In turn result in the binding of HP-1 and generates chromatin domains that are transcriptionally inert. Finally, our data also suggests that the presence of DNA methylation at the Avy IAP in differentiated cells is a consequence of other signals that control the activity of the locus between generations. This has implications for the nascent field of environmental epigenetics and studies that attribute perturbations in DNA methylation, particularly in the early embryo, as the mechanism responsible for diet/environmentally induced alterations in gene expression. Depression is a common illness in primary care. Some of the optimism regarding the potential of selective serotonin re-uptake inhibitors as a treatment for depression has faded in the light of concerns about effectiveness and safety. A recent metaanalysis has concluded that antidepressants have only a modest advantage over Clofentezine placebo, with the magnitude of benefit increasing with severity of depression. There is an ongoing interest, especially among patients, in the potential of non-pharmacological treatments for depression, with the hope that they might avoid some of the concerns about antidepressants regarding safety and dependency. Furthermore, for many patients, depression is a chronic and recurring illness, and non-pharmacological treatments that seek to improve longer-term outcomes are potentially of interest. Evidence from a recent large-scale trial has suggested that acupuncture and counselling can provide longerterm benefits for many patients with on-going depression in primary care. The ACUDep 
trial recruited 755 patients with depression via 27 participating primary care practices; 302 were randomised to up to 12 acupuncture sessions; 302 to up to 12 counselling sessions; and 151 to usual care alone. The counselling was delivered within a recognised, manualised competency framework developed by Roth et al. at the University College of London’s Centre for Outcomes Research and Effectiveness. The acupuncture diagnosis and treatment, including selection of points, was based on the principles of traditional Chinese medicine, the details of which are reported elsewhere. Both acupuncture and counselling were found to be effective in reducing the symptoms of depression when compared to usual care, and these differences were significant at the 3 and 6 month time points, as well as when averaged over the 12 month period. The trial focused on the effectiveness and cost effectiveness of the interventions. However, we were keen to understand the experiences of those providing treatments within the trial, and in particular the aspects of these Butylhydroxyanisole interventions that practitioners perceived to be associated with their longer-term benefit. In doing so, these insights will help understanding of the interventions and help inform both clinical practice and any future research design. Underreported within randomised controlled trials are qualitative analyses of strategies employed by acupuncturists and counsellors within treatment for depression that are intended to promote longer-term change. In one qualitative study, interviews with patients receiving counselling in routine practice were used to identify the key characteristics of the intervention that were experienced as beneficial in the longer term. In the authors’ interpretation, a key component was the client’s active engagement during and between counselling sessions. In turn this enabled a change to take place in the way they conducted their lives and relationships.