Alternative Medicine Approaches Research Articles

Improving Sustainability of Cognitive-Behavioral Therapy (CBT) by Complementary and Alternative Medicine Approaches (CAM) on Reducing Workplace Stress of Teachers

This article argues that the sustainability of cognitive behavioral therapy (CBT) may be improved by the addition of complementary and alternative medicine (CAM) approach in helping teachers reduce their workplace stress. This is demonstrated by two clinical trials testing the effectiveness of a multi-component stress management program with the concurrent use of CBT and CAM approaches developed in Hong Kong. The multi-component stress management is shown to be effective in reducing and relieving stress-related emotional or psychosomatic symptoms. Meanwhile, the self-administered CAM techniques may serve to sustain the effects produced by CBT approach. This has the advantage of saving the additional resources needed from intervention by trained professionals such as occupational therapists and psychologists. Implications and future directions are discussed

Alternative methods for feline fertility control: Use of melatonin to suppress reproduction.

Reversible contraceptives are highly desired by purebred cat breeders for managing estrous cycles and by scientists managing assisted reproduction programs. A variety of alternative medicine approaches have been explored as methods to control feline fertility. In the field of veterinary homeopathy, wild carrot seed and papaya have been used for centuries. Both appear to be safe, but their efficacy as feline contraceptives remains anecdotal. In contrast, the use of melatonin in cats has been investigated in a number of studies, findings from which are reviewed in this article. Cats are seasonally polyestrous (they cycle several times during their breeding season) and are described as long-day breeders because endogenous melatonin negatively regulates estrous cyclicity. Exogenous melatonin administered parenterally also suppresses ovarian activity in cats, and long-term oral or subcutaneous melatonin administration is safe. The therapeutic use of melatonin is limited by its short biological half-life (15-20 mins), its poor oral bioavailability and its central effects in reducing wakefulness. Research is required to determine whether higher doses, longer-release formulations, repeated administration or combination implants might overcome these limitations.

Breast Cancer - Review of Complementary and Alternative Medicine (CAM) and Traditional Chinese Medicine (TCM) Approach

In this article we reviewed currently breast cancer risk factors diagnosis and therapeutic opportunity in conventional medicine and complementary alternative medicine CAM as well as Chinese Traditional Medicine CTM summarized different views on breast cancer between two medicines and application of utilizing CAM CTM in treatment of breast cancer nbsp In old CTM book described breast cancer as ldquo Yan rdquo and considered it is significantly related to emotional change special depression and lifetime hardship In early stages acupuncture and herb medicine can be considered as alternative medicine for treatment nbsp Exercise to maintain good emotion can be considered as an effective way to prevent from breast cancer However better designed trials of CAM CTM methods on breast cancer prevention progression treatment and outcomes are needed in order to standardize their use as we move towards the personal medicine approach nbsp Regular screen breast cancer in conventional medicine and early stage treatment is important

The protozoan, Paramecium primaurelia, as a non-sentient model to test laser light irradiation: The effects of an 808nm infrared laser diode on cellular respiration.

Photobiomodulation (PBM) has been used in clinical practice for more than 40 years. Unfortunately, conflicting literature has led to the labelling of PBM as a complementary or alternative medicine approach. However, past and ongoing clinical and research studies by reputable investigators have re-established the merits of PBM as a genuine medical therapy, and the technique has, in the last decade, seen an exponential increase in the numbers of clinical instruments available, and their applications. This resurgence has led to a clear need for appropriate experimental models to test the burgeoning laser technology being developed for medical applications. In this context, an ethical model that employs the protozoan, Paramecium primaurelia, is proposed. We studied the possibility of using the measure of oxygen consumption to test PBM by irradiation with an infrared or near-infrared laser. The results show that an 808nm infrared laser diode (1W; 64J/cm²) affects cellular respiration in P. primaurelia, inducing, in the irradiated cells, a significantly (p < 0.05) increased oxygen consumption of about 40%. Our findings indicate that Paramecium can be an excellent tool in biological assays involving infrared and near-infrared PBM, as it combines the advantages of in vivo results with the practicality of in vitro testing. This test represents a fast, inexpensive and straightforward assay, which offers an alternative to both traditional in vivo testing and more expensive mammalian cellular cultures.

Complementary and alternative medicine approaches in the treatment of PTSD.

Complementary and alternative medicine is a diverse set of practices and treatments that has seen a significant increase among Americans over the past decade. These approaches have been applied to a myriad of medical and mental health disorders with varying levels of efficacy. Recent years have seen an increased interest in the use of complementary and alternative medicine to address the growing numbers of individuals suffering from post-traumatic stress disorder and other trauma-related disorders. These approaches include pharmacologic and non-pharmacologic modalities. This article will review some of the most widely used non-pharmacologic complementary and alternative medicine practices used to treat post-traumatic stress disorder such as recreational therapy, animal-assisted therapy, yoga, and acupuncture as well as alternative delivery methods for psychotherapy.

(547) Use of complementary and alternative medicine approaches for cancer pain management in Chinese-American immigrants

Cancer is the leading cause of death in Chinese-Americans, and many patients have poorly controlled pain. The use of complementary and alternative medicine (CAM) approaches for symptom management may be common in this population due to cultural factors. Little is known about the use of CAM approaches to manage cancer pain among Chinese-Americans. We evaluated CAM use for cancer pain management in a sample of 170 first-generation, non-English-speaking Chinese-Americans (mean age 64.3 years, SD=13.7; 62.4% female; 84.7% Cantonese-speaking only, with low acculturation scores, mean=6.1/25.0).

Evidence-Based Treatments for Autism Spectrum Disorder

Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental disorders that manifest in early childhood and persist throughout the lifespan; treatment should reflect the unique challenges for that individual at each developmental stage. In early childhood, treatment should focus on the acquisition of language, play skills, joint attention, and effective communication strategies through intensive behavioral and educational interventions, particularly Applied Behavioral Analysis (ABA). Middle childhood and adolescence presents a time for continued skills acquisition, including development of social skills, peer relationships, and maximizing supports for academic weaknesses. In older adolescence and young adulthood, developing vocational and adaptive living skills to maximize opportunities for independence becomes important. ASD are lifelong disorders, and treatment in adulthood includes ensuring opportunities for social, leisure, and vocational activities, maintaining physical health through diet and exercise, and support for transitions in caregiving as parents age. Throughout the lifespan, clinicians should remain mindful of medical complications that can affect behavior and may not be readily apparent in individuals with limited verbal abilities, including gastrointestinal problems such as reflux and constipation, seizures, and allergies. Current pharmacological interventions are primarily aimed at ameliorating the challenging emotional and behavioral symptoms that accompany ASD rather than the core symptoms of ASD themselves. However, substantial evidence-based research into most medications for ASD is lacking. Two atypical antipsychotics, risperidone and aripiprazole, have indication for the treatment of severe irritability in youths with ASD, though all other medication use in ASD is considered off-label. Behaviorally based therapies, including ABA and cognitive-behavioral therapy (CBT), may be helpful for symptoms of depression, anxiety, and impaired self-regulation. Clinicians should remain mindful that many families will seek out complementary and alternative medicine (CAM) approaches for their child, and appropriate guidance about the safety and efficacy of these interventions should be offered. Drug therapies that directly target the varied neurobiological underpinnings of ASD are an area of great interest for future research and treatment.

Anesthesia Related Toxic Effects on In Vitro Fertilization Outcome: Burden of Proof.

Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. This review article provides an overview of published data regarding the potential toxic effects of different anesthetic techniques (Loco-regional, general anesthesia (GA), and monitored anesthesia care (MAC)), different anesthetic agents, and alternative medicine approach (principally acupuncture) on the IVF outcome. From our analysis, evidence of serious toxicity in humans is not well established. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about GA came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly associated with toxicity. MAC and Loco-regional anesthesia appear as safe alternative choices and there is evidence of improved outcome. Whereas acupuncture may provide assistance increasing IVF success according to some trials, some others could not obtain these effects. Questions about the appropriate time of application and the underlying mechanism of action are not answered yet, so further investigation should be done.

National Cancer Institute's support of research to further integrative oncology practice.

