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Gaurdian SummonMature
The world is in a dark age no one knows what has happened in the past and whats with the ruined metal skeletons (cities) everywhere. Alot of the world has been turned into sand and compacted dirt. Food and water are short and worst of all its hard to trust people. The only thing that keep people together is power through gaurdian summons. Beast, animals, and monsters that are summoned into the material realm through ones energies. In the distance though a darkness is amassing while the allegianc
The crunch of gravel underneath weathered and worn boots filled the cool night air as a lone figure trudged weakly towards a fire that rested on the horizon. Which casted rays of light down a rippled surface of a sand dune. The lone figure kept his or her face buried underneath a torn up hood and stood at a estimated height of five foot nine. The figures shape was hard to distinguish underneath the cloak but up front it was easy to tell that the figure had broad shoulders with torso and legs to match the shoulders. The figure continued to slowly progress in the lonely openness of the cold night with only the distant fire to keep him going; as the night went on a full moon rose filling the wind scarred terrain with its pale light revealing small shadows and surfaces that wouldn't normally catch ones eye during the day. The figures footsteps still sounded within the night as steady as a stream of water crawling across smooth rounded rocks as weak as they were the figure never missed a step.
In the distance a violent howl shook the night air which was then quickly followed by a strong wind which was picking up sand and dust between the rocks. The figure stopped in their tracks and held his or her hands out against the wind to no avail; as their hood was forced back revealing a mane of hair that gave off an orange tinge to it in the pale moon light. Their face was smooth and sharp with eyes as blue as glacier lake, untamed stubble broke the smooth surface of his skin near his cheek bones. On his neck the pale moon light revealed a dark tattoo of 15. The man gave a low mumble as the wind died down giving a look at the source which was to his right.
Just beyond the rays of light emitted by the distant fire the man could see four silhouettes standing away from each other. Two of the silhouettes darted towards each other emitting another blast of wind while shaking the ground. The man this time shielded his face with his cloak letting the harsh blast of wind blow by without much care.
"What do we have here?" He said quietly while looking into his right arm. As if he was talking to someone or something," Yes that would be most advisable, but food is short and talking to the victor might yield beneficial results, all risks aside we can't miss this opportunity I'm afraid." His voice was harsh and dry it also seemed that whatever sanity was decimated much like the wasteland around him. He changed his direction and headed towards the fight while breaking into a sprint. As he got closer to the fight was nearing a close as the man to the right was on his knees swung his left arm about desperately as if commanding the figure ahead of him which looked a bit like a Minotaur. In front of the Minotaur was a large wolf shape and behind it was a standing human shape that pointed towards the Minotaur and spoke in a deep powerful voice.
"Finish this off Sarukan!" Another howl shook the night and the wolf jumped at the Minotaur that swung its massive fist down at the wolf only to find it falling backwards and being mulled by the oversized wolf.
"NO!" The man shouted on his knees. He then began to scream in pain. The wolf howled again into the night silencing the man.
"Your work is done Sarukan, return to me!" The other man commanded the wolf," Thank your Dran the society will honour and remember your contribution to bring about a brighter future." The man continued to say as a bright light shot out towards the victor from the fallen man. The victor held his arm out absorbing the light and the wolf. The man in the cloak stopped dead in his tracks watching the scene unfold before him. Quickly regretting his choice to come here he turned tail but he did not make it far as the victor had managed to appear behind him and grab his long dark cloak.
"And who might you be?"


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|Henri Gomez <henri.go...@gmail.com>
|Re: Creating tomcat VFS
|Fri, 15 Oct 2010 09:55:24 GMT
2010/10/15 Mladen Turk <email@example.com>: > Hi, > > > I'm working for quite some time on the light-weight > VFS layer (with the java.io.* as the only provider at > the moment) to be used as the Tomcat's physical file > system access. The ultimate goal is to be able to run > the Tomcat on top of things like Hadoop or similar distributed > file systems (eg. GFS) by just using the provider module. > > Now, the amount of changes is pretty huge but it involves > mostly changing the java.io.* with the o.a.t.vfs.* > counterparts. > Since this "Pseudo VFS" has exactly the same API > (with the Java7 additions), no functional code change is needed. > Sure there are some additional config directives used > to define which parts are using which vfs provider as default. > (or by just using the > root="file://web/apps" or hdfs://<host>:<port>/web/apps > notion for non-clustered environments) > > I'd like to create a sandbox project for that > (was thinking of /sandbox/tomcat-vfs) > > Comments? Seems to me a good idea, I'm also investigate stuff around VFS and Hadoop. Since the VFS word could be an issue, term should be updated may be (Wrapper FS or whatever), but I like the idea. --------------------------------------------------------------------- To unsubscribe, e-mail: email@example.com For additional commands, e-mail: email@example.com
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text:
For stories I began to read and left reviews, but I haven't finished: sorry, eventually most of them I'll read to the end, but not all.. I lost the track of them... through some unfortunate events...
For my Fav Lists: I really like them all, but don't mistook it as absolute, think of it more as a guide which I think is worth when you're a Tenchi and/or Slayers fan, adding a few others and now more Naruto fics.
Tenchi stories:
Now to my favorit story's: Fate by Nomadicone, its my favorit OVA continutation ( I've seen OVA 3 as well, but I love OVA 2 continutations, I think it will take some time until the first good OVA 3 contis.)
My fav AU story is Purity and Corruption by Kryo2000 , I hope the last chapter will be posted...
Finally I managed to watch Tenchi Universe and I love Tenchi WAKUSEI by Joe Meadows, can't wait for the second book
The first and a special fanfiction is Happiness,Tears and War by Geor-sama, like I said it was the first wich I started to read.
"One of the story's" I really enjoyed are the linked one by SSJ4 BROLI
Slayers stories:
A new addition: high ranked and beloved by me Modern Day I simply read it you will love it too, maybe
The "In..." stories of Kaeru Shisho are the ones which not may appear in my list but are CERTAINLY one of my absolute FAV's.
Pairings I like and normaly read:
Tenchi/"All together"
Pairings which I like but mostly read when couples above are mentioned:
Sasuke/Hinata (fav of fav)
Thats all I wanted to say
Maybe you want to be bothered by a short description of me:
I'm 18 (Öhmm now I'm twenty... damn seems to be a long time since I last updated, and again now I'm almost 24 ), male and living in Germany.
I'm an Anime/Manga/RPG freak. I like to read and sadly have no talent in writing (I think), or at least no drive to write.
For what I'm certainly proud of: my Pen Name, 'cause the first part of it is original in a way and with the fun addition its quite something (the fun addition is of Psychic Academy, as well is the Inspiration of my whole name) :
Ryu Zero Rei Baura Alapa Diil no Zerodyme Cupura pa Azarak Vile Lua Darog
The rest: Sore wa Himitsu desu! .


text: The following is just one section of the larger article. It's about how to grow even hotter chillies than what would normally grow. ======================================== Maximising the heat Some varieties of chilli are naturally hundreds of times hotter than others, but Mark says they all have a "maximum genetic potential" that can be achieved through clever growing techniques. Working with NSW business The Chilli Factory, Mark used liquid runoff from a worm farm to fertilise a particularly spicy chilli known as the Trinidad Scorpion Butch T. Months later, the Butch T claimed the Guinness World Record for the hottest chilli. Like all fertilisers, 'worm juice' is rich in nutrients like phosphorous and nitrogen, but what makes it particularly effective for bringing out the heat are the bodies of insects that have decomposed in the worm farm. "The insects in there are living and dying pretty rapidly, and bits of their shell will break down," says Mark. "When you apply the juice to the plants' roots, they think they're getting eaten by insects." In response, the chillies produce more of their defensive compounds like capsaicin. "It's like getting an injection to boost your immune system," he says. Complete Story


