Talking therapies for mental disorders are an ever-expanding field, with variations in treatments appearing all the time. It can be hard to know which treatment path to recommend to a patient, or which one you might choose for yourself.

Major depressive disorder (MDD) is characterised by episodes of low mood, loss of self-esteem and interest in activities (DSM-IV). Statistics show that nearly 7% of adults in Europe experience depression at any one time (Witchen, 2005). NICE guidelines recommend antidepressant medication and/or Cognitive Behavioural Therapy (CBT) or Interpersonal Therapy (IPT) for the outpatient treatment of MDD without chronic physical illness. Which of these treatments are likely to have the best outcome?

A systematic review published in BMC Psychiatry (Van Hees et al 2013) has attempted to address this question. The review examined whether individual IPT is more effective at treating depression than alternative talking therapies, medication or usual care.

IPT, like CBT is a time-limited, structured talking treatment for depression. It focuses on how the relationships of the depressed person may be connected to their mood. Particular uses of IPT include treating depression associated with loss of role, bereavement, relationship conflict and loneliness.

Methods

Authors conducted a thorough search of the literature published between Jan 1970-Aug 2012 to find randomised controlled trials (RCTs) that compared IPT to other treatments. Only 8 out of 2,981 studies found matched their strict inclusion criteria. Participants had to have a diagnosis of MDD or postpartum depression and be between 18-65 years old. Of 1,233 participants included, 854 (68%) participants completed their outpatient treatment. 392 of these received individual IPT.

Results

• IPT vs medications
  • IPT+ nefrazadone was better than nefrazadone or IPT alone (adjusted OR 3.22 (1.02-10.12, P=0.045)
  • IPT was as good as venlafaxine at 6 weeks
• IPT vs other talking therapies
  • CBT was similar to IPT (mean difference in treatments 1.01 (95% CI: -0.04-2.37)
  • Cognitive Behavioural Analysis System of Psychotherapy (CBASP) was slightly better than IPT (mean BDI 10.79 vs 21.7 p=0.047)
• IPT vs no treatment
  • Having IPT and usual care was better than usual care alone (p=0.017)

Conclusions

The authors concluded:

Several kinds of treatments are effective or efficacious for depressed patients.

The difference between the effects and efficacy of several types of treatment are very small and not always significant.

They recommended that:

Policy makers are advised to base regulations on the effectiveness of treatment in general, instead of a slightly different effect between one treatment and the other.

Limitations

• Strict inclusion criteria mean that the results are not generalisable to individuals suffering with other types of depression, comorbidities or from different age groups
• It is a small review. 8 studies are not really enough to be confident that bias has been eliminated
• The variety of treatments assessed make comparison of each study difficult
• No studies compared IPT to selective serotonin re-uptake inhibitors, the usual first choice of antidepressant (NICE)
• The review did not examine behavioural activation or behavioural couple therapy, other talking therapies recommended by NICE

In summary

IPT is equally as effective as any one treatment alone, best when combined with medication and better than nothing (as we would hope!). Sadly, this Elf is not jumping up and down with excitement, as this study is too small to answer her question. We need more RCTs in this area (surprise surprise!). Choice of treatment should come down to an individual’s personal preference, illness severity, resources and consideration of the negative consequences of the treatment.

Links

Van Hees MLJM, Rotter T, Ellermann T and Evers MAA. The effectiveness of individual interpersonal psychotherapy as a treatment for major depressive disorder in adult outpatients: a systematic review. BMC Psychiatry 2013, 13:22.

Witchen HU, Jacobi F. Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies (PDF). Eur Neuropsychopharmacol 2005, 15:357-376

Depression in adults: the treatment and management of depression in adults (PDF). NICE, CG90, Oct 2009.

Mental health information leaflet on psychotherapies.  Royal College of Psychiatrists, Sep 2009.