Depression is the world’s top cause of disability, affecting millions and deeply impacting daily life (World Health Organization, 2022). Although there are effective treatments available, we do not know which treatment works best for a given person. Our latest study aimed to tackle this question by comparing two common treatment options: antidepressant medication and short-term psychodynamic psychotherapy (STPP). Rather than relying on data from a single study, which are often too small to give clear answers, we combined data from multiple trials around the world using a method called individual participant data (IPD) meta-analysis. This approach allowed us to take a closer look at how different people respond to different treatments.
Short-term Psychodynamic Psychotherapy (STPP)
STPP is a structured, time-limited therapy that typically involves 12 to 24 weekly sessions (Abbass et al., 2014). It focuses on helping patients understand and work through emotional conflicts, often unconscious and rooted in early life experiences, that contribute to depression (Eppel, 2018). By increasing awareness of patterns in thoughts, feelings, and relationships, STPP aims to promote emotional growth and symptom relief (Charman, 2004).
What is an IPD Meta-analysis?
An IPD meta-analysis is a powerful research method that combines and analyses participant-level data from multiple studies (Tudur Smith et al., 2016). Unlike traditional meta-analyses, which rely on averages from publications, IPD meta-analyses offer several advantages:
- Greater precision: Working with participant-level data allows for more accurate estimates of treatment effects (Lambert et al., 2002).
- Reducing bias: By accessing original datasets, IPD meta-analyses minimize biases that can occur when relying only on published results (Stewart & Parmar, 1993; Tudur Smith et al., 2016).
- Exploring individual differences: Patient characteristics like age, gender, and baseline symptom severity can be examined regarding their influence on treatment outcomes (Tudur Smith et al., 2016). In this way, we can investigate which treatment works best for whom.
What stood out
- We combined data from four studies conducted in Finland, Mexico, the Netherlands, and the USA, in which participants were randomly assigned to either antidepressants or STPP. Our main findings were:
- Short-term effectiveness: At the end of treatment, antidepressants showed a slight advantage over STPP in reducing depression symptoms as assessed by an independent rater. However, the difference was modest and may not be clinically meaningful.
- Patient-reported outcomes: Patients themselves reported no significant differences between antidepressants and STPP in their symptoms of depression, anxiety, overall psychological distress, or physical health.
- Long-term outcomes: Over follow-up periods ranging from 6 to 28 months, both treatments demonstrated no differences, suggesting that any early advantage of antidepressants may not persist over time.
- What works for whom: Patients with higher initial depression severity appeared to have benefited more from antidepressants than STPP by the end of treatment, but this difference was not sustained in the long term. No patient demographic (including age, gender, marital status, or education level) changed how patients responded to the two treatments.
Why this matters for clinicians
These findings support the importance of personalized treatment planning for depression. For patients with more severe symptoms, antidepressants may offer a quicker reduction in symptoms. However, since long-term outcomes are comparable, personal preferences, potential side effects, accessibility, and costs should be considered in a shared decision-making process between service seekers and providers. A flexible, individualized approach remains crucial.
Study Limitations
While our study provides important insights, several limitations should be kept in mind:
- The majority of participants were middle-aged women from moderate- to high-income countries, which may limit how these findings apply to other patient groups.
- The observational nature of our moderation analyses means we identified an association between pre-treatment severity and differential treatment outcome, but not a definitive causal relationship.
- We could not relate some potentially important patient characteristics, such as ethnicity and comorbidities, to treatment outcomes because of unavailable data.
- The number of studies and participants on which the analyses were based was relatively modest, and few recent studies comparing antidepressants and STPP were available.
Looking Ahead
Our findings suggest that both antidepressants and psychodynamic therapy are effective treatments for depression. While antidepressants may offer short-term advantages for patients with more severe symptoms, there are no differences in long-term outcomes between the two treatments. Future research should focus on including more diverse populations and exploring additional patient characteristics and combined treatment to further inform personalized treatment recommendations.
DISCUSSION QUESTIONS
- What other patient factors or illness characteristics might be related to the differential efficacy of antidepressants and STPP and should be explored in future research?
- How can patients and clinicians best balance evidence-based recommendations with individual preferences and circumstances in the shared decision-making process?
- What are the potential implications of these findings for clinical practice guidelines for depression?
Reference/Target Article
Wienicke, F. J., Dekker, J. J. M., Peen, J., Van, H. L., Barber, J. P., McCarthy, K. S., Solomonov, N., Karlsson, H., Hietala, J., López-Rodríguez, J., Villamil-Salcedo, V., Burk, W. J., Spijker, J., Twisk, J. W. R., Cohen, Z. D., Cuijpers, P., & Driessen, E. (2025). Antidepressant medication or short-term psychodynamic psychotherapy for depression? A systematic review and meta-analysis of individual participant data. Clinical Psychology: Science and Practice. https://doi.org/10.1037/cps0000281
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ABOUT THE AUTHORS
Frederik J. Wienicke, M.Sc., is a doctoral candidate at Radboud University in the Netherlands. His research focuses on the efficacy of short-term psychodynamic psychotherapy and identifying which patients may particularly benefit from this treatment.
He can be contacted at fritz.wienicke@ru.nl and on X @FritzWienicke.
Jack J. M. Dekker, PhD, is an emeritus professor of clinical psychology at the Faculty of Behavioral and Movement Sciences at Vrije Universiteit Amsterdam. He also serves as Head of Research at Arkin Mental Health, where he has been instrumental in fostering academic research and building expert treatment centers in collaboration with Arkin professors and lead researchers.
