Psychological Medicine

Review Article

Effects of cognitive therapy versus interpersonal psychotherapy in patients with major depressive disorder: a systematic review of randomized clinical trials with meta-analyses and trial sequential analyses

J. C. Jakobsena1a2 c1, J. L. Hansena2, S. Simonsena1, E. Simonsena1 and C. Gluuda2

a1 The Psychiatric Research Unit, Copenhagen University Hospital and Region Zealand, Roskilde, Denmark

a2 The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344 Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

Abstract

Background Major depressive disorder afflicts an estimated 17% of individuals during their lifetime at tremendous suffering and cost. Cognitive therapy and interpersonal psychotherapy are treatment options, but their effects have only been limitedly compared in systematic reviews.

Method Using Cochrane systematic review methodology we compared the benefits and harm of cognitive therapy versus interpersonal psychotherapy for major depressive disorder. Trials were identified by searching the Cochrane Library's CENTRAL, Medline via PubMed, EMBASE, Psychlit, PsycInfo, and Science Citation Index Expanded until February 2010. Continuous outcome measures were assessed by mean difference and dichotomous outcomes by odds ratio. We conducted trial sequential analysis to control for random errors.

Results We included seven trials randomizing 741 participants. All trials had high risk of bias. Meta-analysis of the four trials reporting data at cessation of treatment on the Hamilton Rating Scale for Depression showed no significant difference between the two interventions [mean difference −1.02, 95% confidence interval (CI) −2.35 to 0.32]. Meta-analysis of the five trials reporting data at cessation of treatment on the Beck Depression Inventory showed comparable results (mean difference −1.29, 95% CI −2.73 to 0.14). Trial sequential analysis indicated that more data are needed to definitively settle the question of a differential effect. None of the included trial reported on adverse events.

Conclusions Randomized trials with low risk of bias and low risk of random errors are needed, although the effects of cognitive therapy and interpersonal psychotherapy do not seem to differ significantly regarding depressive symptoms. Future trials should report on adverse events.

(Received February 22 2011)

(Revised August 11 2011)

(Accepted September 07 2011)

(Online publication November 04 2011)

Correspondence

c1 Address for correspondence: J. C. Jakobsen, M.D., Psychiatric Research Unit, Copenhagen University Hospital, Region Zealand, Roskilde, Denmark. (Email: janusjakobsen@mac.com)

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