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

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.

PMID: 39494789
PMCID: PMC11578913
DOI: 10.1017/S0033291724001788

Review

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

Zachary D Cohen et al. Psychol Med. 2024.

. 2024 Nov 4;54(14):1-10.

doi: 10.1017/S0033291724001788. Online ahead of print.

Authors

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.

PMID: 39494789
PMCID: PMC11578913
DOI: 10.1017/S0033291724001788

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.

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Conflict of interest statement

Dr. Cohen previously held stock options in AbleTo, which he received as compensation for advice on the clinical content of Joyable's digital cognitive therapy for depression. Dr. Markowitz reports salary support from New York State Psychiatric Institute, research grant support from the Columbia Velocity Fund, National Institute of Mental Health, and Department of Defense, and minor book royalties, some related to interpersonal psychotherapy. Dr. Weissman receives royalties from books on IPT from Oxford Press, Perseus Press and APA publishing, but she also provides one open access book published in 2024 (free of charge) which describes the methods and current use of IPT. Dr. Blom reports personal fees from ‘Leerboek Interpersoonlijke psychotherapie’ outside the submitted work. Dr. Driessen reports a grant from the Netherlands Organisation of Scientific Research (NWO) during the conduct of the study. Drs. Weitz, Hollon, Browne, Rucci, Corda, Menchetti, Bagby, Quilty, Altamura, Zobel, Schramm, Gois, Twisk and Cuijpers, Ms. Breunese, and Mr. Wienicke have nothing to disclose.

Figures

**Figure 2.**
Funnel plot of effect estimates of studies examining IPT and antidepressants for depression.

See this image and copyright information in PMC

References

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1. American Psychological Association. (2019). Clinical practice guideline for the treatment of depression across three age cohorts. Washington, DC: American Psychological Association. https://www.apa.org/depression-guideline
1. Bet, P. M., Hugtenburg, J. G., Penninx, B. W., & Hoogendijk, W. J. (2013). Side effects of antidepressants during long-term use in a naturalistic setting. European Neuropsychopharmacology, 23(11), 1443–1451. 10.1016/j.euroneuro.2013.05.001 - DOI - PubMed
1. Blom, M. B., Jonker, K., Dusseldorp, E., Spinhoven, P., Hoencamp, E., Haffmans, J., & van Dyck, R. (2007). Combination treatment for acute depression is superior only when psychotherapy is added to medication. Psychotherapy and Psychosomatics, 76(5), 289–297. 10.1159/000104705 - DOI - PubMed
1. Browne, G., Steiner, M., Roberts, J., Gafni, A., Byrne, C., Dunn, E., … Wallik, D. (2002). Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs. Journal of Affective Disorders, 68(2–3), 317–330. 10.1016/S0165-0327(01)00343-3 - DOI - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources