Depression is the third most common reason for primary care consultations, and the cost to the economy is set to exceed £9 billion per year. Despite these considerable costs, current interventions such as anti-depressant medication have limited acceptability and effectiveness. Patients have expressed the view that there is an over-reliance on prescribed antidepressant medications and they are keen to have a range of possible treatment choices. Counselling is a credible and widely used intervention for patients with depression, with approximately half of the 9000 GP practices in England employing a counsellor. Depression is commonly treated by acupuncturists, although this is rarely provided within the NHS, and the evidence on acupuncture for depression to date is limited.
Commencing in 2009, the Acupuncture, Counselling and Usual Care for Depression (ACUDep) Trial aimed to determine how effective short courses of acupuncture or counselling might be for treating depression when used as an addition to usual GP care. Researchers compared how effective these treatments were, and also assessed the cost-effectiveness of the interventions. This trial has been funded as part of a £1.3 million Programme Grant for Applied Research within the National Institute for Health Research (NIHR) (Grant Reference Number RP-PG-0707-10186). More information can be found on the register of clinical trials: http://www.controlled-trials.com/ISRCTN63787732/.
Carried out over a three year period, the study was run by the Complementary Medicine Evaluation Group in the University’s Department of Health Sciences. We recruited 755 participants. Eligible participants were randomly allocated to either 12 weekly acupuncture sessions plus usual GP care, 12 weekly counselling sessions plus usual GP care, or to continue with usual GP care only. The acupuncture sessions were carried out by therapists with a minimum of 3 years experience and all were members of the British Acupuncture Council. The counselling sessions were carried out by accredited members of the British Association of Counselling and Psychotherapy.
The analysis of the trial data is now complete and we expect the data to help patients, therapists, providers and policy makers make informed choices. The results of the trial have been published in PLOS Medicine.
In addition to the trial the research team have conducted a number of associated studies which may be of further interest:
This sub-study explores the experiences of acupuncturists, counsellors and GPs in delivering the trial intervention to patients with depression. The purpose of this sub-study will be to enhance standards of practice in relation to the treatment of depression, to guide the development of future trials for depression and to identify implications for health policy.
Co-morbid pain sub-study
The objective in this sub-study is to explore pain in a depressed population, and determine whether patients reporting pain have different depression and pain outcomes over time in response to acupuncture, counselling or usual care.
A number of patients took part in in-depth interviews on their perceptions and experiences of acupuncture, counselling and usual GP care. We also explored patients’ preferences, beliefs and understanding of their depression, and the impact these factors might have on their experience of treatment and the subsequent outcome.
This analysis will compare the three treatment options at twelve months in terms of incremental cost effectiveness and generate cost effectiveness acceptability curves exploring the probability that the interventions will produce an acceptable cost per QALY (quality-adjusted-life-years) at different cost effectiveness thresholds. We will extend the trial analysis to use decision modelling to extrapolate over longer term time horizons and to incorporate other relevant evidence.
SMS text messaging
The purpose of this project to evaluate the feasibility, acceptability and validity of using an automated SMS text messaging system of the purposes of monitoring symptoms of depression in clinical research.
|Funder(s):||NIHR Programme Grant for Applied Research|