text:
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ZIP inc
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Berkeley, CA
Posted: March 26 2016
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DescriptionJob description
Entry Level to Management Business Development Program
Zip Inc is looking for enthusiastic and ambitious intern to join our growing team in the marketing and sales industry.
About Zip Inc
Zip Inc is one of the fastest growing sales and marketing company in the US. We are looking for ambitious, enthusiastic quick thinking and well-spoken individuals to immediately join our growing company in Berkeley.
What's next for our Entry Level to Management Assistants?
Our expansion plan currently involves us developing our client portfolio with multiple campaigns schedules to launch across the US in 2016. As such, we are looking for interns who want to be part of a young, fast paced company, spear heading its development across the region and providing high quality client services.
We are looking for candidates, who may hold some experience in sales, however experience within the sales or marketing sector are not fundamental as we work with candidates to develop product knowledge and presentation skills.
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The Cosmology of Bing(2001)
A novel by Mitch Cullin
At Eric's Rotisserie, Bing sat outside by himself, nursing white zinfandel beneath the large sunshade that jutted from the center of his table, while blustery wind roamed across campus - swirling dead leaves and bits of trash around the chairs and tables, flapping the awnings on the massive umbrellas. The weather kept the patio abandoned, and Bing preferred it that way - no chatty couples nearby, no loudmouth students talking about sports, or, even worse, popular music. On this chilly afternoon, he didn't care that he was alone. He didn't care that he'd left his coat in his office. And, for a moment, he almost didn't mind that his head wasn't quite screwed on tightly today. In The Cosmology of Bing Mitch Cullin offers a tale of intersecting lives during one school year in Houston: the college student and his artist roommate, the reclusive poet, the astronomer studying a supernova at a remote West Texas observatory, the young Japanese woman hopelessly in love with her gay friend - and at the center of this group is Bing Owen, a college professor who drowns his heartbreak, paranoia, and secret desires with alcohol. It's a darkly humorous novel about longing, buried feelings and muted relationships, forgotten poetry and thrown pies - in which the mysteries of love, the interconnectedness of individuals, and the inexplicable nature of attraction occupy the same microcosm as exploding stars, ghost lights, and specters from the past.
Used availability for Mitch Cullin's The Cosmology of Bing
See all available used copies of this book at Abebooks UK or Abebooks US
Hardback Editions
March 2001 : USA Hardback
|Title: The Cosmology of Bing
Author(s): Mitch Cullin
ISBN: 1-57962-030-2 / 978-1-57962-030-1 (USA edition)
Publisher: Permanent Press (NY)
Availability: Amazon Amazon UK Amazon CA
Kindle Editions
April 2015 : USA, Canada, UK Kindle edition
|Title: The Cosmology of Bing: A Novel
Author(s): Mitch Cullin
Publisher: The Permanent Press
Availability: Amazon Amazon UK Amazon CA
Genre Pages


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DORNIER about to launch brand new website
Gilching, 1.1.2017
2017 will be a total start from scratch for DORNIER Technologie Aviation Services GmbH.
All our developments have taken us to a whole new level of understanding how the market works.
Of course we will continue supporting DORNIER Aircrafts in the future but over the years we did a lot of new things which made us think:


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30k instagram followers need
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text:
In mid-august we decided to take a few days off for some much needed R&R. Our destination of choice was the absolutely beautiful Yosemite park and the nearby Mono Lake.
Being the photo-lovers that we are, it was only natural we were drawn to the strange mineral formations that can be found at Mono Lake. They say winter time changes this place into a more surreal spectacle, but we found plenty to see and enjoy during our time here.
In the nearby vicinity we were also able to see Bodie State Historic park. This is known to be one of the best preserved gold-mining ghost towns in the US. Residents have moved out over 50 years ago, yet the place looks almost the way did it back then.
It was interesting to check out how people lived seemingly not that long ago, yet it feels like a world apart.
One of the highlights for us on this trip was taking a spontaneous stop on a mountain overpass and witnessing one of the most amazing sunsets we've ever seen. It seemed to last and last, with colors changing over and over again throughout the entire sky. It was a humbling moment just to be standing in this sea of red and orange colors wherever we looked.
On the drive back we had one more night which we decided to spend in Yosemite's Tuolumne Meadows. Boy were we glad we stopped by here! This is the one of the largest campsites in the park and it's located on the east side, close to Mono Lake. It was so peaceful, warm, inviting and beautiful :)
Bears are regular visitors to the campsites in Yosemite and for this reason they have special bear-proof food lockers at each campsite. Food is not to be kept in cars or anywhere but in these containers. Apparently, it's a common site to see these big creatures having their way with car doors and windows just to get to the good stuff.
We had so much fun during our small trip out to nature! It's truly a pleasure to get away from our technology-driven worlds once in a while.
Mike and Natasha


text:
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Comic superstar Steve Carell takes on the role of Agent Maxwell Smart and Anne Hathaway steps into the shoes of sexy Agent 99 as the two super spies out to save the world from the nefarious forces of KAOS in this romp based on the classic television show created by Mel Brooks and Buck Henry.


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Product Highlights
The Pivot Tray Flex Arm Adapter from Beneath the Surface enables you to mount any BTS flex arm to a pivot tray assembly. Compatible arms include the FA-16-SOLA, FA-14, FA-14-SEALIFE and FAUK-6. Flex arms permit you to attach accessories such as strobes and other lights, which can enhance your underwater photography.


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Posts Tagged 'breast augmentation'
Mini Tummy Tucks Discovered
Decide on the proper kind of tummy tuck
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A far more contoured physical appearance with the decrease abdomen is generally one among the main positive aspects of the mini tummy tuck this really is accomplished by manipulating the surplus pores and skin and body fat within the naval spot.
The a lot less invasive mini tummy tuck operation is ideally suited to your particular person on the lookout for negligible correction with the least intrusive surgical procedure. Medical center outpatient surgery facilities and business surgical suites are both able of finishing up the mini tummy tuck method. Commonly the selection of anesthesia for the mini tummy tuck procedure can be a typical anesthesia however it is just not uncommon for just a community anesthesia for use with sedation.
The bulk of mini tummy tuck processes rarely prolong past the 1-2 hour mark but personal conditions have been known to warrant a clinic continue to be. Once you surgical treatment you'll truly feel tender and sore as part of your abdomen location due to some inflammation and bruising. This will reduce after a working day or two and any stitches will dissolve leaving just the bandages and any assistance garments to guard the decreased abdomen region. Your progress should be monitored soon after operation within a number of abide by up visits to verify every little thing is ok. Any pain that's evident after the mini tummy tuck procedure might be relieved very easily with orally taken suffering killers.
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Is the CIA evil?
That one guy who kept plagiarizing my reports was evil, but other than him they're not. According to the last two paragraphs of official documents released and declassified 50 years after they wer...
Read More »
How to Act Evil?
Sometimes your day just needs to be a little more evil. Regardless of why you're here, this is what you need.
How to Fight Evil?
So you've labored intensely over, and over, and have come up with that perfect villain. Now you have the question of how does your hero (or heroine) fight that evil? If the evil is defeated too qui...
Read More »
How to Look Evil?
Have you ever wanted to look evil, seductive, wild, and sexy? Read on.
How to Give the Evil Eye?
Have you, like many other people in this world, always wanted to give someone the mysterious evil eye? Perhaps you have tried before, but failed. Or, maybe you've been too afraid to attempt it due ...
Read More »


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A team of professional correspondents and writers are responsible for gathering, writing and producing the Radio News Feature: From Dream to Reality and the Radio magazine: The Villages are Flourishing. The programs focus on the NSP rural development and rehabilitation activities throughout the country. The information is broadcast in various formats, such as feature stories, news magazines and weekly digests. The Radio News Feature: From Dream to Reality is 25 minutes and it contains features, inclusive interviews, roundtable discussions, telephone interviews, news bulletins, stories, articles, educational and informative articles, poems, etc. The program has been on the air since 1st April, 2008 and has broadcast more than 1,599 programs.
The NSP news magazine "The Villages are Flourishing" is five minutes of news programming in Dari and five minutes in Pashto daily, except Fridays and other religious and public holidays. The news magazine has been on the air since September 12, 2005 and has broadcast more than 4,648 programs. All radio materials are narrated by well-known Afghan newscasters in both Dari and Pashto and the program is produced by a technical team of editors, a sound engineer and a producer.
Both programs are broadcast six times every week on Radio Afghanistan on AM 1107 KHz = 272, FM 105.2 MHz. The "From Dream to Reality" is broadcast at 8:30 am while the "Villages are Flourishing Program" is broadcast at 7:55 pm (Pashto Language) at 8:55 pm (Dari Language), except Fridays and other national holidays.
A professional team produces print products, such as: monthly newsletter, photo album, file folder, calendar, brochure on the program's success in the rural areas of Afghanistan and distributed to donors, line ministries, FPs, universities and other stakeholders.


text:
ED Magedson – Founder
Ripoff Report
Angel Steven's Rebate Processing - Angel Stevens Process At Home8721 St Monica Blvd Los Angeles, California U.S.A.
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Obviously, you didn't buy your W100 unless you understood you would be getting power and great value both impeccably combined into one automobile. Dodge automobile owners have come to expect a certain level of dependability when driving their W100 around town. It's not all the time that you realize that you have to buy a replacement Fuel Injector to fix your vehicle. Anyone who drives a Dodge knows that when it comes to repairing their automobile only the highest quality replacement parts will do.
You can't get maximum power and fuel economy together without high-quality engine components. The fuel injectors in your engine meter and distribute the ideal amount of liquid fuel right into the intake manifold so that optimum air/fuel ratios can be achieved. A clogged Dodge W100 fuel injector will create a noticeable lack of power, and could result in other failures. When you need a replacement fuel injector for your Dodge W100 engine, it should be fixed immediately.
Trust in the value of the parts you get from carpartsdiscount.com and realize incredible savings on all your upcoming repairs. When your Dodge needs the best replacement Fuel Injector, there's no need to waste time looking anywhere other than the authority, Car Parts Discount. Ordering new Dodge parts from www.carpartsdiscount.com means you are paying the lowest prices for the highest quality original and aftermarket replacement W100 parts on the internet. Need 1989, 1988 Dodge W100 Fuel Injector parts? We've got them right here.


