Two Treatments for Major Depressive Disorder Are Equally Effective When Used in Community Mental Health Settings

An AHRQ-funded study found that two mental health treatments --short-term dynamic psychotherapy and cognitive therapy -- were equally effective in decreasing symptoms of major depressive disorder among patients receiving services in a community mental health center. The study was based on about 240 patients with major depressive disorder who received 16 outpatient sessions of either intervention between 2010 and 2014. Short-term dynamic psychotherapy aims to help patients understand reasons for their relationship conflicts, while cognitive therapy helps patients identify thoughts and behavior that led to their depression. This randomized clinical trial was designed to determine whether short-term dynamic therapy, a widely used treatment that lacks a robust evidence base, is not inferior to cognitive therapy, a treatment with well-documented effectiveness. The treatments were found to be equivalent based on clinical evaluators’ blind ratings of participants’ symptoms. The study, “Comparative Effectiveness of Cognitive Therapy and Dynamic Psychotherapy for Major Depressive Disorder in a Community Mental Health Setting: A Randomized Clinical Noninferiority Trial,” and abstract appeared Sept. 1 in JAMA Psychiatry.

2016 Sep 1;73(9):904-11. doi: 10.1001/jamapsychiatry.2016.1720.

Comparative Effectiveness of Cognitive Therapy and Dynamic Psychotherapy for Major Depressive Disorder in a Community Mental Health Setting: A Randomized Clinical Noninferiority Trial.

Connolly Gibbons MB1, Gallop R1, Thompson D2, Luther D2, Crits-Christoph K1, Jacobs J1, Yin S1, Crits-Christoph P1.

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Abstract

IMPORTANCE:

Dynamic psychotherapy (DT) is widely practiced in the community, but few trials have established its effectiveness for specific mental health disorders relative to control conditions or other evidence-based psychotherapies.

OBJECTIVE:

To determine whether DT is not inferior to cognitive therapy (CT) in the treatment of major depressive disorder (MDD) in a community mental health setting.

DESIGN, SETTING, AND PARTICIPANTS:

From October 28, 2010, to July 2, 2014, outpatients with MDD were randomized to treatment delivered by trained therapists. Twenty therapists employed at a community mental health center in Pennsylvania were trained by experts in CT or DT. A total of 237 adult outpatients with MDD seeking services at this site were randomized to 16 sessions of DT or CT delivered across 5 months. Final assessment was completed on December 9, 2014, and data were analyzed from December 10, 2014, to January 14, 2016.

INTERVENTIONS:

Short-term DT or CT.

MAIN OUTCOMES AND MEASURES:

Expert blind evaluations with the 17-item Hamilton Rating Scale for Depression.

RESULTS:

Among the 237 patients (59 men [24.9%]; 178 women [75.1%]; mean [SD] age, 36.2 [12.1] years) treated by 20 therapists (19 women and 1 man; mean [SD] age, 40.0 [14.6] years), 118 were randomized to DT and 119 to CT. A mean (SD) difference between treatments was found in the change on the Hamilton Rating Scale for Depression of 0.86 (7.73) scale points (95% CI, -0.70 to 2.42; Cohen d, 0.11), indicating that DT was statistically not inferior to CT. A statistically significant main effect was found for time (F1,198 = 75.92; P = .001). No statistically significant differences were found between treatments on patient ratings of treatment credibility. Dynamic psychotherapy and CT were discriminated from each other on competence in supportive techniques (t120 = 2.48; P = .02), competence in expressive techniques (t120 = 4.78; P = .001), adherence to CT techniques (t115 = -7.07; P = .001), and competence in CT (t115 = -7.07; P = .001).

CONCLUSIONS AND RELEVANCE:

This study suggests that DT is not inferior to CT on change in depression for the treatment of MDD in a community mental health setting. The 95% CI suggests that the effects of DT are equivalent to those of CT.