Authors' reply

Abstract

the relationship between community treatment orders and readmission rates is of a different complexity than that between chemotherapy and cancer remission, or between digitalis and cardiac function. We acknowledge, and celebrate, the contribution of RCTs to evidence-based healthcare. But there remains a need for a plurality of methods. However astute and research-literate the clinician, RCTs select participants in ways that can make generalisation to real-world settings difficult. Realist approaches that help bridge the gap between the 'what' and the 'how' of clinical outcomes can only be a good thing. And the more complex the interventionand the more context dependentthe more important this is. For us, RCTs alone are unlikely to be sufficient. Parity of esteem for psychiatry is undoubtedly worthwhile, but this does not mean we have to imitate other specialities; as so often in the past, we can lead the way instead. Primus inter pares.

“Flow” Transcranial Direct Current Stimulation (tDCS) for Depression Treatment in a Primary Healthcare General Practice—Depression, Functioning, and Health-Related Quality of Life Outcomes

“…Psychotherapy is recommended for depression, with recovery rates of around 50% for those who complete treatment, but 60% of people drop out after two sessions or less and, as it is delivered over multiple sessions over a period of several weeks or months, it is costly and lengthy; in the UK the average waiting time for psychotherapy to start is 21 days (Gyani et al, 2013;Griffiths & Griffiths, 2014;NHS Digital, 2022). In addition, some people do not find psychotherapy to be an acceptable option due to, for example, cultural beliefs, mobility issues, travel costs, or work and caring responsibilities (Bandelow et al, 2018).…”