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Objectives: To review the evidence for the effectiveness of complementary and self-help treatments for depression.
Data sources: Systematic literature search using PubMed, PsycLit, the Cochrane Library and previous review papers.
Data synthesis: Thirty-seven treatments were identified and grouped under the categories of medicines, physical treatments, lifestyle, and dietary changes. We give a description of each treatment, the rationale behind the treatment, a review of studies on effectiveness, and the level of evidence for the effectiveness studies.
Results: The treatments with the best evidence of effectiveness are St John's wort, exercise, bibliotherapy involving cognitive behaviour therapy and light therapy (for winter depression). There is some limited evidence to support the effectiveness of acupuncture, light therapy (for non-seasonal depression), massage therapy, negative air ionisation (for winter depression), relaxation therapy, S-adenosylmethionine, folate and yoga breathing exercises.
Conclusion: Although none of the treatments reviewed is as well supported by evidence as standard treatments such as antidepressants and cognitive behaviour therapy, many warrant further research.
Every year, 5.8% of Australian adults experience a depressive disorder,1 and such disorders are the biggest source of non-fatal disease burden in Australia, accounting for 8% of disability.2 Depressive symptoms that fall short of a diagnosis of a depressive disorder are also very common and are an additional contributor to disability.3
A number of treatments for depressive disorders are supported as effective by evidence-based systematic reviews, and these have been incorporated in clinical practice guidelines. However, it is estimated that only 50% of Australians who are depressed receive an evidence-based professional intervention.4 One possible reason for this is that many Australians state a preference for self-help and complementary therapies for depression.5,6 For example, in a national sample, 57% regarded vitamins, minerals, tonics or herbal medicines as likely to be helpful for treating depression, compared with 29% who regarded antidepressants as likely to be helpful.5 People in the community have also been found to use self-help interventions more commonly than professional treatments when they have anxiety and depressive symptoms. In one survey, the most commonly used self-help interventions over a six-month period were taking alcohol to relax (55% of respondents), taking pain relievers (55%) or becoming involved in physical activity (50%), compared with 35% who consulted a general practitioner, 20% who took antidepressants, and 4% who received psychotherapy.6 Australians also commonly use complementary therapies. It has been estimated that almost half of Australian adults used complementary medicines in the past year and a fifth consulted complementary practitioners.7 Although we do not know how much of this use is attributable to mental health problems, results from surveys in the United States indicate that people who are depressed have a higher use of complementary treatments.8,9
Given their frequent use, complementary and self-help treatments warrant the same degree of evaluation as conventional treatments. The community needs information about which treatments are likely to be effective, which are not, and which have not been adequately evaluated. General practitioners can play an important role in providing guidance.
The purpose of this review is to provide an overview of the evidence on complementary and self-help treatments. We define:
a complementary treatment as one that involves practices and beliefs that are not generally upheld by the dominant health system in Western countries; and
a self-help treatment as one that can be used by a person without necessarily consulting a healthcare professional.
Although some self-help treatments are complementary, others are not (eg, bibliotherapy, exercise). Our review focuses on depressive disorders and depressive symptoms, but excludes bipolar disorder.
Treatments were identified by searching the 21 most popular websites on depression,10 amazon.com's list of the top 25 books on stress management, and treatments mentioned in pamphlets gathered from pharmacists and health food shops. Once the treatments had been identified, PubMed, PsycLit and the Cochrane Library were searched using the following terms: Name-of-Treatment AND (Depressi* OR Dysthym* OR Affective OR Mood). Searches were carried out of literature up to August 2001. Three recent review articles and a book on complementary therapies for mental disorders were also consulted.11-14 Articles were included only if they reported studies of individuals selected to have a depressive disorder or a high level of depressive symptoms. Occasionally, articles on depressive symptoms in non-clinical samples not selected for depression or depressive symptoms are mentioned in the reviews below if they form an important part of the literature. However, they were not used in rating the effectiveness of treatments. Articles on bipolar disorder were excluded.
The evidence was evaluated using the levels of evidence shown in Box 1.15 It should be noted that these levels relate to the quality of the evidence, not the effectiveness of the intervention. A treatment could have been evaluated by rigorous methodologies and found to be ineffective, or, conversely, evaluated by weaker methodologies but found to be highly effective.
For convenience, treatments have been grouped under the categories of medicines, physical treatments, lifestyle, and dietary changes. For some treatments, no evidence regarding effects on depression was available. These treatments are briefly summarised in Box 2.
Extracts of the leaves of the maidenhair tree, Ginkgo biloba, are available in tablet form from health food shops.
Ginkgo biloba has mainly been used for treating impaired cerebral circulation. The symptoms of this condition overlap with some symptoms of depression, suggesting the possible usefulness of ginkgo in depression.16
We found no trials on the treatment of depression with ginkgo. However, one randomised controlled trial has examined ginkgo as a treatment for the prevention of Seasonal Affective Disorder/Winter Type (winter depression).16 No effects were found.
Glutamine is an amino acid. Glutamine supplements are available from health food shops.
Glutamine is a precursor of the neurotransmitter glutamate. There is evidence that the processing of glutamine into glutamate might be affected in depression.17 Glutamine is promoted in health food shops as a "brain food" which gives more energy and improves mood.
Only uncontrolled case studies have been reported to support glutamine as a treatment for depression.18
Homoeopathy is a system of alternative medicine involving administration of substances that are diluted until very little or none of the substance remains.
Homoeopaths see the patient's symptoms as a sign of how the body is helping itself. To assist healing, they administer very diluted substances that produce the same symptoms and further stimulate the body's healing powers.
One placebo-controlled study has been carried out.19 Although this found homoeopathy to be effective for depression, the study's methodology was poor.
Natural progesterone is usually supplied in a cream, but is also available as a suppository. It differs from the synthetic progestogens or progestins. Natural progesterone has received widespread public attention as a result of its promotion in the popular book What your doctor may not tell you about menopause.20 It can be purchased over the Internet.
Progesterone might influence serotonergic function in the brain. It has therefore been postulated that supplementation might be a useful treatment for postnatal, premenstrual, perimenopausal and postmenopausal depression (when progesterone levels are low).
There have been two recent systematic reviews of the effectiveness of progesterone in treating postnatal depression. The first, a Cochrane review, failed to find any studies of acceptable methodological quality.21 The only study of the effectiveness of natural progesterone in postnatal depression22 was excluded on the grounds of insufficient quality. The excluded study found no effect of natural progesterone on postnatal depression. The second systematic review also concluded that there is little evidence to suggest that the hormone was effective, and that the available evidence is of low quality.23 There are no studies of the effectiveness of natural progesterone for perimenopausal, menopausal or premenstrual depression. However, a systematic review of double-blind prospective studies found that natural progesterone does not improve mood in women diagnosed with premenstrual syndrome in general.24
Phenylalanine is an essential amino acid. Phenylalanine supplements are available from health food shops.
A controlled trial found that phenylalanine worked as well as imipramine.25 However, there was no placebo control, so neither treatment may have been effective. Another study found that phenylalanine was more effective than placebo in women with premenstrual depressed mood.26 However, the generalisability to other types of depression is unknown.
S-Adenosylmethionine (SAMe) is an amino acid derivative that occurs naturally in all cells. It is available in tablet form and has recently been approved for use in Australia.
SAMe plays a role in many biological reactions by transferring its methyl group to DNA, proteins, phospholipids and biogenic amines.27 This could result in SAMe indirectly influencing neurotransmitter metabolism and receptor function.
A meta-analysis of six randomised controlled trials found that 70% of subjects showed some response to SAMe, compared with 30% for placebo. Furthermore, pooling of data from seven trials comparing SAMe with tricyclics found no difference.28 Although these results are encouraging, the studies all had small sample sizes and were short term, and there have been no comparisons with the newer antidepressants.
An advantage of SAMe is that it seldom has side effects. However, the Therapeutic Goods Administration has warned that individuals who are using prescription antidepressants for bipolar depression should not use SAMe unless under the supervision of a healthcare practitioner.29
St John's wort (Hypericum perforatum) is a herb available in tablets, capsules and liquid form from supermarkets and health food shops.
St John's wort is a traditional herbal remedy in Europe. Its mode of action is not fully understood, but it appears to inhibit the synaptic reuptake of serotonin, norepinephrine and dopamine.30
A meta-analysis of 27 randomised controlled trials concluded that this treatment is superior to placebo and not different from tricyclic antidepressants in the treatment of mild to moderate depression.31 A meta-analysis of six studies that met stringent methodological criteria concluded that St John's wort is 50% more likely to produce an antidepressant effect than placebo and is equivalent to standard antidepressants.32 The side effects and drop-out rate are lower with St John's wort than with tricyclic antidepressants. Fewer trials have compared St John's wort with the newer antidepressants, but results to date indicate that it is as effective as selective serotonin re-uptake inhibitors.33-35 Although most of the evidence on St John's wort is positive, the largest trial so far found no difference between St John's wort and placebo.36 This study was too recent to be included in the meta-analyses cited above.
Although St John's wort is generally reported to have fewer side effects than antidepressants, the Therapeutic Goods Administration has warned that it can interact with a number of prescription medicines, leading to a loss of therapeutic effect of these medicines. Medicines affected include HIV protease inhibitors, HIV non-nucleoside reverse transcriptase inhibitors, cyclosporin, tacrolimus, warfarin, digoxin, theophylline, anticonvulsants, oral contraceptives, SSRIs and related drugs, and triptans. An information sheet is available for healthcare professionals.37
Selenium is an essential trace element. Selenium supplements are available from health food shops.
It has been suggested that a subclinical deficiency in selenium might affect mood. Some countries have a low level of selenium in the soil, leading to reduced dietary intake. Australia is not one of these countries; New Zealand is.
A double-blind study has found that selenium supplements improve mood in normal subjects, suggesting the possibility of a subclinical deficiency.38 However, there are no reported studies of the effectiveness of selenium supplementation as a treatment for depression.
Tyrosine is an amino acid produced from phenylalanine. Tyrosine supplements are available from health food shops.
One controlled trial has been carried out.39 This trial compared tyrosine with imipramine and placebo and found no evidence that tyrosine had an antidepressant effect.
Vitamins are organic chemicals that are required in small amounts for the proper functioning of the body. They are available from pharmacists, health food shops and supermarkets. They are administered in tablet, capsule or powder form, or by intramuscular or intravenous injection. Vitamins are also present in foods.
It has been suggested that folate and vitamin B12 might facilitate monoamine neurotransmitter synthesis by promoting synthesis of tetrahydrobiopterin, a cofactor involved in converting amino acids to serotonin, dopamine and norepinephrine.40 Folate and vitamin B12 might also facilitate the production of S-adenosylmethionine, leading to an increase in serotonin levels.40 There is less detailed discussion of the proposed mechanisms by which other B vitamins might work. Several B vitamins are involved in amino acid metabolism, and vitamin B6 is involved in the synthesis of serotonin from tryptophan. It is thought some vitamins (eg, the antioxidants) might improve mood by decreasing oxygen free radicals in the brain.41 Vitamin D might affect mood through activational effects on the brain.42 Vitamin D levels decrease during winter, leading to the suggestion that a deficiency in vitamin D might play a role in winter depression.43
Folate. There have been four published, double-blind, randomised-controlled studies of the effectiveness of folate.44-47 Three of these trials (two using intent-to-treat analyses44,45) found that methylfolate/folic acid combined with an antidepressant was more effective than an antidepressant alone,44-46 although in one study the effect was confined to women.44 In another, the effect was observed for clinical outcome scores but not depression scores and included only patients with low folate levels.45 The fourth study (intent-to-treat design) reported that methylfolate is at least as effective as trazadone for patients with a combined diagnosis of Alzheimer's disease and depression, with both groups showing an improvement in depression scores, and 45% of the folate group and 29% of the trazadone group showing a partial or complete response to treatment.47 Positive effects of folate have also been reported for depressed alcoholics and depressed (but otherwise healthy) older people, although in less well controlled studies. In an open pre–post trial (one week placebo washout) of methylfolate with older patients with depressive disorder there was an 81% response rate among completers and a marked decrease in depression scores.48 Similarly, a study using a double-blind, pre–post design with one-week placebo washout reported an improvement in depression among alcoholics with depressive disorder.49
Other B vitamins. There have been three randomised trials of the effectiveness of B vitamins other than folate for depression50-52 and two less well controlled trials. The results of these studies are summarised below.
Vitamin B1. There are no reported controlled trials of the effect of thiamine alone for depressed patients. However, according to one recent review, there is evidence from several double-blind, placebo-controlled studies that thiamine improves mood among people who are not selected for depression.53
Vitamin B6. A randomised controlled trial comparing the effect of vitamin B6 with placebo on the mood of women who reported significant premenstrual mood changes found no effect of B6 on self-reported mood change.52 By contrast, a meta-analysis of 10 studies involving patients with premenstrual syndrome did conclude that vitamin B6 improves mood (odds ratio, 2.12).54 However, the review was not restricted to patients complaining of mood problems, nor was it confined to randomised controlled trials. Two other trials of the effectiveness of B6 for depression did not use a randomised controlled trial design. One used parallel groups and reported that adding B6 to an antidepressant did not confer any additional benefit compared with antidepressants alone.55 Arguably, this two-week trial was too short to permit meaningful conclusions to be drawn. The other study used a placebo-controlled cross-over design and found B6 to be more effective than placebo in women who were B6 deficient and suffering from depression due to the contraceptive pill.56
Vitamin B12. No significant difference between placebo and vitamin B12 was found in a small, short (two-week) randomised controlled trial of the vitamin in people with winter depression.51
Combined B1, B2 and B6. It has been suggested that B vitamins are most effective when taken together. There has been one small, short, randomised controlled trial comparing a combination of B vitamins (B1, B6 and B12) and tricyclic antidepressants with placebo and tricylic antidepressants.50 Although the results were described as containing "promising" trends, the effects on mood were not significant.
Vitamin C. Although it has been suggested that vitamin C may be effective for depression,57 there are no reports of group trials on the effectiveness of ascorbic acid in treating depression.
Vitamin D. In a small, short, single-blind, randomised-controlled trial involving patients with winter depression, depression was alleviated in patients receiving vitamin D but not in those receiving light therapy.43
Vitamin E. There are no reported randomised controlled trials of the effectiveness of vitamin E for depression. In a very small, uncontrolled trial, vitamin E was administered to nine subjects with prolonged major depressive disorder who had responded partially to antidepressants.41 All but one patient had tried at least two antidepressants and there had been no change in the patients' clinical states in the six months preceding the trial. Following the addition of vitamin E, there was a significant improvement in depressive symptoms in the group, and six of the nine patients showed more than 80% improvement in their depression scores.
There is promising evidence relating to the effectiveness of folate for depression, but more research is required to confirm the findings and to identify people for whom it may be indicated (eg, males vs females; younger vs older; alcoholics vs all; augmentation vs primary treatment). There is insufficient good-quality evidence to determine whether other vitamins are effective for depression.
Acupuncture is a traditional Chinese treatment in which needles are inserted at specific points in the body and either manipulated or electrically stimulated (electroacupuncture).
The traditional Chinese theory is that health depends on the balance of yin and yang forces that circulate along channels in the body. Acupuncture corrects imbalances in these forces. Western scientific research with animals has indicated that acupuncture can stimulate the synthesis and release of norepinephrine and serotonin.58
A small, randomised controlled trial compared acupuncture for symptoms of depression, acupuncture for other symptoms (placebo group) and a wait-list control group.59 The specific acupuncture group improved more than the placebo group, but only marginally more than the wait-list group. A larger trial examined the benefits of adding acupuncture to antidepressant medication. Both specific acupuncture and placebo acupuncture added a therapeutic benefit, but did not differ from each other.60 Three controlled trials carried out in China have shown that electroacupuncture is as effective as tricyclic antidepressants.58,61 While two of these studies were double-blind, it is not clear if the third was. The double-blind studies included patients with both unipolar and bipolar depression, complicating the interpretation of the results.
Electrical devices are available to increase the concentration of negative ions in the air. These devices have been used as a treatment for winter depression, but not for other types of depression.
Brain serotonin levels decrease in autumn and winter, which may lead to a propensity to depression. It has been proposed that negative air ions lead to an increase in serotonin levels.
Two randomised controlled trials have compared high-density air ionisation (1 × 104 ions/cm3) with low-density air ionisation (2.7 × 106 ions/cm3) for winter depression.62,63 Patients were exposed to an air ioniser at home for 30 minutes each morning over 2 to 3 weeks. These studies found that high-density air ionisation was more effective than low-density ionisation. No studies have been carried out on the effectiveness of air ionisation for other types of depression.
Patients are exposed to a bank of bright lights for about an hour a day. They can read or do other activities during the period of exposure, provided the light is within their visual field. An early morning walk also gives sufficient light exposure, even on overcast winter days.64
Exposure to bright light is used as a treatment for winter depression. Light therapy has also been proposed for non-seasonal depression. The reduced availability of sunlight in winter is hypothesised to cause a phase delay in the circadian rhythm, which in some people leads to depression. Exposure to light in the morning produces a phase advance and relieves the depression.
A series of well-controlled trials has shown that light therapy is effective for winter depression, particularly if given in the early morning.65-67 A meta-analysis of trials showed that the brighter the light, the better the response.68 A review of trials of light therapy with non-seasonal depression also showed positive effects, although the evidence is more limited.69
Massage therapy involves "the manipulation of soft tissue by trained therapists for therapeutic purposes".70
Massage therapy has ancient origins. Researchers have proposed two mechanisms for an effect in depression:
massage shifts electroencephalogram activation from a right frontal pattern (associated with sad affect) to a left frontal or symmetrical pattern (associated with happy affect);
massage increases vagal activity and stimulates facial expressions and vocalisations which contribute to less depressed affect.70
Two randomised controlled trials have been carried out. In one, depressed children and adolescents either received massage over five days or viewed relaxing videotapes.71 The massage group improved more on depressed mood and anxiety. In the second study, depressed adolescent mothers were randomly assigned to massage therapy or relaxation therapy over a five-week period.72 Only the massage group showed a reduction in depression. Neither study assessed whether massage therapy had longer-term effects.
Essential oils of plants can be heated to diffuse in a room or used as components of massage oils. The essential oils proposed for use in depression include bergamot, geranium, German chamomile, lavender and rosemary.73
Case reports of aromatherapy in depression, but no controlled trials, have been reported.74
A person receives a standardised treatment in book form and works through it independently. Most bibliotherapy uses cognitive behaviour therapy.
Cognitive behaviour therapy is usually administered by a professional therapist. It involves the therapist teaching the patient strategies for controlling negative emotions and practising these in daily life. Meta-analyses of randomised controlled trials show that it is effective for treating anxiety and depression. Cognitive behavioural bibliotherapy tries to impart these same strategies using a standard manual.
A meta-analysis of six studies evaluating a range of books found that bibliotherapy is superior to no treatment for depression.75 On measures of depressive symptoms, treated individuals averaged 0.82 standard deviation units above wait-list controls (individuals placed on a treatment waiting list). Bibliotherapy was as effective as individual or group therapy in the four studies that examined this comparison. Most studies used small samples. Participants were recruited usually by media announcements, and therapists maintained minimal contact. Two more recent studies76,77 support the findings of the meta-analysis. In the first, people from the community with depressive symptoms and who met criteria for major depressive disorder were compared with a wait-list control group. There were significant improvements in depressive symptoms and dysfunctional thoughts. A follow-up study reported that the effects were maintained over a three-year period. The second study77 examined the efficacy of bibliotherapy in 30 adolescents using a cross-over design. The intervention was found to significantly reduce symptoms and lead to clinically significant levels of change. Bibliotherapy does not lead to a greater dropout rate compared with other interventions.78
This treatment looks promising, but there is a need for further studies comparing it with standard professional treatments. Bibliotherapy has not been tested on people with severe depression (these participants have been actively excluded) or people seeking help in a clinical setting. A high reading level is required for a number of the self-help books. Specific books with evidence to support them are Control your depression79 and Feeling good: the new mood therapy.80
Dance and movement therapy is a professional treatment provided by dance therapists in which patients are encouraged to express themselves in movement. Dance and movement can also be used as a self-treatment.
Expression of feelings in movement is thought to be beneficial for mood. However, no specific mechanism has been proposed. Dance and movement involve physical exercise, which may in itself be beneficial, as well as group interaction and listening to music.
One trial has examined the effectiveness of this treatment with depressed people.81 It randomly assigned depressed patients to receive treatment on some days and not on others. Mood was compared on treatment versus no-treatment days for each of 12 patients. Some patients were found to have better mood on treatment days. However, long-term effects on depression were not studied.
Psychologically based explanations suggest that exercise might interrupt dysfunctional thoughts, serve to distract negative thoughts, or, if the exercise programs are supervised or conducted in groups, increase social interaction. Exercise may increase levels of the monoamine neurotransmitters that mediate stress and depressive reactions. Strenuous exercise may release endorphins, which have "morphine-like" qualities. Fitness levels are lower in depressed individuals. Therefore, it has been argued that increased aerobic fitness may directly lift mood.
Three meta-analyses of the effects of exercise on mood are available. The first two do not address specifically whether exercise is effective in clinically depressed individuals, nor do they provide clear outcomes separately for randomised controlled trials in depressed subjects.82,83 A more recent review specifically examined the effectiveness of exercise in depression.84 This review identified 11 studies which compared exercise with "no treatment". Two of these reports were conference abstracts and two were doctoral dissertation studies. The mean difference in effect size for the studies was – 1.1 standard deviation units (95% CI, – 1.5 to – 0.6). However, three of these studies85-87 evaluated exercise as an adjunct to standard treatment or permitted the continuation of antidepressant medication/psychotherapy. As a result, the effects of exercise may have been underestimated. Our search of published reports where antidepressant or adjunctive treatment was not permitted identified seven studies using randomised controlled trials to evaluate exercise that used clinically depressed groups.87-93 Six of these were included in the earlier review, but one study92 is additional. Two studies included in the earlier review were excluded from our analysis because they included adjunctive treatments.85,86 Five of the seven randomised controlled trials88-92 compared exercise with a no-treatment control, and all found exercise (jogging, running, walking, progressive resistance training, bicycling) to be superior. Exercise was more effective than relaxation88 in one study, but not in another.87 In other studies, exercise was more effective than light therapy (for non-seasonal depression),92 and as effective as social contact90 and antidepressants.93 Follow-up findings from the latter study indicate that individuals who benefited from exercise at four months had significantly lower relapse rates than individuals who took antidepressant medication.94 One study that directly compared two types of exercise found no difference between weightlifting and running.89
The authors of the earlier review84 concluded that the effects of exercise might be overestimated, as many individuals who were not motivated to exercise may have been screened out, people with depression were recruited from the community rather than from clinics, and outcomes were expressed in terms of change in symptoms rather than shifts in diagnosis. They concluded "it is not possible to determine from the available evidence the effectiveness of exercise in the management of depression". In our view, this is a conservative interpretation. Further randomised controlled trials, particularly in younger people and using intent-to-treat analyses, are needed, as three of the seven articles we reviewed used older people.90,91,93 However, given the large effect sizes reported in these trials, the recent evidence that the effects of exercise persist at follow-up94,95 and the consistency of positive findings in studies excluding potentially effective treatments as "control treatments" we conclude that the use of exercise for depression is supported by the available evidence.
A healer meditates on the ill individual. The healer does not have to meet the ill person.
Lawrence LeShan, a psychologist, has developed a theory that healing occurs naturally when the healer is in an altered state of consciousness, often achieved through meditation.
There is one randomised, double-blind trial examining LeShan distance healing as an adjunct to psychiatric treatment for major depression.96 No significant effect was found, but the study lacked the statistical power to detect a small effect.
