Randomised controlled trial of interpersonal psychotherapy and cognitive–behavioural therapy for depression

Abstract

BACKGROUND: Interpersonal psychotherapy and cognitive-behavioural therapy (CBT) are established as effective treatments for major depression. Controversy remains regarding their effectiveness for severe and melancholic depression. AIMS: To compare the efficacy of interpersonal psychotherapy and CBT in people receiving out-patient treatment for depression and to explore response in severe depression (Montgomery-Asberg Depression Rating Scale (MADRS) score above 30), and in melancholic depression. METHOD: Randomised clinical trial of 177 patients with a principal Axis I diagnosis of major depressive disorder receiving 16 weeks of therapy comprising 8-19 sessions. Primary outcome was improvement in MADRS score from baseline to end of treatment. RESULTS: There was no difference between the two psychotherapies in the sample as a whole, but CBT was more effective than interpersonal psychotherapy in severe depression, and the response was comparable with that for mild and moder-ate depression. Melancholia did not predict poor response to either psychotherapy. CONCLUSIONS: Both therapies are equally effective for depression but CBT may be preferred in severe depression.