbies have a lower risk for dementia and depression. Enjoyment of our favorite activities helps reduce blood pressure, relieve stress, and elevate mood. These activities add interest to our lives and make us more interesting people to be with.

A Hobby can serve as a diversion. Something that will take your mind off work and your illness.

Are you actively involved in your hobbies?


You do not have to be 100% well to return to work. Indeed many studies show that working has a therapeutic effect upon mental illness, and can contribute to recovery; hence the benefits outweigh the downsides.
The benefits include:
•    Helps to promote recovery and rehabilitation
•    Improved financial situation, and thus, greater control over one’s life and choices
•    Increases confidence and self-esteem
•    Creates a feeling of contribution and social inclusion
•    A greater sense of identity and purpose
•    Greater independence
•    Improved general mental health
•    The opportunity to make friends

Work, even if a person is not 100% well, is generally good for well-being and quality of life.

Having to go to work on a regular basis, gets you out of bed in the morning and provides a routine. Be aware, however, that you’re not devoting too much of your time to work at the expense of other spokes in your wheel.

Are you currently working or looking for work? Are you working too much?



Volunteering provides many benefits to both mental and physical health.
•    Volunteering increases self-confidence. Volunteering can provide a healthy boost to your self-confidence, self-esteem, and life satisfaction. You are doing good for others and the community, which provides a natural sense of accomplishment. Your role as a volunteer can also give you a sense of pride and identity. And the better you feel about yourself, the more likely you are to have a positive view of your life and future goals.
•    Volunteering combats depression. Reducing the risk of depression is another important benefit of volunteering. A key risk factor for depression is social isolation. Volunteering keeps you in regular contact with others and helps you develop a solid support system, which in turn protects you against stress and depression when you’re going through challenging times. Working with pets and other animals has also been shown to improve mood and reduce stress and anxiety.
•    Volunteering helps you stay physically healthy. Volunteering is good for your health at any age, but it’s especially beneficial in older adults. Studies have found that those who volunteer have a lower mortality rate than those who do not, even when considering factors like the health of the participants. Volunteering has also been shown to lessen symptoms of chronic pain or heart disease.

Even if you’re having difficulty finding paid work, Volunteering is just as rewarding. Sometimes not getting paid for what you do is even more gratifying.

The selfless task of helping others without being paid, is good for your soul.

Are you volunteering your services?


When someone has a mental health problem or is experiencing mental distress, it is important to try to keep friendships going, even though people with mental health problems often want to see their friends less than usual.

Friendship is a crucial element in protecting our mental health. We need to talk to our friends and we want to listen when our friends want to talk to us. Our friends can keep us grounded and can help us get things in perspective. It is worth putting effort into maintaining our friendships and making new friends. Friends form one of the foundations of our ability to cope with the problems that life throws at us.

Are you maintaining contact with your friends?


How are families affected?
•    Many forms of mental illness first appear when the person is in their late teens or early twenties. Whether it’s depression, an anxiety disorder, or a less common condition such as bipolar disorder or schizophrenia, the first episode is likely to occur when the person is still living with their family. Even if they have moved out of home or are older, the mental illness may not only be distressing for them, it may affect others too.
•    Mental illness often has a ‘ripple effect’ on families, creating tension, uncertainty, troubled emotions and big changes in how people live their lives. Different family members are likely to be affected in different ways. These effects on the family are sometimes not acknowledged by health professionals.
•    Families may also take on the role of day-to-day care. This often happens with little training or support, or acknowledgment of their own needs and mental health. When families are accepted as partners in care and do receive training and support, there is strong evidence that this leads to better outcomes for everyone involved.
•    Sometimes families are not listened to by health professionals. ‘Patient confidentiality’ may be given inappropriately as a reason for this. Yet families are often the main support for people affected by mental illness, and have a right to be treated as ‘partners in care’. They need information about the illness and treatment provided, and about training and support to help themselves as well as the person who is ill.

Our family are like our friends, only they are related to us. Just as we should accept the support and remain in conduct with our friends, the same applies to our family. Often they are the forgotten ones who are left to pick up the pieces from relationships gone wrong. It’s important to remember where we came from and respect our family.

Do you maintain a relationship with your family?

Where do we start?  Developing a practical, positive attitude is always a good place to start. This means:
Coming to terms with the fact that someone you care for has a mental illness and that this is likely to have a serious emotional impact on you as well as them. There may be anger at this happening in your family, confusion or a sense of loss and grief at how the person has been changed by their illness. It’s important to acknowledge and talk about these feelings.

Developing a sense of balance between
•    acknowledging the effects of the illness on the person and hopes for recovery
•    wanting to do things to help the person and encouraging them to be independent
•    showing you care and not being over-involved
•    giving the person your time and having time for yourself and other family members too
•    encouraging the person to do things and not being unrealistic and demanding.

Preparing yourself
by learning as much as you can about the illness and its treatment, and considering what you can reasonably do to support the person. Discuss this with other family members and the treating health professionals. If there is a type of care you cannot provide, then discuss with the health professional what arrangements can be made to provide it in some other way.

What skills do we need?
Having a mental illness isn’t easy. Caring for someone affected often isn’t easy either, and sometimes first instincts are not helpful. The SANE Guide for Families contains lots of information and tips that others have found useful.
•    Talk things over with the person affected and other family members. Talk about how you feel and encourage others to do the same. Try to ensure everyone has the same understanding and position.
•    Find out about any training for family carers of people with a mental illness you can attend, and consider joining a support group to meet others in your position.
•    Encourage the person with a mental illness to be involved as much as possible in looking after themselves, and to get out socially and do things in their local community as much as is practical.
•    Consider the person as a whole – remember that they have the same range of personal, emotional and sexual needs as anyone else. Is their physical health being looked after by a GP? Are alcohol or drugs a problem which needs attention?
•    If there are suicidal thoughts, self-harm or aggression towards others, take these seriously and discuss with a health professional. Prepare a plan together for what to do if someone becomes unwell again. Always have crisis numbers handy.
•    Plan ahead for when you are unable to provide care. Talk about this with the person and health professionals, and consider what legal and financial steps may be needed to ensure care continues.

What do we do in a crisis?
When someone becomes extremely unwell, it can be distressing and confusing for others, as well as the person concerned.
Remember these three principles for what to do:
•    Communicate clearly in an honest, understanding manner. Do not crowd, rush or unnecessarily touch the person.
•    Provide a calm, safe environment. Move to quieter, more open surroundings. If necessary, remove items with which the person might harm themselves or others. Seek help from a doctor, Psychiatric Emergency Team or the police.
•    Try to behave in a quietly confident manner. Be firm but friendly and unthreatening. Reassure that help is on its way.

How can we look after ourselves?
When caring for someone else, it’s important to remember to look after yourself and other family members too.
•    Allow for regular ‘time out’. Make sure to make time to regularly do things you enjoy and to socialise. Ask about respite care to give everyone a break.
•    Talk about how you feel. Don’t ‘bottle up’ feelings if you are sometimes frustrated or need support. Let the treating health professionals and others know how you feel, and ask for support if you need it.
•    Be sensible about what you reasonably can – and cannot – do. Try to prioritise and organise what you need to do, by making a weekly list for example. Ensure that this is realistic and fair, and that it includes time for yourself and others as well as the person you are caring for.
•    Don’t try to do too much. Pace yourself and look out for signs that you are becoming stressed. Have a plan for what to do if this happens.

Do you have family affected by your disorder?

Social Life

Social relationships are important for anyone in maintaining health, but for the mentally ill it is especially important.  Social isolation is also sometimes due to the unwillingness of others to befriend the mentally ill. The public may avoid them altogether. The stigma associated with mental illness creates huge barriers to socialization.

People with severe mental illness are probably the most isolated social group of all. They are judged, disrespected and made into pariahs. They fear rejection from others, who may be afraid of the mentally ill, so the mentally ill person may feel overwhelmed by the thought of attempting to form new friendships. Just avoiding any contact is often the choice. Or, they may make a great effort to conceal their condition from others, which results in additional stress from worrying about their true condition being discovered.

