Acupuncture for Depression: Patterns of Diagnosis and Treatment within a Randomised Controlled Trial

H Macpherson,H Lansdown,B Elliot,A Hopton,S Richmond

doi:10.1155/2013/286048

Abstract

Background. In a large randomised controlled trial of acupuncture, counselling, or usual care for depression, we document the acupuncture intervention and explore the relationship between traditional acupuncture diagnosis and outcome. Methods. Patients who were continuing to experience depression were recruited from primary care to the ACUDep trial (n = 755). Practitioners documented for each patient the traditional Chinese medicine diagnosis, the points needled, and additional components of the treatment, such as lifestyle advice, as recommended by the STRICTA guidelines. Results. Over an 18-month period, 23 acupuncturists delivered 2741 treatments to 266 patients, an average of 10 sessions per patient. The primary and secondary zang fu syndromes were identified for 99% of patients. When combining primary and secondary diagnoses, there was a predominant Liver Qi Stagnation cluster (66% of patients) and a Spleen Deficiency cluster (34%). Practitioners sought de qi responses 96% of the time. Lifestyle advice was given to 66% of patients, most commonly dietary. When comparing patient outcomes, no significant differences were found between the two main syndrome clusters. Conclusion. In this large-scale trial, our documentation of diagnosis and treatment provides a useful snapshot of common patterns that patients present with when continuing to experience depression after consulting in primary care.

Highlights

Trials of acupuncture have often been criticised for providing insufficient details of the intervention [1]
Though the STRICTA recommendations provide a framework for better reporting of interventions in clinical trials of acupuncture, a survey of authors discovered that journal editors, when reviewing manuscripts of acupuncture trials, sometimes required cuts to the reporting on the intervention in order to keep to a minimum article word length [3]
In a three-arm pragmatic randomised controlled trial, we randomised patients to acupuncture, counseling, and usual care as interventions in the proportions of 2 : 2 : 1, respectively. This trial was designed to evaluate whether referral of people who had consulted in primary care with depression, yet continued to be depressed, and were seeking alternatives would benefit or not from a referral to acupuncturists who practised in the style of traditional Chinese medicine

Summary

Introduction

Trials of acupuncture have often been criticised for providing insufficient details of the intervention [1]. In a large randomised controlled trial of acupuncture, counselling, or usual care for depression, we document the acupuncture intervention and explore the relationship between traditional acupuncture diagnosis and outcome. Patients who were continuing to experience depression were recruited from primary care to the ACUDep trial (n = 755). Practitioners documented for each patient the traditional Chinese medicine diagnosis, the points needled, and additional components of the treatment, such as lifestyle advice, as recommended by the STRICTA guidelines. In this large-scale trial, our documentation of diagnosis and treatment provides a useful snapshot of common patterns that patients present with when continuing to experience depression after consulting in primary care

Methods

Results

Discussion

Conclusion