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Meta-Analysis
. 2023 Oct;53(13):6090-6101.
doi: 10.1017/S0033291722003270. Epub 2022 Nov 21.

Which patients benefit from adding short-term psychodynamic psychotherapy to antidepressants in the treatment of depression? A systematic review and meta-analysis of individual participant data

Ellen Driessen  1   2   3 , Marjolein Fokkema  4 , Jack J M Dekker  5 , Jaap Peen  5 , Henricus L Van  6 , Giuseppe Maina  7   8 , Gianluca Rosso  7   8 , Sylvia Rigardetto  8 , Francesco Cuniberti  7 , Veronica G Vitriol  9 , Antonio Andreoli  10 , Yvonne Burnand  10 , Jaime López Rodríguez  11 , Valerio Villamil Salcedo  11 , Jos W R Twisk  12 , Frederik J Wienicke  1 , Pim Cuijpers  3
Affiliations
Meta-Analysis

Which patients benefit from adding short-term psychodynamic psychotherapy to antidepressants in the treatment of depression? A systematic review and meta-analysis of individual participant data

Ellen Driessen et al. Psychol Med. 2023 Oct.

Abstract

Background: Adding short-term psychodynamic psychotherapy (STPP) to antidepressants increases treatment efficacy, but it is unclear which patients benefit specifically. This study examined efficacy moderators of combined treatment (STPP + antidepressants) v. antidepressants for adults with depression.

Methods: For this systematic review and meta-analysis (PROSPERO registration number: CRD42017056029), we searched PubMed, PsycINFO, Embase.com, and the Cochrane Library from inception to 1 January 2022. We included randomized clinical trials comparing combined treatment (antidepressants + individual outpatient STPP) v. antidepressants in the acute-phase treatment of depression in adults. Individual participant data were requested and analyzed combinedly using mixed-effects models (adding Cochrane risk of bias items as covariates) and an exploratory machine learning technique. The primary outcome was post-treatment depression symptom level.

Results: Data were obtained for all seven trials identified (100%, n = 482, combined: n = 238, antidepressants: n = 244). Adding STPP to antidepressants was more efficacious for patients with high rather than low baseline depression levels [B = -0.49, 95% confidence interval (CI) -0.61 to -0.37, p < 0.0001] and for patients with a depressive episode duration of >2 years rather than <1 year (B = -0.68, 95% CI -1.31 to -0.05, p = 0.03) and than 1-2 years (B = -0.86, 95% CI -1.66 to -0.06, p = 0.04). Heterogeneity was low. Effects were replicated in analyses controlling for risk of bias.

Conclusions: To our knowledge, this is the first study that examines moderators across trials assessing the addition of STPP to antidepressants. These findings need validation but suggest that depression severity and episode duration are factors to consider when adding STPP to antidepressants and might contribute to personalizing treatment selection for depression.

Keywords: Combined treatment; depression; individual participant data meta-analysis; moderator; short-term psychodynamic psychotherapy (STPP).

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Conflict of interest statement

ED reports grants from the Dutch Psychoanalytic Funds and Netherlands Organisation of Scientific Research (NWO) during the conduct of the study. MF, JJMD, JP, HLV, GM, GR, SR, FC, VGV, AA, YB, JLR, VVS, JWRT, FJW, and PC have no conflicts of interest to declare.

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Fig. 1.
PRISMA-IPD flow diagram. © Reproduced with permission from the PRISMA-IPD Group, which encourages sharing and reuse for non-commercial purposes.
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