It is sometimes the case that the severely mentally ill person becomes homeless. This in itself is isolating, and they then must suffer the double stigmatization of being homeless as well as mentally ill.

Another reason the person with mental illness may experience social isolation is the nature of their mental illness. Social phobias like agoraphobia, or severe anxiety or depression often cause the suffering person to be afraid to venture out into society.

When anyone, mentally ill or not, does not have enough social contact, it affects them mentally and even physically. Loneliness creates stress, taking a toll on health. Other things affected can be the ability to learn and memory function. High blood pressure is also seen. It can be the trigger of depression and alcoholism. (2) Imagine the consequences, then, if you are already depressed or have other mental illnesses? Loneliness can make you worse. Loneliness and loss of self-worth lead many mentally ill to believe that they are useless, and so they live with a sense of hopelessness and low self-esteem.

Social isolation is both a cause and an effect of mental distress. When the person isolates more, they face more mental distress. With more mental distress, they want to isolate. This vicious cycle relegates many people with severe mental illness to a life of social segregation and isolation.

Many people with severe psychiatric disabilities say that the stigma associated with their illness is as distressing as the symptoms themselves. This stigmatization not only prevents them from interacting with others, but may prevent them from seeking treatment, which in turn exposes them to a greater risk of suicide.

Too often the public does not understand the challenges of the mentally ill and doesn’t want to try. It is therefore necessary to confront biased social attitudes in order to reduce the discrimination and stigma of people who are living with mental illness.

Are you keeping in touch with your friends, family and community?


One of the most common symptoms of Depression is a lack of motivation. To remedy this, we need to discover what motivates and makes us tick.

Your Passion is the fuel that ignites the joy that you are meant to experience throughout your life.Incorporating this Passion into your life has a dramatic effect on the happiness you will experience throughout your life.

Discovering your Passion will improve your life, no end. Everybody has the ability to feel passionate about something. The secret is to find out what yours is. When you discover your Passion, there will be a corresponding increase of joy, happiness and confidence in all areas of your life.

For instance, if you can find a career doing what you’re passionate about, you’ll approach every day of work with enthusiasm. There will no longer be the daily grind.

Discovering your Passion can lead you to meet new and interesting people. People who share the same Passion get together and talk, fun and topical conversations always occur.

When you’ve discovered your Passion, you become a more interesting person. Your improved self confidence allows you to express ideas on a new level. Your Passion may become contagious and you’ll experience a deeper relationship when you share your Passion with others.

Have you discovered your Passion?



Spirituality is a globally acknowledged concept. It involves belief and obedience to an all powerful force usually called God, who controls the universe and the destiny of man. It involves the ways in which people fulfill what they hold to be the purpose of their lives, a search for the meaning of life and a sense of connectedness to the universe. The universality of spirituality extends across creed and culture. At the same time, spirituality is very much personal and unique to each person. It is a sacred realm of human experience. Spirituality produces in man qualities such as love, honesty, patience, tolerance, compassion, a sense of detachment, faith, and hope.

Recent studies show that religious beliefs and practices are supportive to cope with stresses in life and are beneficial to mental health.

Are you exploring your spirituality?


Relaxation is a valuable component of life that really can improve our physical, mental and emotional wellbeing.  Like exercise, it can be likened to an effective natural medicine; if taken correctly it will be beneficial and it has good side-effects too!

Regularly practicing relaxation techniques can play a significant role in helping to lessen many of the negative consequences we may experience from feeling mentally and emotionally low.

The positive results of practicing relaxation techniques will often put us in a stronger position to actually start to effectively tackle some of the external causes that lead to us suffering mentally and emotionally.  These could include:

•    Improved confidence leading to increased feelings of personal control over our lives
•    A consistently calmer state of mind that can lead to more rational and positive thinking
•    A greater sense of self-worth
•    Less apathy
•    Greater strength and energy to effectively cope with life’s ‘ups and downs’
•    And better able to relate to family, friends and work colleagues and gain support from them

Are you incorporating some form of relaxation into your life?



