title: The effect of interpersonal psychotherapy and other psychodynamic therapies versus 'treatment as usual' in patients with major depressive disorder.
abstract: BACKGROUND
  Major 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.
  
  
  RESULTS
  Cochrane 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.
  
  
  CONCLUSIONS
  We 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.
authors.affiliation: Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344 Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. janusjakobsen@mac.com
authors.forename: Janus Christian
authors.initials: JC
authors.lastname: Jakobsen
authors.forename: Jane Lindschou
authors.initials: JL
authors.lastname: Hansen
authors.forename: Erik
authors.initials: E
authors.lastname: Simonsen
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
mesh_terms: D003865:Major Depressive Disorder / Q000628:therapy*; D006801:Humans; D007398:Interpersonal Relations; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome