Antidepressant medication or short-term psychodynamic psychotherapy for depression? A systematic review and meta-analysis of individual participant data.

Abstract

Antidepressant medication and short-term psychodynamic psychotherapy (STPP) are frequently used to treat depression, but it is unclear which works best for whom. This preregistered individual participant data (IPD) meta-analysis (PROSPERO No.: CRD42017056029) examined efficacy and moderators of antidepressants versus STPP for adult depression. Randomized comparisons of antidepressants and STPP on standardized measures for depressed adults were included. A systematic literature search was performed on May 1, 2024. IPD were requested and analyzed using mixed-effects models. Of the six trials identified (n = 472), IPD were obtained for four (n = 310; 65.7%). At posttreatment, antidepressants were slightly more efficacious than STPP regarding depressive symptom levels (d = 0.28, 95% confidence interval = [0.03, 0.53], p = .031), but no significant differences were observed at follow-up nor for self-reported depression or any of the secondary outcomes at posttreatment. Baseline depression severity was found to moderate posttreatment outcomes (d = 0.24, 95% confidence interval = [0.08, 0.40], p = .004), such that antidepressants were more efficacious than STPP for participants with higher severity levels rather than those with lower baseline severity. This is the first study examining moderators across trials comparing antidepressants and STPP. The findings suggest that baseline severity might be a factor to consider when choosing between these treatments. However, this finding is observational and requires validation in future studies before it can be used to inform treatment selection for depression.