In the United States, the term “integrative oncology” may be variably defined, but most definitions would include the idea and prac tice of adding complementary and alternative medicine (CAM) approaches to the range of therapeutic options provided to cancer patients in previously strictly conventional medical environments. This shift in practice has been paralleled and aided by a gradually evolving evidence-base established from the results of welldesigned and conducted research, often funded by the National Institutes of Health. Both the absolute and proportional sizes of the National Cancer Institute’s (NCI’s) CAM research portfolio grew substantially in the early 2000s reaching a peak in FY2004 ($128.7 million; 2.7% of NCI’s appropriations). Over the intervening decade, NCI has annually supported over 300 intramural and extramural projects with some component of CAM research, with research costs totaling 80–120 million dollars annually (1). The great majority of these projects explore aspects of basic science or clinical cancer research; however, NCI also supports research to improve communication about CAM issues (2). The NCI’s Physician’s Data Query program also provides summaries of the literature about several CAM interventions with separate formats developed for healthcare practitioners and for patients (3). NCI’s extramural research portfolio (ie, grants, cooperative agreements, contracts) includes projects addressing all phases of the cancer continuum and is distributed throughout several scientific programs within NCI. The field of cancer survivor ship touches on nearly all the aspects of cancer management and some of prevention as well, thus the great majority of NCI’s CAM research portfolio is relevant to it. This diverse portfolio includes both preclinical and clinical research exploring aspects of traditional medical systems (eg, traditional Chinese medicine [TCM]), exercise, mind-body interventions, manual therapies, various botanicals, and diet (from individual components to whole diet interventions). One major component of NCI’s clinical research activi

Underuse of yoga as a referral resource by health professions students.

Nearly 38% of U.S. adults use complementary and alternative medicine approaches to manage physical conditions (e.g., chronic pain, arthritis, cancer, heart disease, and high blood pressure) and psychological or emotional health concerns (e.g., post-traumatic stress disorder, anxiety, and depression). Research evidence has accumulated for yoga as an effective treatment approach for these conditions. Further, yoga has increased in popularity among healthcare providers and the general population. Given these trends, this study explored perceptions about yoga as a viable complementary treatment to which health professions students would refer patients. More than 1500 students enrolled in health professions programs at a Pacific Northwest school were enrolled; data were obtained from 478 respondents. The study assessed willingness to refer patients to yoga as a complementary and alternative medicine for 27 symptoms (identified in the literature as having evidence for yoga's utility), which were subsequently grouped into skeletal, physical, and psychological on the basis of factor analysis. Responses were assessed using a mixed-model analysis of variance with health profession and yoga practitioner as between-subjects variables and symptoms as a within-subjects factor. In descending order of likelihood to refer patients to yoga were students in occupational therapy, physician assistant program, psychology, physical therapy, pharmacy, dental hygiene, speech and audiology, and optometry. All groups perceived yoga's greatest utility for skeletal symptoms, followed by psychological and physical symptoms. Findings also revealed a significant positive relationship between level of personal yoga practice and willingness to refer patients to yoga. Although students expressed some openness to referring patients to yoga, ratings of appropriateness were not accurately aligned with extant evidence base. Personal experience seemed to be a salient factor for accepting yoga as a referral target. These findings suggest the importance of developing strategies to make health professionals more aware of the merits of yoga, regardless of whether they themselves are yoga practitioners.

Pharmacological Benefits of Herbal Formulations in the Management of &lt;i&gt;Psoriasis vulgaris&lt;i&gt;

Psoriasis is a chronic inflammatory skin disease, with an important impact on the patient’s quality of life. Its incidence and prevalence are continuously increasing. The complex ethiopathology of this disorder is only partially known; there is a clear genetic predisposition, which associates a number of environmental triggering factors such as an unbalanced diet and lifestyle. The conventional therapeutic options are not always satisfactory in terms of efficiency and safety, therefore, complementary and alternative medicine approaches are frequently chosen by patients, mostly as self-medication. This review, based on recent literature flow data, outlines the pharmacological benefits of herbal formulations with antipsoriatic activity. It also reveals the molecules esponsible for their effects, as well as their interference with the metabolic and immunopathogenic mechanisms of this disease. An important number of plants have been proved to act as antipsoriatic agents, many botanical-based preparations containing key-phytochemical molecules (belonging mainly to phenolics, triterpenoids and phytosterols or unsaturated fatty acids, as mentioned in specific phyto-pharmaceutical databases). Specific mechanisms of action, which can explain their activity (such as lipoxygenase inhibition, antioxidant, anti-inflammatory, anti prostaglandin), were recently described. Only some of these formulations have been actively tested in vitro or in vivo . Most publications in the field agree on the need for more in vitro and in vivo studies, especially clinical assessment on patients with Psoriasis vulgaris . These would provide more accurate data on the efficacy and safety of such herbal formulations for this disease.

