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ALTERNATIVETHERAPIESjulaug2011VOL.17NO.433AnEvidence-basedIntegrativeCAMModelforDepressionSomepeoplemayAndIPTbeneAcial.IPTcanbeusedtoidentifyproblemsocialsituationsthataredepressogenicandtodeveloptranspersonaltechniquessuchassocialskillstomanagerelationships.84ByincreasingconAdenceandcompetencyinman-agingsocialinteractionsarobustsenseofself-esteemmaydevel-op.ThisapproachmayinvolvesupportivegrouptherapywhichisincreasinglyoccurringviatheInternetamethodwithemergingsupportiveevidence.85ReferraltoCBTInternetprogramssuchasMoodGYMwww.moodgym.anu.edu.auprovidealow-costoptionforpatientswithInternetaccess.Unemploymentalsoincreasestheriskanddurationofadepressiveepisode8687sodis-cussionofthepatientx19semploymentstatusinthetherapeuticcon-sultationandifappropriateareferralegtoemploymentagenciesalsomaybeofassistance.Spiritualityisanotherimportantfacetofthetranspersonalelementofthesocialcomponentofthemodelthatcouldpoten-tiallybetermedax1cbiopsychosocio-spiritualx1dmodel.Religiosityandspiritualitymayprovideaprotectiveeffectagainstdepres-sion.14ThoughreligionisasensitiveareaandshouldperhapsbeleftoutsidethetherapeuticdomainthecliniciancanencouragepatientstoexploretheirspiritualityandAndexistentialmeaninginthechallengesoftheirdepression.Anothertranspersonalele-mentthatmayprovideasimpleeuthymiceffectistheactofaltruismorkindness.ThoughpeoplewithsigniAcantdepressedmoodmayAnditdifAculttoengageinsocialconnectionactsofhelpingothersmayincreaseself-esteemandprovideaeuthymicdistractionfromtheirmelancholy.14Clinicalx0Considerationsx0andx0Applicationx0ofx0thex0Modelx0Fromaclinicalperspectivethegoaloftreatingdepressionistoamelioratethedepressionasquicklyandsafelyaspossible.Duringinitialcasetakingtheclinicianneedstoassesstheseverityofthedepressioniemildmoderateorsevere.TheDiagnosticx0andx0Statisticalx0Manualx0ofx0Mentalx0Disorders-IVx0DSM-IVassess-mentcriteriacanbeusedtodiagnoseMDD2whileanassessmentscalesuchasHDRSmaybeusedtodeterminetheseverity.Anini-tialfocusofcasetakingistoscreenforsuicidalideationorplanstocommitsuicide.Thisisamajorconcernassuicideisadevastat-ingpotentialconsequenceofMDD.88IfsuicidalideationissigniA-cantorifself-harmisadistinctpossibilityatanystagereferraltoamedicalpractitionerortoanemergencywardofahospitalforimmediatepsychiatricassessmentiscrucial.Totreatdepressedmoodeffectivelyithelpstounderstandthebiologicalpsychologicalandsociologicalfactorsthatareinvolved.Ascausationsofdepressionaremultifacetedindividu-alpresentationsvarymarkedly.Theinitialcase-takingprocessisimportanttoassessthecausationsofthedepressivepatternwithinabiopsychosocialframeworkwhenthefirstepisodeoccurredthenumberofdiscreteepisodestheseveritywhatmaytriggeranepisodeeganniversaryofadeathchangeintheweathermaintainingfactorsthatmayexacerbateorprolongtheepisodeegillhealthchronicstressunemploymentandwhatalleviatesthedepression.ComorbidmedicalconditionsalsomaybecausativefactorsofdepressionandcomorbidanxietyandneedtobescreenedforeghypothyroidisminBammatorydis-easecancersleepdisordersheartormetabolicdiseaseorotherpsychiatricdisorders.8990Certainmedicationssuchascorticos-teroidsalsomaybeimplicated.91Substanceoralcoholmisusealsoneedstobescreenedforasthisiscommonlyinvolvedinthepathogenesisofdepressedmoodandalsooftenoccursindepressedindividualswhoaretryingtox1cself-medicate.x1d65Afterthoroughcasetakinganindividualtailoringofthepre-scriptionwithintheAnancialmeansofthepatientisvitaltoaddressthespecificunderlyingcausesofthedepressionthusassistingincomplianceandrecovery.Afterinitialcasetakingandprescriptionafollow-upappointmentapproximately1weeklaterifpossibleisespeciallyimportantnotonlytomonitorforanyloweringofmoodbuttoensurecompliancecheckforadversereactionsandprovideasupportivetherapeuticrole.AtthistimetheprescriptioncanbemodiAedaccordinglymoreelementsoftheALPSmodelappliedandadditionalcase-takingdetailpur-sued.Atanypointofthetherapyreferralmayalsoberequiredaseventhemostskilledpractitionersoftencannotofferallthethera-peuticinterventionsrequiredtoeffectivelytreatthepatient.DuetothisjudiciousreferralmaybeofbeneAtforinterventionssuchaspsychologyacupuncturesocialworkorexerciseinstruction.Figure3outlinesadecisiontreethatmayhelpinprovidingtheclinicianwithastepwiseframeworktotreatMDD.Theclini-caldecisionofwhichinterventionsfromtheALPSmodelshouldbeusedinitiallyshouldbepredicatedupontheclinicianx19sjudg-mentregardingthecausesofandlikelysolutionsforamelio-ratingthedepressiveepisode.Insomecasestheunderlyingorsustainingcausemaybeobvioushoweverinmanycasesacom-plexinterplaybetweenfactorswilloccursoanintegratedapproachtoaddressingthesefactorsisadvised.Thoughitispos-sibletodevelopasystematicapproachbasedonanalgorithmthatrecommendsspeciActreatmentsforspeciAcpresentationsax1cwholepersonx1dapproachtotreatmentisusuallyacomplexandindividualizedaffairthereforeitisultimatelyuptotheclini-cianx14withthepatientx19sconsentx14todeterminewhichinterven-tionsmaybeusedandinwhatordertheycanbeapplied.InquiringaboutwhathaspreviouslybeenbeneAcialiname-lioratingthepatientx19sdepressivesymptomsmayprovidethemostobvioussignposttopotentiallybeneAcialtreatments.Thismaybereinstitutedoradjustedaspresentconsiderationsmayrequire.Regardlessoftheclinicianx19sproposedtreatmentplanitisimportanttogivethepatientadegreeofthelocusofcontrolonthepreferencesanddirectionofhisorhertreatment.Thismayfosterself-empowermentandself-reliance.Itisalsoimpor-tanttoensurethatthetreatmentplanisalignedwiththepatientx19sbeliefsystem.Whileaholisticintegrativeapproachisadvocatedinthisarticleitisimportantnottooverburdenthepatientwithamyriadofinterventionsasthismayexacerbatethedepressiveepisode.Themostapplicableprimaryinterventionscanbeinstigatedinitiallyandthenovertimeothertreatmentscanbeofferedatapacethatiscomfortablefortheperson.ThereisgrowingevidenceoftheefAcacyofthisx1cstepped-carex1dapproachandalthoughitismorecostlyithasrevealedimprovedoutcomes