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ALTERNATIVETHERAPIESjulaug2011VOL.17NO.435AnEvidence-basedIntegrativeCAMModelforDepressionoverusualtreatment.2492InmanycasestheuseofabiologicalinterventionegSJWorSAMeasastandardapproachmaybeconsideredastakingapillmaynotbeasonerousforsomeasembarkingondietarymodiCcationreducingalcoholinitiatingexerciseorengaginginpsychotherapy.AnimportantconsiderationregardingprescriptionofCAMproductsconcernsqualitysafetyanddosagelevels.Prescribedherbalmedicinesproductsshouldbefromtrustedcompaniesthatmanufacturethemaccordingtopharmaceuti-calstandardsstandardizingtheproductforactiveconstituentswherepossible.Safetyconsiderationsinvolvepotentialdrug-herbnutrientinteractionsandsideeffectsthuspeoplepre-scribingherbalmedicinesshouldhaveadequatequaliCcationsinthisarea.DosagesforCAMproductsareoftendebatedandmaybeinDuencedbythetypeandqualityofaproductthepatientx19sweightageandmetabolismandmodifyingfactorssuchascurrentmedicationcomorbiddiseaseorgenetics.Ideallyadequatevitaminsandmineralswillbesufficientlyfoundinthedietandifnotsupplementationwithnutraceuti-calscanbeconsidered.Itshouldbenotedhoweverthatinthecaseoffolicacidsupplementationstudieshaveshownaslightincreaseincancerrates.93The5-methyltetrohydrofolate5-MTHFformmaybesafertouseinmajordepression.93Variousinterventionsmaybeofuseadjuvantlytoaddressco-occurringconditionsorcomplicationstheseincludethehor-moneDHEAinthecaseoflowandrogenstherapeuticmassageforcomorbidmusculartensionandpainandomega-3CshoilsincomorbidinDammatoryandcardiovascularconditions.144794EveningdosesofL-tryptophanor5-HTPwithrelevantcofactorsegB6B12folatemagnesiummaybeofbenefitincasesofdepressionwithco-occurringinsomnia.47Insuchcasessleephygienetechniquesmayalsobeofassistance95inadditiontorelaxationtechniquesmorninglighttherapyprimarilyinsea-sonalaffectivedisorder96andyoga.6997Prescriptiveconsiderationsregardingexerciseareimpor-tantasincreasedphysicalactivitymayhavenegativehealthcon-sequencesespeciallyinpeoplewithcomorbidmedicalconditionssuchasheartdiseaseorarthritis.98Evidencecurrentlyfavorsanaerobicoveraerobicactivitytogainthegreatestbene-fitsandtheintensityneedstobemoderatetohighandper-formedtwotothreetimesperweek.99Cliniciansshouldbeawarethatdepressionmaybeworsenedifthepersonisunabletomeethighexpectationsregardinglevelandfrequencyofexercisepotentiallypromotingasenseoffailureandguilt.ThismaybemorelikelytooccurinsevereMDDespeciallywherepsychomo-torretardationhypersomniasomnolencemarkedfatigueoranhedoniaarepresent.Exerciseplansshouldbeinstitutedafteramedicalassessmentandinitiallycommencedatalowintensitytoallowforphysicalandpsychologicaladaptationtooccurtothenewstimulus.68ClinicalconsiderationsregardingdietarymodiC-cationalsoshouldbeobserved.Thoughgeneraldietaryadviceonhealthyeatingisbenignmodifyingfactorssuchasvegetari-anveganismcurrentnutritionaldeCciencieseatingdisorderspregnancytheageofthepatientandculturalfactorsneedtobeconsidered.Finallyimportantadvicesometimesoverlookedbycliniciansistoencourageexplorationoffunactivitiesinthepatientx19slife.Pleasurableeuthymicactivitiesespeciallyinvolvingsocialcontactofferapowerfulantidotetolifex19sstressors.DISCuSSIONx0Asareviewoftheliteraturedetailsinthetreatmentofclini-caldepressionmanynonpharmaceuticaloptionswithgradeAx13orBx13levelevidenceexist.TheALPSmodelmayprovideaclinicalframeworktoapplytheseinterventionsinpractice.ItisnotedhoweverthatthoughtheindividualinterventionshaveRCTevi-dentiarysupporttheoverallmodelusingacombinationofthesetreatmentshasnotyetbeenclinicallyvalidated.ThisremainsakeyareaoffutureresearchandreDectsanoverallmethodologicalchallengefortheareaofCAMtotestholisticmodelsaspracticedbycliniciansusingsoundmethodology.ThoughRCTsarevitalinvalidatingindividualtherapeuticinterventionsitisanimpor-tantstepintheevolutionofCAMresearchtomovebeyondreductivemethodology.Optionsmayincludeax1cwholesystemsx1dresearchformat100wherebyevidence-basedcomponentsarecombinedintoanindividualizedtreatmentpackagethatcanbedisseminatedtopatientsaccordingtoasystematicclinicaldeci-siontree.Thisdecisiontreecouldprovideanalgorithmwherebycertainpresentationscouldx1ctriggerx1dtreatmentoptionsandcouldbeachievedinpartbyinformationelicitedfromaninter-viewformbasedonthisalgorithminadditiontopersonalizedcasetaking.Inaclinicaltrialthiscouldbecomparedtotreat-mentasusualconventionalpharmacotherapyorawaitlistorplaceboarmwithassessmentbeingperformedbyblindedinde-pendentresearcherswhoperformtheassessmentswithnoknowledgeofthestudyparticulars.Apotentialdrawbackwithmultipleinterventionsisincreasedcosteghealthyfoodsgymmembershipspsychologistcounsel-ingCAMproductswhilephysicaldiscomfortandorinjurymayinrareinstancesoccurwithexerciseoracupuncture.Whiletheselimitationsandweaknessesareacknowledgedstrengthsexistinthecreationstudyandimplementationofanintegrativemodel.Itishopedthatthetailoredcombinationoftreatmentswouldbeeffec-tiveinthetreatingdepressionwithpotentiallyfewersideeffectsthanconventionalpharmacotherapies.Importantlythisapproachmayprovideasustainedlong-termeffectthusincreasinglong-termremissionofMDD.Thismaybeespeciallysowhenpsychologicaltechniquesareemployeddietaryadviceisadheredtoexerciseisincorporatedintothepersonx19sdailyroutineandsocialskillswherewarrantedaretaughttoincreaseresilienceandenhanceself-es-teem.TheALPSdepressiontreatmentmodelcanbeemployedbyCAMoralliedhealthpractitionersegnursesclinicalpsycholo-gistsormedicalphysiciansasastand-alonemodeloritcanbeappliedinconjunctionwithantidepressantsasanadjuvant.Inconclusionthefutureofclinicalresearchintodepressionneedstoprovideagreateremphasisonintegrativeworkingmodels.Thenextstepistodesignadetailedcomprehensivetreatmentalgo-rithmandtrialmethodologytostudytheALPSdepressiontreat-mentmodelwithinarigorousmethodologicalframework.