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Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Vasternorrland County Council, Sweden.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.ORCID iD: 0000-0003-4753-6745
Vasternorrland County Council, Sweden.
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2016 (English)In: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 33, no 12, 1090-1098 p.Article 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, 1090-1098 p.
Keyword [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: 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

Available from: 2017-01-11 Created: 2017-01-09 Last updated: 2017-01-11

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Ekeblad, AnnikaFalkenström, FredrikAndersson, GerhardHolmqvist, Rolf
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CiteExportLink to record
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