Dynamic interpersonal therapy for moderate to severe depression: a pilot randomized controlled and feasibility trial.

Area of Science:

• Psychiatry
• Clinical Psychology

Background:

• Improving Access to Psychological Therapies (IAPT) services in England primarily treat major depression in primary care.
• Dynamic Interpersonal Therapy (DIT) is a psychodynamic and mentalization-based treatment for depression, delivered over 16 sessions.
• The effectiveness of DIT versus low-intensity treatment (LIT) and the feasibility of randomizing patients to DIT or cognitive-behavioural treatments (CBT) in IAPT settings were not previously established.

Purpose of the Study:

• To assess the effectiveness of Dynamic Interpersonal Therapy (DIT) compared to low-intensity treatment (LIT) for major depression.
• To evaluate the feasibility of randomizing patients to DIT, LIT, or CBT within an IAPT service.
• To compare the outcomes of DIT and CBT in a primary care setting.

Main Methods:

• A randomized controlled trial with 147 patients allocated to DIT (n=73), LIT (n=54), or CBT (n=20) in a 3:2:1 ratio.
• Patients with major depressive disorder were assessed at baseline, 3 months, and 6 months using the Hamilton Rating Scale for Depression (HRSD-17) and Beck Depression Inventory-II (BDI-II).
• DIT patients received a 6-month follow-up assessment post-treatment.

Main Results:

• DIT demonstrated significantly lower HRSD-17 scores at 6 months compared to LIT (d = 0.70).
• Clinically significant improvement was observed in 51% of DIT patients versus 9% of LIT patients on the HRSD-17.
• DIT and CBT groups showed equivalent outcomes for most measures, including the BDI-II, with DIT showing benefits in secondary outcomes.

Conclusions:

• Dynamic Interpersonal Therapy (DIT) delivered in primary care is more effective than LIT for treating depression.
• DIT is a viable treatment option that can be effectively compared against CBT in future randomized controlled trials within IAPT services.