Letters to the Editor

Abstract

I com mend the ex cel lent work of Dr Kennedy, Dr Lam, and the work ing group that pro vided the Clin i cal Guide lines for the Treat ment of De pres sive Dis or ders (1). This let ter is to pro vide up dated in for mation from a sys tem atic re view of short-term dy namic psychotherapies (STDPs) cur rently be ing con ducted under the Cochrane Col lab o ra tion (2) and to dem on strate that con verg ing data now sup port STDP as a valid first-line treatment for de pres sion.Al though their first point is that few published tri als ex ist, we have found over 40 pub lished con trolled tri als of STDP, includ ing 9 stud ies as sess ing 888 pa tients with de pres sion (3-11). This rep re sents at least 20 more stud ies than An der son and Lam bert's re view (12) which, un like our re view, in cluded stud ies of in ter personal ther apy (IPT). Fur ther, 4 of these stud ies in cluded pa tients di ag nosed with per son al ity dis or ders treated with Davanloo's ver sion of STDP (in ten sive STDP), with one-third of the sam ples hav ing comorbid de pres sion or dysthymic dis or der (13)(14)(15)(16)). An other study ex am ined pa tients with per son al ity dis or ders and de pres sion or anx i ety dis orders (17).In terms of rel a tive ef fi cacy, a re cent review showed STDP to be as ef fec tive as cog ni tive-behavioural ther apy (CBT) for re duc ing symp toms in pa tients with depres sion (18). In one head-to-head study, ISTDP out per formed a "more cog ni tive" dy namic treat ment on the de pres sion subscale of the Symp tom Check list-90 (SCL-90) with an ef fect size of 1.35 (15).STDPs ap pear to have a broad ap pli ca bility, with stud ies show ing ef fi cacy in patients with per son al ity dis or ders and de pres sion or dysthymic dis or der, as noted above. Con versely, the Na tional Insti tutes of Men tal Health (NIMH) de pres sion study iden ti fied lim i ta tions in both CBT and IPT treat ment for pa tients with per son al ity dis or ders (19).The au thors point out the "wide use of psychodynamic psy cho ther apy in clin ical prac tice"(1, p 32S). Ac cord ing to the au thors, then, psychodynamic mod els are many cli ni cians' pri mary in stru ments, with or with out train ing in newer, em pir ically val i dated brief psychodynamic ther a pies.When one com bines these prac tice patterns with the sub stan tial num ber of newer con trolled tri als show ing ef fi cacy, the dem on strated equal ef fi cacy with CBT, and the broad scope of ap pli ca bility, one has to con sider vari ants of STDPs as po ten tial first-line treat ments of de pres sion. We thank Dr Abbass for his com ments on the Clin i cal Guide lines for the Treat ment of De pres sive Dis or ders and his at ten tion to short-term dy namic psychotherapies (STDPs), which he con tends have a suf ficient ev i dence base to be a first-line psycho ther apy treat ment.We are grate ful to him for draw ing at tention to Leichsenring's re cent metaanalysis of short-term psychodynamic psy cho ther apy (STPP) and cog ni tive-behavioural ther apy (CBT) in de pres ...