Learning new skills positively affects our mental wellbeing. Many of us associate learning with our student or younger days, and we are too often time poor to learn as we age.

Studies show that life long learning improves and maintains good mental health. This means you feel good about yourself and the world around you. You are then able to get on with life in the way you want.

Learning boosts self confidence and self esteem, and has a major part to play in developing a sense of purpose. Attending learning groups helps us to connect with others, as it often has a social aspect associated.

Learning is not just connected with a classroom situation. There are many other ways you can incorporate learning into your life.
•    Learn to cook a favourite dish that you’ve never done before. Explore different recipes from the internet and refer to your favourite recipe books.
•    Study an era in history and a person from that time. Perhaps you might like to go the library or a museum to do so.
•    Instead of always getting someone to repair simple things around the house, have a go yourself. There are many DIY books and the internet is a great reference source.
•    What about rediscovering a childhood hobby that is a challenge. This might mean making model aeroplanes, writing stories, sewing or knitting.
•    If learning more about your family interests you, there are many ways to research your family tree.
•    Buying the paper everyday and reading the news and feature articles helps to stimulate the brain cells far more than watching a television screen. There are always plenty of crosswords and word games to keep the brain young, also.

Are you continuing to learn throughout your life?


When you desire something or someone, a sense of longing is excited by the enjoyment or the thought of attaining the item or person, and you want to take actions to obtain that goal.

The motivational aspect of desire has long been studied and it’s been discovered that human desire is the fundamental motivation of all actions.

This particularly relates to good Mental health. One of the primary symptoms of Depression is a distinct lack of motivation, caused by a loss of interest in things you previously found pleasure in.

Knowing this, if you desire something to be present in your life, it stands to reason, that desire will provide the motivation to achieve what you want.

Examples of different things we can desire are
•    To be able to complete a fun run
•    To join a Men’s Shed Group
•    To learn how to ride a horse
If you can maintain your desire to do these examples, excitement about reaching the goal you’ve listed will cause motivation to come, and that aspect of Depression can be eradicated.

Do you have the Desire to excite your motivation?



Purpose can best be described as the reason for which something exists, it is a person’s sense of resolve or determination.

During periods of Depression, it’s common to lose that Purpose. It becomes hard to even get out of bed. Before long, feelings of guilt and worthlessness appear and your Purpose in life is forgotten.

Having a Purpose gives us something to look forward to. This may be a job, a daily exercise regime, volunteering, joining a social group.

A famous quote that explains what having a Purpose is all about is,

“ The mystery of human existence lies not in just staying alive, but in finding something to live for”?

Does you life have a Purpose?



Wouldn’t it be nice if there was just one medication to take to treat Bipolar Disorder? Or better still if we had the technology so that medication wasn’t required at all? One day this may happen with further research into genetics.  In the mean time we have to use the best that’s available to us. Don’t be alarmed however, there is quite an array of medications available that can be tailored to suit the specific needs of each patient.

There are basically three main types of medication used to treat Bipolar Disorder. Usually only one type of medication is not enough. Often there needs to be a mixture of more than one type.

Medications are classified into –
1.  Mood stabilizer medications
2.  Anti Psychotic medications
3.  Anti Depressant medications

Mood Stabilizer Medications

These are the first line medications used to treat Bipolar Disorder. Since Bipolar is an illness where people suffer from oscillating extremes of moods, being major depression in the low form and mania or hypomania in the high form, it is essential to try and flatten out these extreme peaks and troughs. That is exactly what a Mood Stabilizer does. It has a stabilizing effect on the level of mood.

By flattening out the peaks and troughs, the person with Bipolar has less mood swings and can live a much more fulfilled and meaningful life.

In the early days of Bipolar treatment, Mood Stabilizers were the sole form of treatment. Unfortunately, despite bringing about vast improvement for sufferers, there was still room for improvement. Luckily, with further research, new developments occurred and treatment improved (see later in this topic).