Chinese herbal medicines in the treatment of IBD and colorectal cancer: a review.

Opinion statementInflammatory bowel diseases (IBD) are a group of chronic inflammatory gastrointestinal (GI) disorders, mainly represented by Crohn's disease and ulcerative colitis. Although the etiology of IBD is not fully understood, there is substantial evidence that immunologic, genetic, and environmental factors are the main contributors in IBD pathogenesis. Conventional therapies for IBD include anti-inflammatory and immunosuppressive drugs, such as 5-aminosalicylic acid, corticosteroids, antibiotics, and biologicals, such as anti-TNFα antibodies. However, because of low efficacy and high risk of side effects, there is a clear need for the development of novel and efficient pharmacologic strategies in IBD treatment. Among various complementary and alternative medicine (CAM) approaches, which are used for the treatment of gastrointestinal (GI) disorders, traditional Chinese medicine (TCM) is one of the most developed and diversified. TCM encompasses methods and therapies that emerged over centuries and is based mostly on ethnic wisdom and observations transmitted from generation to generation. In the recent years, the efficacy of TCM as treatment of IBD has been extensively characterized in preclinical and clinical studies, which resulted in a significant number of research reports. Moreover, the popularity of TCM among patients with IBD has rapidly increased not only in Asia, but also in the Western hemisphere.

Herbal therapy in migraine.

The use of herbal therapies is ancient and increasing worldwide. There is a growing body of evidence supporting the efficacy of various "complementary" and alternative medicine approaches in the management of headache disorders. Promising tools to treat migraine patients are herbal products. In particular constituents of Petasites hybridus, Tanacetum Parthenium and Ginkgo Biloba have shown antimigraine action in clinical studies. A miscellaneous of recreational drugs and other herbal remedies have been supposed to have a role in headache treatment but quality of clinical studies in this field is low and inconclusive. Further research is warranted in this area.

Appropriate Use of Complementary and Alternative Medicine Approaches in Gynecologic Cancers

Gynecologic cancer patients frequently desire alternative and/or complementary interventions or medicines to aid in relief of both cancer-related and treatment-related side effects. Furthermore, women also seek treatment to aid in superior outcomes and cure rates. Unfortunately, evidence suggests that the use of complementary and/or alternative medicine (CAM) is underreported or not discussed with physicians providing cancer care. In gynecologic cancer literature, there is a lack of scientific evidence either supporting or negating CAM. Because of the lack of information available, health care providers do not have good information regarding safety, efficacy, and dose of CAM. This leads to miscommunication or absence of communication between providers and patients. Because patients do use CAM to improve quality of life (QOL) during and after treatment, it would be educational for providers to know the specific QOL deficits among patients that require attention. Thus, with the ultimate goal of improving QOL for gynecologic cancer patients, providers should be pushed to investigate CAM and determine an honest support or rejection of these therapies.

Medical Ethnobiology and Ethnopharmacology in Latin America 2013

Medical Ethnobiology and Ethnopharmacology in Latin America 2013

Weight reduction in patients with coronary artery disease: Comparison of Traditional Tibetan Medicine and Western diet