There are many types of meditation, but all involve focusing attention on something, such as a word, a phrase, an image, an idea or the act of breathing. For some people, meditation is a spiritual activity and they use appropriate thoughts as the focus of their meditation. However, meditation can be used as a relaxation method without any spiritual goal.
Meditation is usually advocated for "stress" or anxiety rather than depression. However, because anxiety is often comorbid with depression, it could have a therapeutic role.
There is one randomised controlled trial on meditation as a treatment for depression.87 This trial compared meditation with physical exercise and group therapy and found little difference between these treatments. However, there was no comparison with no treatment or placebo.
Music is hypothesised to have effects on frontal and limbic system functioning, although the mechanisms are unknown.97,98
Randomised controlled trials of the acute effect of music on mood in depressed patients have found no effects.97,98 However, a controlled trial of music therapy which incorporated elements of cognitive behaviour therapy (a known effective treatment) did find a beneficial effect on depressive symptoms. There is also a Chinese study reporting a more rapid response in depressed patients exposed to music combined with antidepressants compared with patients receiving antidepressants alone, but the details of the method are not available in English.99
Pet ownership is promoted in the media as good for health. Regular exposure to pets is used as a therapy for people living in long-term care.
Social support is thought to be beneficial for depressed people. Animals have the potential to have a similar effect to human social support.
Few randomised controlled trials have been carried out with depressed people and all have had methodological weaknesses. One trial with psychogeriatric inpatients found no therapeutic benefit, but it gave exercise (a possibly active treatment) to the control group and did not specifically analyse the results for the depressed subgroup.100 Another negative study involved hospitalised psychiatric patients, but evaluated anxiety symptoms rather than depression as the outcome.101 A third trial with depressed students did find benefits, but did not use random assignment and the control group had lower depression initially.102 All studies have looked only at the short-term benefits of pet therapy rather than at the long-term benefits of pet ownership. There have been cross-sectional studies of the association between pet ownership and depressive symptoms in the general population, but these studies cannot determine cause and effect.
The depressed person identifies activities they find pleasant and does them more frequently.
Depressed people have been observed to engage in a lower rate of pleasant activities. Therefore, engaging in a higher rate might improve their mood.
Encouraging a depressed person to engage in pleasant activities is a common component of cognitive behaviour therapy, which is one of the best treatments for depression. However, there has been little research into this component on its own. One randomised controlled trial found that scheduling pleasant activities helped relieve depression as much as cognitive behaviour therapy and interpersonal skills training. Furthermore, immediate treatment with pleasant activities produced a quicker response than delayed treatment.103 However, a series of case studies using an interrupted time series design found that increases in pleasant activities did not affect mood.104
Relaxation therapy refers to a number of techniques designed to teach a person to relax voluntarily. Most techniques evaluated with depression involve progressive muscle relaxation.
Relaxation therapy is primarily designed to reduce anxiety, but has been used with depression because of the high comorbidity of anxiety and depression.
Seven small, controlled trials have been carried out on relaxation therapy with depression. These have found relaxation therapy to be better than no treatment,88,105-107 as good as tricyclic antidepressants108,109 and cognitive behaviour therapy,105,106,109 or less effective than exercise.88 Relaxation therapy combined with antidepressant medication has been found to be more effective than medication alone.110
Yoga is often used for relief of stress and anxiety. Given the comorbidity of anxiety and depression, it may have a role in treatment of depression.
Two randomised controlled trials have been carried out on the use of yogic breathing exercises in depression. One compared yogic breathing with no treatment in students who had a high level of depressive symptoms.111 After training, the students were instructed to practise for 30 minutes each morning for 30 days. The treated group was found to improve significantly more than the control group. In the second study, hospitalised patients with melancholic depression were randomly assigned to receive training in yogic breathing, electroconvulsive therapy (ECT) or imipramine.112 All groups were found to improve, with the greatest improvement after ECT. Yogic breathing did not differ from imipramine. This study did not have a placebo or no treatment control group.
Drinking alcohol is common in many countries and features in celebrations and other social occasions.
Heavy drinkers, and especially those with alcohol-misuse or dependence disorders, have an increased risk of suffering from depression. There are two main ways in which reducing alcohol intake might help:
heavy alcohol consumption might lead directly to depression, and so avoiding alcohol would reverse this effect; and
avoiding alcohol could help by reducing problems caused by drinking (eg, financial, occupational, relationship and health problems).
There have been no controlled trials of reducing alcohol intake in heavy drinkers with depression. However, studies of patients admitted to alcohol treatment programs show very high rates of depression initially and a very rapid decline in depressive symptoms following cessation of alcohol.113,114 The rate of recovery is much greater than seen in patients with depression unrelated to alcohol use.
Drinking alcohol is common in many countries and features in celebrations and other social occasions.
It has been suggested that alcohol has stress-buffering properties.115,116 Some recent surveys have shown that moderate drinkers have lower levels of depressive symptoms than non-drinkers, but the reasons for this are not known.117-119
There have been no controlled trials of using alcohol for treating depression. Experimental studies with normal populations have shown that alcohol has mood-enhancing effects, but many factors are involved, including the quantity consumed, individuals' past experience of drinking, and the circumstances in which drinking takes place.120,121
It has been proposed that some individuals have a sensitivity to caffeine which leads to depression.122 These people tend to have a particular constellation of symptoms (see Sugar avoidance). There is also some evidence that caffeine can increase anxiety in individuals who experience panic attacks.123 Because anxiety disorders often co-occur with depression, caffeine avoidance may confer an indirect benefit by relieving anxiety.
One small, randomised controlled trial has been carried out on patients whose depression was thought to be due to dietary factors.122 Patients were randomly assigned either to avoid sugar and caffeine or (as a control) to avoid red meat and artificial sweeteners. Patients assigned to avoid sugar and caffeine showed significantly greater improvement in depressive symptoms. Ten patients were assigned to sugar and caffeine avoidance, and subsequent testing indicated that three were sensitive to caffeine. There is no evidence on whether caffeine avoidance helps most people with depression.
Fish, particularly oily varieties, are a natural source of omega-3 fatty acids. Fish oils are also available in capsule form as dietary supplements.
Polyunsaturated fatty acids are important in nervous system function and fish oils are a major dietary precursor. Low plasma concentrations of a fatty acid found in fish have been associated with low concentrations of a serotonin metabolite in cerebrospinal fluid.124 Low concentrations of this metabolite have in turn been associated with depression and suicide.
Countries with a low level of fish consumption have been reported to have a higher prevalence of major depression.124 A number of studies have reported a reduced level of omega-3 fatty acids in the plasma or red blood cells of depressed patients.125 There are no randomised controlled trials of fish oils as a treatment for unipolar depression. However, there is a randomised trial of omega-3 fatty acids in bipolar disorder; this reported positive effects.126
Reducing the amount of sucrose in the diet has been proposed to help alleviate depression in some people.
It has been proposed that some individuals have a sensitivity to sucrose which leads to depression.122 These individuals are said to have symptoms such as feeling fatigued, moody and depressed, with many having headaches, sleeping more than usual, and feeling tense and irritable. Some of these symptoms (eg, sleeping more) are atypical for depression.
One small, randomised controlled trial has been carried out on patients whose depression was thought to be due to dietary factors.122 Patients were randomly assigned either to avoid sugar and caffeine or (as a control) to avoid red meat and artificial sweeteners. Patients assigned to avoid sugar or caffeine showed significantly greater improvement in depressive symptoms. Ten patients were assigned to sugar and caffeine avoidance, and subsequent testing indicated that four were sensitive to sugar. There is no evidence on whether sugar avoidance helps most people with depression. On the contrary, there is some evidence that carbohydrate intake has a short-term effect of improving mood.53
The complementary and self-help treatments with the best evidence of effectiveness are St John's wort, physical exercise, self-help books involving cognitive behaviour therapy, and light therapy for winter depression. However, none of these has as much support as antidepressants or face-to-face cognitive behaviour therapy, both of which are standard treatments recommended in clinical practice guidelines.127 For example, according to recent meta-analyses, newer antidepressants have been tested on more than 30 000 participants in 315 trials128 and cognitive behaviour therapy on 2765 participants in 48 trials.129 By contrast, St John's wort has been tested on 2291 participants in 27 trials,31 exercise on 724 participants in 14 trials,84 and self-help books involving cognitive behaviour therapy on 273 participants in six trials.75 Furthermore, while there are some well-designed studies on these complementary and self-help treatments, in general the reported studies are of poorer quality, with common deficiencies being small sample sizes, short follow-up periods, lack of blinding, and failure to use intent-to-treat analysis. We also know little about how some of these self-help treatments perform in special populations such as children and adolescents, the elderly, and perinatal women.
There are a number of other complementary and self-help treatments which have limited evidence to support their effectiveness: acupuncture, light therapy (for non-seasonal depression), massage therapy, negative air ionisation (for winter depression), relaxation therapy, SAMe, folate and yoga breathing exercises. Some of these treatments might be effective, but they have received very little research attention. Research on the effectiveness of treatments for depression has tended to focus on a small number of standard treatments and needs to be broadened, particularly in view of the public's more favourable attitudes to some non-standard treatments.
Although some complementary and self-help treatments may be useful, the available evidence is almost entirely confined to patients with mild to moderate depression. However, mild to moderate depression is more prevalent in the community than severe depression. According to data from the National Survey of Mental Health and Wellbeing,1 the prevalences are 4.4% for mild to moderate and 2.3% for severe depression. For severely depressed people, only conventional medical treatment is supported by evidence.
Given the frequent use of complementary and self-help treatments, it would be prudent for GPs and others treating depressed patients to routinely inquire about the use of these other treatments. An important reason is to prevent potentially harmful interactions with conventional treatments. The Therapeutic Goods Administration has already issued warnings about the use of St John's wort and SAMe in conjunction with some prescribed medications, and there might be unknown interactions with other complementary medicines.
Another reason to inquire about use of complementary and self-help treatments is to educate patients to make better choices. If patients wish to use such treatments, it is preferable that they use those best supported by evidence. To assist the education of the public about evidence-based treatments, a consumer guide to treatments for depression is available as a companion to this review.130
1: National Health and Medical Research Council (NHMRC) levels of evidence15
Evidence obtained from a systematic review of all relevant randomised controlled trials
Evidence obtained from at least one properly designed randomised controlled trial
Evidence obtained from well-designed pseudorandomised controlled trials (alternate allocation or some other method)
Evidence obtained from comparative studies (including systematic reviews of such studies) with concurrent controls and allocation not randomised, cohort studies, case-control studies, or interrupted time series with a parallel control group
Evidence obtained from comparative studies with historical control, two or more single-arm studies, or interrupted time series without a parallel control group
Evidence obtained from case-series, either post-test, or pretest/post-test
No evidence or minimal evidence such as testimonials
* We have added Level V to the NHMRC scheme to allow for even weaker types of evidence
2: Treatments for which there is no evidence evaluating effects on depression
Description and rationale
The roots of ginseng plants, or preparations of them, are used to improve energy levels and vigour. Ginseng is held to help the body cope with stress through its effects on the adrenal gland.
Lemon balm
This member of the mint family has been used traditionally for a number of medicinal purposes, including sedative and antidepressant effects.
Although there is no sound rationale for expecting painkillers to be helpful, many people report taking them when they feel depressed. Codeine (a narcotic), in higher doses, does have some mood-enhancing properties, and there has been speculation that aspirin could have beneficial mood-modulating effects.
The aerial parts of this flowering plant are a traditional herbal remedy and have been used for treating depression.
Colour therapy
It has been proposed that colours in the environment can affect the mood of someone who is depressed.
Prayer is a traditional way of relieving illness and is often used by the public for mental health problems.
Dietary changes
Chocolate has several properties that could affect mood. It has a high carbohydrate content (hypothesised to increase serotonin production), contains several psychoactive substances (phenylethylamine, caffeine and theobromine, anandamide analogues), and has pleasant sensory characteristics (hypothesised to stimulate the release of endorphins).


