Comparative efficacy of interpersonal psychotherapy and antidepressant medication for adult depression: a systematic review and individual participant data meta-analysis

Zachary D Cohen; Jasmijn Breunese; John C Markowitz; Erica S Weitz; Steven D Hollon; Dillon T Browne; Paola Rucci; Carolina Corda; Marco Menchetti; Myrna M Weissman; R Michael Bagby; Lena C Quilty; Marc B J Blom; Mario Altamura; Ingo Zobel; Elisabeth Schramm; Carlos Gois; Jos W R Twisk; Frederik J Wienicke; Pim Cuijpers; Ellen Driessen

doi:10.1017/S0033291724001788

Comparative efficacy of interpersonal psychotherapy and antidepressant medication for adult depression: a systematic review and individual participant data meta-analysis

Psychol Med. 2024 Nov 4;54(14):1-10. doi: 10.1017/S0033291724001788. Online ahead of print.

Authors

Zachary D Cohen¹, Jasmijn Breunese², John C Markowitz^{3

4}, Erica S Weitz⁵, Steven D Hollon⁶, Dillon T Browne⁷, Paola Rucci⁸, Carolina Corda⁹, Marco Menchetti⁸, Myrna M Weissman^{3

4}, R Michael Bagby¹⁰, Lena C Quilty¹¹, Marc B J Blom¹², Mario Altamura¹³, Ingo Zobel¹⁴, Elisabeth Schramm¹⁵, Carlos Gois¹⁶, Jos W R Twisk¹⁷, Frederik J Wienicke², Pim Cuijpers^{18

19}, Ellen Driessen^{2

20}

Affiliations

¹ Department of Psychology, University of Arizona, Tucson, AZ, USA.
² Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.
³ Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
⁴ New York State Psychiatric Institute, New York, NY, USA.
⁵ Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Department of Psychology, Vanderbilt University, Nashville, TN, USA.
⁷ Department of Psychology, University of Waterloo, Waterloo, ON, Canada.
⁸ Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
⁹ Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
¹⁰ Departments of Psychology and Psychiatry, and Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, ON, Canada.
¹¹ Centre for Addiction and Mental Health and Department of Psychiatry, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada.
¹² Parnassia Groep, Den Haag, Netherlands.
¹³ Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
¹⁴ Psychology School, Hochschule Fresenius, University of Applied Sciences Berlin, Berlin, Germany.
¹⁵ Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
¹⁶ Department of Psychiatry, University of Lisbon, Lisbon, Portugal.
¹⁷ Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, Netherlands.
¹⁸ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
¹⁹ International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
²⁰ Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, Netherlands.

Abstract

Interpersonal psychotherapy (IPT) and antidepressant medications are both first-line interventions for adult depression, but their relative efficacy in the long term and on outcome measures other than depressive symptomatology is unknown. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses. This IPD meta-analysis compared the efficacy of IPT and antidepressants on various outcomes at post-treatment and follow-up (PROSPERO: CRD42020219891). A systematic literature search conducted May 1st, 2023 identified randomized trials comparing IPT and antidepressants in acute-phase treatment of adults with depression. Anonymized IPD were requested and analyzed using mixed-effects models. The prespecified primary outcome was post-treatment depression symptom severity. Secondary outcomes were all post-treatment and follow-up measures assessed in at least two studies. IPD were obtained from 9 of 15 studies identified (N = 1536/1948, 78.9%). No significant comparative treatment effects were found on post-treatment measures of depression (d = 0.088, p = 0.103, N = 1530) and social functioning (d = 0.026, p = 0.624, N = 1213). In smaller samples, antidepressants performed slightly better than IPT on post-treatment measures of general psychopathology (d = 0.276, p = 0.023, N = 307) and dysfunctional attitudes (d = 0.249, p = 0.029, N = 231), but not on any other secondary outcomes, nor at follow-up. This IPD meta-analysis is the first to examine the acute and longer-term efficacy of IPT v. antidepressants on a broad range of outcomes. Depression treatment trials should routinely include multiple outcome measures and follow-up assessments.

Keywords: Depression; antidepressant medication; efficacy; individual participant data meta-analysis; interpersonal psychotherapy.

Publication types

Review