To test alternative medicine approaches with a specifically designed Tibetan dietary and behavioral program in patients with established coronary artery disease (CAD) and manifest metabolic syndrome. This was a randomized, controlled, double-blinded, parallel group dietary and behavioral intervention study. Between December 2008 and November 2010, patients were randomly adjudicated either to evidence-based Western diet (usual care), or to Tibetan diet. We evaluated 524 patients undergoing coronary angiography. All patients were white Caucasian, presented with a body mass index (BMI) >25 kg/m(2), and had evidence of metabolic syndrome. The primary endpoint was change in body weight and BMI at 6 months follow-up. Secondary endpoints included blood pressure, heart rate, intima media thickness, lipids, fasting glucose, glycated hemoglobin, fibrinogen, C-reactive protein (CRP) at 6 months follow-up and change in body weight and BMI at 12 months. Both groups of patients showed significantly reduced body weight and BMI compared to baseline (6 months, usual care weight change: -3.2 ± 3.0 kg; BMI change: -1.1 ± 1.0 kg/m(2); Tibetan diet weight change: -6.2 ± 4.4 kg/m(2); BMI change: -2.1 ± 1.5 kg/m(2)), but these changes were more pronounced in Tibetan diet compared to usual care (all, p<0.001). Beneficial effects on weight and BMI were maintained after 12 months of follow-up (p<0.0001). Levels of total and LDL cholesterols, fibrinogen and CRP were decreased in both groups, but more pronounced in Tibetan diet (Tibetan diet vs. usual care (total cholesterol): 176.2 ± 43.7 vs. 185.1 ± 47.8 mg/dL; p=0.024; LDL: 111.6 ± 37.8 vs. 119.4 ± 40.9 mg/dL; p=0.026; fibrinogen: 318.3 ± 90.4 vs. 334.1 ± 87.9 mg/dL; p=0.040; CRP: 1.2 ± 3.0 vs. 2.2 ± 4.5mg/dL; p=0.036). Tibetan diet reduces body weight and BMI in patients with CAD and metabolic syndrome after 6 months significantly better than Western diet and may induce lipid-modifying and anti-inflammatory effects (ClinicalTrials.gov identifier: NCT00810992).

Characteristics of Exclusive Users of Mind-Body Medicine vs. Other Alternative Medicine Approaches in the United States

Persons using one group of complementary and alternative medicine (CAM) may differ in important ways from users of other CAM therapies. The aim of this study was to characterize the United States (US) adult population using exclusively mind-body medicine (MBM) and to determine if their characteristics differed from those using exclusively non-vitamin natural products. Using the 2007 National Health Interview Survey (NHIS) and its periodic supplement on CAM use, descriptive characteristics of exclusive MBM users, as well as those using exclusively non-vitamin natural products were identified. A total of 75,764 persons completing the 2007 NHIS with adults aged 18 years and older. Characteristics of MBM users, prevalence of MBM use, and characteristics of exclusive MBM users compared to exclusive non-vitamin natural product users. Among CAM users (N = 83,013,655), 21.8% of the adult population (age 18 or older) reported using exclusive MBM therapy. In multivariate models, exclusive MBM use was associated with female gender, higher educational attainment, younger age, residing in Northeast US, being Asian or black race, and a current smoker compared to those using exclusive non-vitamin natural products. Using bivariate comparisons, individuals that exclusively used MBM were more likely to be white females (60.5%), in a younger age category (18-39 years), educated beyond high school (68.3%), and more likely from the Southern US (32.4%). A greater level of depression in MBM users was noted compared to non-vitamin natural product users (6.6%).

Acupuncture for glaucoma.