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Stars do the Mobot for Mo Farah's charity Christmas song
The 41 Most Memorable Moments From The London 2012 Olympics!
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Wowsers! This is page is old, head to the LIVE Planet PDF Forum. It features more than 10 conferences, covering everything from beginner to in-depth developer and pre-press discussions. If you wish to continue... one & two archive covers 1999-2011 (160,000 pages).
New Forum | Previous | Next | (P-PDF) Mac Issues
Topic: Can't edit original
Conf: (P-PDF) Mac Issues, Msg: 114233
From: scottws
Date: 6/26/2004 04:04 AM
Acrobat 6.02 Professional, Mac OS 10.3.4, Adobe CS Suite
When I control click on a graphic in Acrobat, it will launch either Photoshop CS or Illustrator CS, as I defined in Preferences, but no graphic is opened. Here is how I am trying to to do this.
1. Use Touchup object tool on advanced editng toolbar.
2. Option>click on image.
3. Popup gives me choices including Edit Image.
4. When I select this photoshop (or illustrator, depending) is launched.
5. No file opens up.
Also - file looks fine when rasterized. No layer warning message in Acrobat. I can cut and copy the picture, but not paste it.
The ultimate plug-in for Adobe Acrobat. Advanced splitting, merging, stamping, bookmarking, and link...Download free demo
It's simple to use and will let you preview and edit PDF files, it's a Windows application that makes...Download free demo
Planet PDF talks with another Master of the PDF Universe, Eugene Y. Xiong, Founder and Chairman of the Board at Foxit Software Inc. in Fremont California. Xiong is a quiet yet astounding achiever, you (usually) won't find him talking at conferences, exhibits, or publishings, but what you will find is the result of his leadership in places you would never expect.
The ultimate plug-in for Adobe Acrobat. Advanced splitting, merging, stamping, bookmarking, and link control. Take Acrobat to the next level.
OK, so you want to stamp your document. Maybe you need to give reviewers some advice about the document's status or sensitivity. This tip from author Ted Padova demonstrates how to add stamps with the Stamp Tool along with related comments.
To connect, read Foxit's Blog and Debenu's Blog, follow Foxit Software on Twitter, or join the Foxit Software's LinkedIn group. Planet PDF, Debenu Quick PDF Library - Foxit PDF SDK and Debenu PDF SDK are all © 2016 Foxit Software and Debenu Pty Ltd . All rights reserved. Privacy
To connect, read Foxit's Blog, follow Foxit Software on Twitter, or join the Foxit Software's LinkedIn group. Planet PDF, Debenu Quick PDF Library - Foxit PDF SDK and ARTS PDF are all © 2016 Foxit Software. All rights reserved. Privacy


