Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient ClinicShow others and affiliations
2016 (English)In: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 33, no 12, p. 1090-1098Article in journal (Refereed) Published
Abstract [en]
BackgroundInterpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. MethodsNinety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. ResultsIPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score amp;lt;10). The dropout rate was significantly higher in CBT (40%; 19/47) compared to IPT (19%; 8/43). Statistically controlling for antidepressant medication use did not change the results. ConclusionsIPT was noninferior to CBT in a sample of depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be considered an effectiveness trial, with strong external validity but some limitations in internal validity.
Place, publisher, year, edition, pages
WILEY-BLACKWELL , 2016. Vol. 33, no 12, p. 1090-1098
Keywords [en]
cognitive behavior therapy; interpersonal psychotherapy; depression; clinical trials; behavioral activation
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:liu:diva-133738DOI: 10.1002/da.22495ISI: 000389927400003PubMedID: 27029912OAI: oai:DiVA.org:liu-133738DiVA, id: diva2:1063816
Note
Funding Agencies|REHSAM (a Swedish research program by Swedish Social Insurance Agency and Vardalstiftelsen) [RS 2010/013]; L J Boethius foundation, Sweden; Emil Andersson foundation, Sundsvall, Sweden; County Council of Vasternorrland, Sweden
2017-01-112017-01-092017-11-29