The original Mood Stabilizer medication was Lithium. It still remains the “gold standard treatment” for Bipolar and is often the first medication of choice. More recently, Anti Epileptic medications have been found to exhibit Mood Stabilizer activity. These include:

Epilim – (Sodium Valproate)
Tegretol – (Carbamazepam)
Lamictal- (Lamotrogine)

It is possible to be taking one of this class but not unusual to be taking Lithium and one of the others concurrently.

Anti Psychotic Medications

For most people faced with the proposition of having to take medication for life, the name of this class of medication can be frightening. When you break the name down, it becomes less scary.

As part of mania, at the top end of the scale, psychosis is a real possibility. This is a scenario where the person can experience delusions and hallucinations. These experiences seem very real to the person but in actual fact are not.

It stands to reason, then, to correct this psychotic behavior, Anti Psychotic medications have to be used.

Anti Psychotic medications are primarily used in the treatment of acute mania. They’re action can reverse the symptoms of mania and are used widely in this phase of the illness.

As well as being useful in the treatment of mania, they also play a role as a Mood Stabilizing medication and even have some Anti Depressant activity.

Here we see an example of where one medication can have a variety of indications and can work in well by augmenting other classes of medication.

Anti Psychotic medications can be divided in two groups.

Typical and Atypical Anti Psychotics

1.Typical Anti Psychotics
These are the traditional or older forms of this medication. Examples include

Largactil – (Chlorpromazine)
Neulactil – (Pericyazine)
Stelazine – (Trifluperazine)

This class of medications work very effectively as Anti Psychotics, however they are associated with Parkinson’s Disease type side effects. This includes the patient suffering rigidity and tremors.

As a result a new generation of Anti Psychotics has been developed. These include the following

2. Atypical Anti Psychotics
These are just as effective as their older cousins but have less side effects. Examples include

Zyprexa – (Olanzapine)
Seroquel – (Quietapine)
Saphris – (Asenapine)
Clozaril – (Clozapine)
Invega – (Paliperidone)
Risperdal – (Risperidone)
Abilify – (Aripiprazole)

There are different ways of administering these medications, ranging from a tablet, to wafers dissolved on the tongue, to an injection.

The side effect profile of this new generation of Anti Psychotic medications is very encouraging. The most significant problem is weight gain. It’s important to understand the mechanism behind this and then weight gain can be less of a problem.

The medications themselves don’t cause weight gain. Instead they affect an area of the brain called the “satiety centre”. This area, normally, let’s the brain know when the patient has eaten sufficient or when they are full (satisfied).Because the medication affects this process, the signal the brain normally receives to tell it that’s enough, is lacking. As a result, over eating can occur and this is what puts on weight.

Knowing this, there are strategies that can be developed to overcome this problem.
1.    Limiting portion size
2.    Using a smaller plate
3.    Not lining up for a second helping
4.    Leave the table at the finish of the meal
5.    Cleaning teeth immediately after eating

Anti Depressant Medications

Since Depression plays such a large role in Bipolar Disorder, it is very common to have Anti Depressants included in the medication treatment plan.

Anti Depressants can only be prescribed if a Mood Stabilizer is also in use. If an Anti Depressant is used in isolation, the patient can quickly cycle into mania, as there is no Mood Stabilizer present to halt this from occurring. Having an Anti Psychotic as well, can add further to the Mood Stabilizer effect, assisting with prevention of mania and depression.

By now, you will notice how all three classes of medication work together to provide the optimum effect.

There are a number of different classes of Anti Depressants available. These include
1.    Selective Serotonin Reuptake Inhibitors (SSRI’s)
2.    Selective Serotonin and NorAdrenaline Reuptake Inhibitors (SNRI’s)
3.    Tricyclic AntiDepressants
4.    Mono Amine Oxidase Inhibitors (MAOI’s)
5.    Tetra Cyclic Anti Depressants
6.    Others
7.    Natural Substances and Strategies


Without doubt, these are the most commonly prescribed of all the Anti Depressants. The reason for this is they have the least amount of side effects. Their mechanism of action is to increase the amount of Serotonin in the brain. Serotonin is a brain chemical that appears to be lacking in someone with Bipolar Disorder or Depression. When the levels are increased, there is a corresponding rise in mood of the patient.