text:
Get an overview of this hotelHotel in Gap with free parking
Collect 200 Nectar points!
Simply enter your Nectar card number when you check out. Your points will be credited 35 days after you return from your trip.*Offers may apply
Popular property highlights
Situated in Gap, this hotel is 2 mi (3.3 km) from Gap Cathedral and within 6 mi (10 km) of Paradrenalin and Alpin Flying Club. Gap Bayard Golf Club and La Chevrerie de Ceuze are also within 12 mi (20 km).
Along with a restaurant, this hotel has meeting rooms and tour/ticket assistance. Free WiFi in public areas and free self parking are also provided. Other amenities include barbecue grills.
Hotel Features
All 42 soundproofed rooms feature free WiFi and room service. Satellite TV and showers are among the other amenities available to guests.
Room AmenitiesInformation missing or incorrect? Tell us!Opens in a new window
P'tit Dej-Hotel Gap Le Pré Vert
Hotel Amenities
Hotel Amenities
The hotel offers a restaurant. Public areas are equipped with complimentary wireless Internet access. This Gap hotel also offers a terrace, tour/ticket assistance, and barbecue grills. Onsite self parking is complimentary.
- Total number of rooms - 42
- Number of floors - 4
- Barbecue grill(s)
- Breakfast available (surcharge)
- Front desk (limited hours)
- Tours/ticket assistance
- Free WiFi
- Meeting rooms
- One meeting room
- Terrace
- Restaurant
- Free self parking
- Conference space size (feet) -
- Number of buildings/towers - 1
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Free self parking
Room Amenities
- Soundproofed rooms
- Private bathroom
- Shower only
- Satellite TV service
- Free WiFi
- Room service
Where to Eat
Continental breakfasts are available for a surcharge and are served each morning between 7:00 AM and 10:00 AM.
Onsite venue - This restaurant specializes in regional cuisine and serves breakfast, lunch, and dinner. A children's menu is available.
Room service is available.
Nearby Things to Do
- Golfing nearby
If you have requests for specific accessibility needs, please note them at check-out when you book your room.
- In-room accessibility
Hotel Policies
Check-in time starts at 4 PM
Check-in time ends at 10:00 PM
Check-out time is 11:00 AM
Payment types
Children and extra beds
- Children are welcome.
- Pets allowed for an extra charge of EUR 9 per pet
You need to know
Extra-person charges may apply and vary depending on property policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
24-hour check-in
Optional extras
- Fee for continental breakfast: EUR 8.50 for adults and EUR 4 for children (approximately)
- Pet fee: EUR 9 per pet
Hotel Name
- Pré Vert Gap
- Pré Vert Hotel
- Pré Vert Hotel Gap
- P'tit Dej-Hotel Gap Pré Vert Hotel
- P'tit Dej-Hotel Pré Vert Hotel
- P'tit Dej-Hotel Gap Pré Vert
- P'tit Dej-Hotel Pré Vert


