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Authors' reply

Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AF

EDITED BY MATTHEW HOTOPF

Dr Ogundipe is, of course, quite right in pointing out that our conclusion about the greater acceptability of couple therapy compared with antidepressant drugs can only apply to the particular regime used in our trial. However, it is worth noting that similarly high drop-out rates have been recorded in other well-regarded trials of antidepressant treatment. For example, in the National Institute of Mental Health trial, the drop-out rate from imipramine treatment was 33% over 18 months (Jacobson & Hollon, 1996).

Dr Ogundipe's view about intention-to-treat analysis is contrary to current statistical opinion and the recommendations of the British Medical Journal for the reporting of clinical trials (Altman, 1996; Schulz, 1996). The comment about baselines is not relevant here, since subjects who comply may fare differently and in an unpredictable way from those who do not comply. Thus, any observed differences between groups constructed in this manner may be due not to treatment but to factors associated with compliance. In this study, patients who dropped out were younger and had higher depression scores than those who completed the trial. The method of analysis should be consistent with the experimental design of a study. For randomised trials, such consistency requires the preservation of the random treatment assignment. Because methods that violate the principles of randomisation are susceptible to bias, they should not be used.

An analysis of the number needed to treat may be a sensible suggestion in general, although for a number of technical reasons it is not popular among statisticians (see Hutton, 2000). In any case, in this trial the high drop-out rate from the medication group would make the results of such an analysis suspect.

Marital discord was assessed using the Dyadic Adjustment Scale. As shown in Table 1 in the paper, the two treatment groups did not differ on this score, making it unlikely that this variable confounded the results.

REFERENCES

Altman, D. G. (1996) Better reporting of randomised controlled trials: the CONSORT statement. British Medical Journal, 313, 570-571.[Free Full Text]

Hutton, J. L. (2000) Number needed to treat: properties and problems. Journal of the Royal Statistical Society, Series A, 163, 403-419.

Jacobson, N. S. & Hollon, S. D. (1996) Cognitive-behavior therapy versus pharmacotherapy: now that the jury's returned its verdict, it's time to present the rest of the evidence. Journal of Consulting and Clinical Psychology, 64, 74-80.[CrossRef][Medline]

Schulz, K. F. (1996) Randomised trials, human nature, and reporting guidelines. Lancet, 348, 596-598.[CrossRef][Medline]

This Article Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Leff, J. Articles by Everitt, B. Search for Related Content PubMed Articles by Leff, J. Articles by Everitt, B.