Glaucoma is a multifactorial optic neuropathy characterized by an acquired loss of retinal ganglion cells at levels beyond normal age-related loss and corresponding atrophy of the optic nerve. Although many treatments are available to manage glaucoma, glaucoma is a chronic condition. Some patients may seek complementary or alternative medicine approaches such as acupuncture to supplement their regular treatment. The underlying plausibility of acupuncture is that disorders related to the flow of Chi (the traditional Chinese concept translated as vital force or energy) can be prevented or treated by stimulating relevant points on the body surface. The objective of this review was to assess the effectiveness and safety of acupuncture in people with glaucoma. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2013), EMBASE (January 1980 to January 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2013), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to January 2013), ZETOC (January 1993 to January 2013), Allied and Complementary Medicine Database (AMED) (January 1985 to January 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en) and the National Center for Complementary and Alternative Medicine web site (NCCAM) (http://nccam.nih.gov). We did not use any language or date restrictions in the search for trials. We last searched the electronic databases on 8 January 2013 with the exception of NCCAM which was last searched on 14 July 2010. We also handsearched Chinese medical journals at Peking Union Medical College Library in April 2007.We searched the Chinese Acupuncture Trials Register, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), and the Chinese Biological Database (CBM) for the original review; we did not search these databases for the 2013 review update. We included randomized controlled trials (RCTs) in which one arm of the study involved acupuncture treatment. Two authors independently evaluated the search results and then full text articles against the eligibility criteria. We resolved discrepancies by discussion. We included one completed and one ongoing trial, and recorded seven trials awaiting assessment for eligibility. These seven trials were written in Chinese and were identified from a systematic review on the same topic published in a Chinese journal. The completed trial compared auricular acupressure-a nonstandard acupuncture technique-with the sham procedure for glaucoma. This trial is rated at high risk of bias for masking of outcome assessors, unclear risk of bias for selective outcome reporting, and low risk of bias for other domains. The difference in intraocular pressure (measured in mm Hg) in the acupressure group was significantly less than that in the sham group at four weeks (-3.70, 95% confidence interval [CI] -7.11 to -0.29 for the right eye; -4.90, 95% CI -8.08 to -1.72 for the left eye), but was not statistically different at any other follow-up time points, including the longest follow-up time at eight weeks. No statistically significant difference in visual acuity was noted at any follow-up time points. The ongoing trial was registered with the International Clinical Trials Registry Platform (ICTRP) of the World Health Organization. To date this trial has not recruited any participants. At this time, it is impossible to draw reliable conclusions from available data to support the use of acupuncture for the treatment of glaucoma. Because of ethical considerations, RCTs comparing acupuncture alone with standard glaucoma treatment or placebo are unlikely to be justified in countries where the standard of care has already been established. Because most glaucoma patients currently cared for by ophthalmologists do not use nontraditional therapy, clinical practice decisions will have to be based on physician judgments and patient preferences, given this lack of data in the literature. Inclusion of the seven Chinese trials in future updates of this review may change our conclusions.

A Brief and Selective Review of Treatment Approaches for Sleep Disturbance following Traumatic Brain Injury

Sleep disturbance often presents as a clinically significant symptom of traumatic brain injury (TBI). Poor sleep may delay recovery, exacerbate psychiatric comorbidities, and even increase suicidal risk among patients with TBI. Thus, effective and efficient treatment of sleep disturbance in this population is critical. This review provides a brief, selective, and focused synopsis of several of the more common and empirically tested pharmacological and behavioral approaches and their efficacy in the treatment of sleep disturbance following TBI. Depending on the nature of the injury and the specific sleep-related problems, there may be appropriate uses for pharmacologic interventions such as hypnotic or wake-promoting agents, cognitive-behavioral therapy, sleep hygiene, circadian rhythm modification, or even alternative medicine approaches. Overall, the literature on this important topic is sparse, and existing studies are hampered by relatively small sample sizes, underrepresentation of youth and females, inconsistencies across reports in both time since injury and injury severity. Existing methodological limitations do not currently allow for definitive conclusions regarding the effectiveness of particular treatment approaches. Future research will not only need to address these limitations, but also develop treatment options for children and adolescents, who are currently underrepresented in the literature

Can an Integrative Approach to the Management of Depression Help Patients Achieve Functional Recovery? A Review of Current Literature

The neurobiology of emotion regulation is complex and multifactorial. Current models suggest that connections between information processing by the brain and its communications with the mind and body are impaired by chronic stress and the system is dysregulated in Major Depressive Disorder (MDD). Despite the high prevalence of MDD, the condition remains poorly managed with current treatment approaches, which have traditionally been aimed at correcting a single level of dysfunction, notably in neurotransmitters. A substantial proportion of patients who achieve symptomatic improvement with conventional therapy continue to report residual depressive symptoms and/or poor psychosocial functioning. Few clinical trials have been powered to detect changes in measures of functioning, resulting in a lack of evidence-based guidance for clinicians. The present paper reviews the evidence for an integrated, multipronged approach to the management of depression that may involve pharmacotherapy, psychotherapy, Complementary and Alternative Medicine (CAM) approaches such as yoga/meditation, exercise, diet and dietary supplements, and social support groups. The author advocates for the use of a patient-centric approach founded on a strong patientprovider alliance for the management of MDD. A shared decision-making approach should consider the potential role of pharmacotherapy, psychotherapy and CAM, which may enhance symptomatic remission and functional recovery in patients with MDD. These results may be mediated, at least in part, through improved regulation of the Hypothalamic- Pituitary-Adrenal (HPA) axis, and reduced allostatic stress load.