text: India's contribution to the rest of the world "India is the cradle of the human race, the birthplace of human speech, the mother of history, the grandmother of legend, and the great grand mother of tradition. Our most valuable and most constructive materials in the history of man are treasured up in India only" Mark Twain "India was the motherland of our race and Sanskrit the mother of Europe's languages. India was the mother of our philosophy, of much of our mathematics, of the ideals embodied in christianity... of self-government and democracy. In many ways, Mother India is the mother of us all." - Will Durant - American Historian 1885-1981 "If there is one place on the face of this Earth where all the dreams of living men have found a home from the very earliest days when Man began the dream of existence, it is India." Romain Rolland - French Philosopher 1886-1944 "We owe a lot to the Indians, who taught us how to count, without which no worthwhile scientific discovery could have been made" Albert Einstein "India conquered and dominated China culturally for 20 centuries without ever having to send a single soldier across her border." Hu Shih, former Ambassador of China to USA "Many of the advances in the sciences that we consider today to have been made in Europe were in fact made in India centuries ago" Grant Duff British Historian of India India never invaded any country in her last 10,000 years of history. India invented the Number System. Zero was invented by Aryabhatta. The place value system, the decimal system was developed in India in 100 BC. This method of graduated calculation was documented in the Pancha-Siddhantika (Five Principles) in the 5th Century But the technique is said to be dating from Vedic times circa 2000 B.C. The value of pi was first calculated by Budhayana, & he explained the concept of what is now known as the Pythagorean Theorem British scholars have last year (1999) officially published that Budhayan's works date back to the 6th Century, which is long before the European mathematicians Algebra, Trigonometry & Calculus came from India. Quadratic equations were by Sridharacharya in the 11th Century The largest numbers the Greeks and the Romans used were 10**6(10 to the power of 6) whereas Hindus used numbers as big as 10**53(10 to the power of 53) with specific names as early as 5000 BCE during the Vedic period Even today, the largest used number is Tera 10**12(10 to the power of 12) The World's first university was established in Takshila in 700BC. More than 10,500 students from all over the world studied more than 60 subjects. The University of Nalanda built in the 4th century BC was one of the greatest achievements of ancient India in the field of education. Sanskrit is the mother of all the European languages. Sanskrit is the most suitable language for computer software reported in Forbes magazine, July 1987. According to the Forbes magazine, Sanskrit is the most suitable language for computer software Bhaskaracharya calculated the time taken by the earth to orbit the sun hundreds of years before the astronomer Smart. Time taken by earth to orbit the sun: (5th century) 365.258756484 days Ayurveda is the earliest school of medicine known to humans.Charaka, the father of medicine consolidated Ayurveda 2500 years ago. Today Ayurveda is fast regaining its rightful place in our civilization. The art of Navigation was born in the river Sindh 6000 years ago. The very word Navigation is derived from the Sanskrit word NAVGATIH. The word navy is also derived from Sanskrit 'Nou'. According to the Gemological Institute of America, up until 1896, India was the only source for diamonds to the world. Chess (Shataranja or AshtaPada) was invented in India Sushruta is the father of surgery. 2600 years ago he and health scientists of his time conducted complicated surgeries like cesareans, cataract, artificial limbs, fractures, urinary stones and even plastic surgery and brain surgery. Usage of anesthesia was well known in ancient India Over 125 surgical equipment were used Deep knowledge of anatomy, physiology, etiology, embryology, digestion, metabolism, genetics and immunity is also found in many texts The earliest reservoir and dam for irrigation was built in Saurashtra When many cultures were only nomadic forest dwellers over 5000 years ago, Indians established Harappan culture in Sindhu Valley(Indus Valley Civilization) Want to know more??? India's Contribution to Production Technology and Mechanical Engineering In ancient times, commodities like sugar, palm oil, coconut oil, cotton cloth, clarified butter, cast iron, tin sheets, copper vessels, dyes and pigments like cinnabar (ochre), indigo and lac, perfumes like sandalwood oil, musk tamarind, costus, macir, camphor, and even crude glass crockery were being exported from India The earliest recorded use of copperware in India has been around 3000 B.C. The findings at Mohen-jo-daro and Harappa, bear this out The earliest documented observation of smelting of metals in India is by Greek Historians in the 4th Century B.C India's Contribution to ASTRONOMY "In India I found a race of mortals living upon the Earth. but not adhering to it. Inhabiting cities, but not being fixed to them, possessing everything but possessed by nothing". Apollonius Tyanaeus Greek Thinker and Traveller 1st Century AD In India the first references to astronomy are to be found in the Rig Veda which is dated around 2000 B.C The Calculation of Eclipses And The Earth's Circumference The Heliocentric Theory of Gravitation This fascmile is from the Panchasiddhantika (Five Principles) dated around the 5th century. This text graphically shows how eclipses are to be calculated. Thus this text foreshadows what Westeren Astronomers propounded nearly one thousand years later India's Contribution to – PHYSICS & CHEMISTRY "Ancient Indian theories lacked an empirical base, but they were brilliant imaginative explanations of the physical structure of the world, and in a large measure, agreed with the discoveries of modern physics" A.L. Basham, Australian Indologist The Five Basic Physical Elements Anu & Parmanu Indian Ideas on Atomic Physics India's Contribution to MEDICAL SCIENCE "In the great teaching of the Vedas, there is no touch of sectarianism. It is of all ages, climes and nationalities and is the royal road for the attainment of the Great Knowledge" Thoreau, American Thinker SHASTRAKARMA THE ART OF SURGERY AYURVEDA THE SCIENCE OF LONGEVITY OF THE BODY AND MIND India's Contribution to THE FINE ARTS "If I am asked which nation had been advanced in the ancient world in respect of education and culture then I would say it was – India" Max Muller German Indologist MUSIC PAINTING LINGUISTICS DANCE THEATRE SPORTS AND GAMES - In Ancient India Chess, Snakes and Ladders, Playing Cards, Polo, the martial arts of Judo and Karate India's Contribution to – PHILOSOPHY "In religion, India is the only millionaire .... The One land that all men desire to see and having seen once, by even a glimpse, would not give that glimpse for all the shows of all the rest of the globe combined". Mark Twain, American Author 1835-1910 MEDITATION AND RENUNCIATION AHIMSA - NON VIOLENCE RELIGIOUS TOLERANCE CURRENT INFORMATION: There are 3.22 Million Indians in America. 38% of Doctors in America are Indians. 12% of Scientists in America are Indians. 36% of NASA employees are Indians. 34% of MICROSOFT employees are Indians 28% of IBM employees are Indians 17% of INTEL employees are Indians 13% of XEROX employees are Indians First democracy to elect a woman Prime Minister. India is the 7th nuclear power in the world India is the 5th largest economy in the world India is the largest democracy in the world India has the 2nd largest population in the world(could be a bad point) India is the 4th nation in the world to have developed/or developing a nuclear submarine India is the 5th nation in the world to be in the multi billion dollar space commerce business. India is the 4th nation in the world to develop(or nearly to) ICBM's(can travel up to 14,000km) India is the 3rd nation in the world, to be able to develop land based and sea based cruise missiles Human excellence depends on development of culture World's first culture (Yajurveda 7/14: Sa Prathama Sanskriti Vishwara) Many small civilizations were formed but were confined to small regions. Only Indian culture can be called as first world culture. Indian Culture = Human Culture Culture that focuses on inculcating human values in a man Unique features of Indian Culture 1. Freedom of thought - Every thought is allowed to develop freely. - Theist & Atheist - Vedanta speaks of soul as image of the Supreme - Everyone is free to imagine and accept God's form according to one's beliefs. - Every thought school is part & parcel of Indian Culture. - A garden has variety of flowers and plants. These differences increase the beauty of the garden 2. Theory of Karmaphal - Rebirth 3. Idealistic families 4. Abundance of saints & reformers. 5. Division of society order (based on personal choice, interest, capabilities) & personal life for personal development, for development of society It is already becoming clearer that a chapter which has a western beginning will have to have an Indian ending if it is not to end in the self-destruction of the human race... At this supremely dangerous moment in history the only way of salvation for mankind is the Indian Way" Dr. Arnold Toynbee British Historian 1889-1975 Mera Bharat Mahan Prepared by : Bhaskar Pindiprolu email@example.com +91-9290460866/9291551290


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