Examples include –
Prozac – (Fluoxetine)
Cipramil – (Citalopram)
Aropax – (Paroxetine)
Lexotan – (Escitalopram)
Zoloft – (Sertraline)
Luvox – (Fluvoxamine)


Also very commonly prescribed, this class improves the levels of both Serotonin and NorAdrenaline in the brain. There is also a corresponding increase in level of mood when this occurs.

Examples include –
Efexor – (Venlafaxine)
Pristiq – (Desvenlafaxine)
Cymbalta – (Duloxetine)

Tri Cyclic Anti Depressants

This group of Anti Depressants were the first to be developed. They are just as effective as an Anti Depressant as the other classes. The problem is they can affect not only Serotonin and Nor Adrenaline, but have a wide ranging effect on other chemicals in the brain. They can make the patient drowsy, which can be an advantage if difficulty sleeping is an issue. They are still very widely used and are very safe.

Examples include –
Dothep – (Dothiepin)
Allegron – (Nortryptiline)
Endep – (Amitryptyline)
Deptran – (Doxepin)
Tofranil – (Imipramine)
Anafranil – (Clomipramine)

Tetracyclic Anti Depressants

This group of Anti Depressants works on improving the levels of Serotonin, Nor Adrenaline and Dopamine. All these brain chemicals, when at sufficient levels, improve the mood. This class of medications cause drowsiness and can stimulate the appetite. This is particularly useful if the patient is having difficulty sleeping and is suffering from decreased appetite whilst battling Depression.

Examples  include-
Avanza – (Mirtazapine)
Brintellix – (Vortioextine)


A relatively new medication available is called Valdoxan (Agomelatine). It works by regulating the body’s stores of Melatonin. Melatonin is a chemical produced by our body when it becomes dark, to assist with sleep.
This medication is used when sleep is an issue and if there is associated Anxiety and Depression.

Natural Substances and Strategies

The supplement, St John’s Wart (Hypericum) is available over the counter in Pharmacies. It is a useful Anti Depressant in mild cases. Caution must be taken however, as it has the ability to interact with a number of Prescription medications including other Anti Depressants. Please consult with your Pharmacist prior to taking this supplement.

The first form of treatment for Depression should always be exercise. Exercise releases the body’s natural “feel good” hormones, endorphins. These are powerful Anti Depressants and as such should always be a part of your treatment plan. Everybody can exercise. Whether it be a Gym membership, jogging, water aerobics, yoga, pilates or simply walking.

For more information about Exercise, read about it in the section on the website, Spoke definitions.

Quite often patients get confused with medication side effects and the symptoms of the illness. Unfortunately, we tend to spend too much time on the negative aspects of medication, ie side effects, and not enough time on the “good effects”.

Remember, every situation in our lives is a “risk benefit” situation. Although it is useful to read information about the medication we take, you will notice that very little space is allocated to the “good effects” whilst there’s always a multitude of “bad effects” listed. Reminds us of the old adage, “good news never made a paper sell”, doesn’t it?

As a Pharmacist, I see it time and time again. People blaming their medications for the way they feel, when it’s actually the effects of their illness that they’re experiencing.

One example of this is, feeling flat, a change in personality from the once vibrant you, unable to get out of bed, overwhelming tiredness, loss of motivation. These are all symptoms of Depression, not side effects from the medication. You have to realize your brain has undergone a major traumatic event and it takes time to recover. Perhaps if you liken it to a total knee reconstruction. Think about how long the affected area is out of action, how you have to have physio and rehab to eventually get it back to it’s former self. Often we aren’t patient enough when it comes to medication, we want the problem fixed now. Maybe it’s because there no outward signs. Be kind to yourself  and let the healing process take its course.

Knowing this can be of great benefit. Understanding where your medication fits in and the different classifications of each and how all of this relates to the Peterz Weel.

Are you managing your medication? Or would you prefer your Pharmacist to provide you with your medications packed on a weekly basis ?

Want to be the first to know when Peter's book is released?