PPRNet Clinical summary: Antidepressant Medication or Short-Term Psychodynamic Psychotherapy for Depression?

Depression is the largest contributor to global disability. And so, researchers have been assessing treatments for depression for many decades. Antidepressant medications and different psychotherapies are the major treatment options for depressive disorders. Treatment guidelines recommend combining the two for moderate to severe depression. However, combining treatments requires more resources, many patients prefer monotreatment, and some have concerns about antidepressants’ side effects. Previous meta-analyses showed that CBT and antidepressant medications are similarly effective, although medications were slightly more effective at post-treatment on observer-rated depressive symptoms. Short-term psychodynamic psychotherapy (STPP) is another empirically supported treatment that is often used in clinical practice. However, until now, there has been no patient-level data meta-analysis looking specifically at the effects of STPP vs antidepressant medications. In this systematic review and meta-analysis, Wieneke and colleagues reviewed six trials with 472 participants directly comparing STPP and antidepressant medications (selective serotonin reuptake inhibitors). The studies used the Hamilton Depression Rating Scale (HAMD), which mostly assessed somatic symptoms of depression, and the Beck Depression Inventory (BDI), which mostly assessed cognitive symptoms of depression. Outcomes were measured at post-treatment and at a longer-term follow-up period. On the HAMD, antidepressants were significantly more efficacious than STPP at post-treatment with a small effect (d= 0.28, 95% confidence interval [CI]: 0.03, 0.53, p = .031). Remission rates (no longer meeting criteria for depression) were 33.3% in the antidepressant medication group and 29.7% in the STPP group. No significant differences between treatments were found on the BDI at post-treatment (d= 0.25, 95% CI= −0.02, 0.52, p= .075). There were no differences on any of the measures at the longer-term follow-up. Baseline depression severity moderated posttreatment depressive symptom levels (d=0.24, 95% CI: 0.08, 0.40, p = .004). Antidepressants were slightly more efficacious than STPP for participants with high rather than low baseline depression severity.