title: A randomised controlled trial of Intensive Short-Term Dynamic Psychotherapy for treatment resistant depression: the Halifax Depression Study.
abstract: While short-term psychodynamic psychotherapies have been shown effective for major depression, it is unclear if this could be a treatment of choice for depressed patients, many of whom have chronic and complex health issues, who have not sufficiently responded to treatment.
  
  
  
  This superiority trial used a single blind randomised parallel group design to test the efficacy of time-limited Intensive Short-Term Dynamic Psychotherapy (ISTDP) for treatment resistant depression (TRD). Patients referred to secondary care community mental health teams (CMHT) who met DSM-IV criteria for major depressive episode, had received antidepressant treatment ≥6 weeks, and had Hamilton Depression Rating Scale (HAM-D) scores of ≥16 were recruited. The effects of 20 sessions of ISTDP were judged through comparison against secondary care CMHT treatment as usual (TAU). The primary outcome was HAM-D scores at 6 months. Secondary outcomes included the Patient Health Questionnaire (PHQ-9) self-report measures for depression and dichotomous measures of both remission (defined as HAM-D score ≤7) and partial remission (defined as HAM-D score ≤12).
  
  
  
  Sixty patients were randomised to 2 groups (ISTDP=30 and TAU=30), with data collected at baseline, 3, and 6 months. Multi-level linear regression modelling showed that change over time on both depression scales was significantly greater in the ISTDP group in comparison to TAU. Statistically significant between-group treatment differences, in the moderate to large range, favouring ISTDP, were observed on both the observer rated (Cohen's d=0.75) and self-report measures (Cohen's d=0.85) of depression. Relative to TAU, patients in the ISTDP group were significantly more likely after 6 months to achieve complete remission (36.0% vs. 3.7%) and partial remission (48.0% vs. 18.5%).
  
  
  
  It is unclear if the results are generalizable to other providers, geographical locations and cultures.
  
  
  
  Time-limited ISTDP appears an effective treatment option for TRD, showing large advantages over routine treatment delivered by secondary care services.
authors.affiliation: Centre for Emotions & Health, Department of Psychiatry, Dalhousie University, Halifax, Canada; Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK. Electronic address: joel.town@plymouth.ac.uk.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Town
authors.affiliation: Centre for Emotions & Health, Department of Psychiatry, Dalhousie University, Halifax, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Abbass
authors.affiliation: The Institute of Work Psychology, University of Sheffield, Sheffield, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Stride
authors.affiliation: Department of Psychiatry, Dalhousie University, Halifax, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Bernier
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000175:diagnosis / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief; D012074:Remission Induction; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Depression; Psychodynamic Psychotherapy; Randomised trial; Short-term; Treatment resistance