The Effect of Interpersonal Psychotherapy and other Psychodynamic Therapies versus ‘Treatment as Usual’ in Patients with Major Depressive Disorder

Abstract

BackgroundMajor depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Interpersonal psychotherapy and other psychodynamic therapies may be effective interventions for major depressive disorder, but the effects have only had limited assessment in systematic reviews.Methods/Principal FindingsCochrane systematic review methodology with meta-analysis and trial sequential analysis of randomized trials comparing the effect of psychodynamic therapies versus ‘treatment as usual’ for major depressive disorder. To be included the participants had to be older than 17 years with a primary diagnosis of major depressive disorder. Altogether, we included six trials randomizing a total of 648 participants. Five trials assessed ‘interpersonal psychotherapy’ and only one trial assessed ‘psychodynamic psychotherapy’. All six trials had high risk of bias. Meta-analysis on all six trials showed that the psychodynamic interventions significantly reduced depressive symptoms on the 17-item Hamilton Rating Scale for Depression (mean difference −3.12 (95% confidence interval −4.39 to −1.86;P<0.00001), no heterogeneity) compared with ‘treatment as usual’. Trial sequential analysis confirmed this result.DiscussionWe did not find convincing evidence supporting or refuting the effect of interpersonal psychotherapy or psychodynamic therapy compared with ‘treatment as usual’ for patients with major depressive disorder. The potential beneficial effect seems small and effects on major outcomes are unknown. Randomized trials with low risk of systematic errors and low risk of random errors are needed.

Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis

“…We also checked the references of earlier metaanalyses (3,(24)(25)(26) and a database of studies on psychological depression treatments (27).…”

“…Some focused on the effects of IPT for depression (3,(24)(25)(26), but none of these included trials published after 2010 (while 22 new trials have been subsequently published since [see below]); some focused on a small subsample of studies (24,25) or on narrow research topics, such as the comparison between IPT and care-as-usual (24) or direct comparisons between IPT and cognitive-behavioral therapy (CBT) (25). No meta-analysis has focused on IPT for disorders other than depression.…”

‘Third wave’ cognitive therapy versus mentalization-based therapy for major depressive disorder. A protocol for a randomised clinical trial

“…In calculating our sample size we have used a ‘minimal relevant mean difference’ (MIREDIF) of five HDRS points between the two interventions. Former systematic reviews have shown much less differences in effects sizes between compared interventions for depression [44,51,52]. It could be argued that we have set our presumed MIREDIF unrealistically high.…”

“…This makes it possible to implement the interventions in clinical practice, and the two interventions can be assessed in future trials. Moreover, we have used the most commonly used outcome measure in trials assessing the effects of psychotherapeutic interventions for depression (HDRS) [28,37,44,51], as well as other clinically relevant outcome measures (e.g., quality of life, suicide attempts, suicides). The two treatments uses about the same resources, so economical considerations seem less important in the choice between the two.…”

Third-wave cognitive therapy versus mentalisation-based treatment for major depressive disorder: a randomised clinical trial

“…Both the cognitive therapists and the mentalisation therapists were involved in developing the treatment manuals for the respective psychotherapeutic treatments, which might make the therapist enthusiasm and thoroughness similar in the two intervention groups. (3) We have used the most commonly used outcomes in trials assessing the effects of psychotherapeutic interventions for depression (ie, HDRS and BDI) 11 30 45 46. This makes it possible to relate our results to results from other trials examining the effects of interventions for depression.…”