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Dosage is a key issue whatever the intervention.

Posted by sylvia16 on 01 Oct 2013 at 09:06 GMT

With any therapeutic intervention it is important to consider what might be the optimal dosage level, in this the case number of sessions of acupuncture or counseling. It is quite possible for a trial to be biased by prematurely terminating therapy and privileging one type of care over another - when therapies work in different ways. Here we have a population with (mostly) high levels of chronic and severe illness. The development of the acupuncture protocol was not specifically for this patient group. It is arguable whether such short courses of treatment were worthwhile investigating given existing knowledge about counseling, and it seems probable that a longer course of treatment might have had better results and more long lasting effects. Protective benefits are also an important consideration in an episodic condition such as depression and should be investigated - but if the initial course of therapy was rather inadequate the treatment is less likely to have sustained benefits. The finding that acupuncture patients took less analgesics is an interesting one given the high levels of pain co-morbidity in depressed populations. This trial certainly adds to knowledge.

Competing interests declared: I conducted the preparatory research for this trial for my PhD and wanted to see longer courses of treatment investigated in the full scale trial, which I was not involved with.

RE: Dosage is a key issue whatever the intervention.

TrialManager replied to sylvia16 on 07 Nov 2013 at 12:05 GMT

In reply to the comments of sylvia16, we firmly reject any suggestion of bias with regards to our research. Participants allocated to either acupuncture or counselling were offered exactly the same number of ‘treatment’ sessions. The number of counselling sessions offered to research participants was twice that of routine NHS care. Statistical adjustments were also specified in advance to account for any differences in contact time and empathy between practitioners.

Sylvia16 has quite rightly declared a conflict of interests in this matter. We therefore feel it would be inappropriate to comment further.

Dr S J Richmond - Trial Manager
On behalf of the ACUDep Trial Team

No competing interests declared.