Jaap Peen, PhD, is a senior researcher at Arkin Mental Health. He is primarily responsible for statistical analyses across various research projects and prepares research datasets by integrating data from multiple sources, such as ROM and ECD. In addition, he produces management reports on client flow and characteristics for the organization.
Henricus L. Van, MD, PhD, is the Medical Director at NPI, Top Clinical Centre for treatment of Personality Disorder; Resident Program Director of Arkin Mental Health Amsterdam; Chief Editor of the Dutch Journal of Psychiatry. He is also a registered psychoanalytic psychotherapist. His research concerns depression, personality disorders, and psychotherapy.
Jacques P. Barber, PhD, ABPP, is Professor Emeritus and former Dean of the Gordon F. Derner School of Psychology at Adelphi University. He also holds appointments as Adjunct Professor of Psychiatry at New York University and Professor Emeritus at the University of Pennsylvania. He is a past president of the Society for Psychotherapy Research.
Kevin S. McCarthy, PhD, is a clinical psychologist whose work focuses on depression, adjustment disorders in adulthood, and couples therapy. He is also experienced in LGBTQ+ mental health and practices short-term and open-ended psychodynamic and supportive psychotherapies. His research interests include therapy processes, patient perceptions, and personality correlates in relationships.
Nili Solomonov, PhD, is Assistant Professor of Psychology in Psychiatry at Weill Cornell Medicine. A licensed clinical psychologist and psychotherapy researcher, she specializes in neurobiological and clinical mechanisms of treatment for depression in mid- and late-life and in postpartum populations.
Hasse Karlsson, MA, MD, PhD, is an emeritus professor of Integrative Neuroscience and Psychiatry at the Department of Psychiatry, Faculty of Medicine, University of Turku, Finland, and a chief physician at the Hospital District of South-West Finland. He has conducted extensive research in mental health epidemiology and neuroscience.
Jarmo Hietala, MD, PhD, is a Professor and Chief Physician at the Department of Psychiatry, University of Turku and Turku University Central Hospital, the Well-being Services County of Southwest Finland. His research focuses on the etiology and treatment of severe mental disorders, and lately on using visual material to facilitate psychotherapeutic treatment.
Jaime López-Rodríguez, MD, PhD, is a Professor in the Department of Psychiatry and Mental Health at the National Autonomous University of Mexico. His work focuses on the clinical treatment and academic training in psychiatry and mental health.
Valerio Villamil-Salcedo, MD, PhD, is a Professor in the Department of Psychiatry and Mental Health at the National Autonomous University of Mexico and also serves as an investigator at the National Institute of Psychiatry Ramón de la Fuente Muñiz. His work spans psychiatry education and clinical research in Mexico.
William J. Burk, PhD, is Associate Professor of Developmental Psychology at Radboud University. His research focuses on peer relationships, social development, and quantitative methods in developmental research.
Jan Spijker, MD, PhD, is a psychiatrist at the Pro Persona Depression Expertise Center and Professor by special appointment at Radboud University, with a focus on chronic depression. He also chairs the Dutch national treatment guideline committee for depression.
Jos W. R. Twisk, PhD, is Professor of Applied Biostatistics at Amsterdam UMC. He is known for his expertise in longitudinal data analysis and mixed-effects modeling in clinical and epidemiological studies.
Zachary D. Cohen, PhD, is Assistant Professor of Clinical Psychology at the University of Arizona. He is an expert in treatment selection research, particularly in identifying moderators and predictors of psychotherapy outcomes through advanced statistical modeling. He can be contacted on X @DepressionLab.
Pim Cuijpers, PhD, is Emeritus Professor of Clinical Psychology at Vrije Universiteit Amsterdam and one of the leading experts in meta-analytic research on depression treatments. He has published extensively on evidence-based mental health care and treatment efficacy. He can be contacted on bluesky @pimcuijpers.bsky.social.
Ellen Driessen, PhD, is Assistant Professor of Clinical Psychology at Radboud University and Senior Researcher at Pro Persona Depression Expertise Center. She is a licensed mental health psychologist and leads international collaborative IPD meta-analytic research on psychotherapy for depression to address what works for whom. She can be contacted on X @driessen_ellen.
REFERENCES CITED
Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., De Maat, S., Gerber, A., Dekker, J. J. M., Rabung, S., Rusalovska, S., & Crowe, E. (2014). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, 7, 1-108. https://doi.org/10.1002/14651858.CD004687.pub4
Charman, P. C. (Ed.). (2004). Core processes in brief psychodynamic psychotherapy. Advancing effective practice. Lawrence Erlbaum Associates.
Eppel, A. (2018). Short-term psychodynamic psychotherapy. Springer. https://doi.org/10.1007/978-3-319-74995-2
Lambert, P. C., Sutton, A. J., Abrams, K. R., & Jones, D. R. (2002). A comparison of summary patient-level covariates in meta-regression with individual patient data meta-analysis. Journal of Clinical Epidemiology, 55(1), 86-94. https://doi.org/10.1016/s0895-4356(01)00414-0
Stewart, L. A., & Parmar, M. K. B. (1993). Meta-analysis of the literature or of individual patient data: Is there a difference? Lancet, 341(8842), 418-422. https://doi.org/10.1016/0140-6736(93)93004-k
Tudur Smith, C., Marcucci, M., Nolan, S. J., Iorio, A., Sudell, M., Riley, R., Rovers, M. M., & Williamson, P. R. (2016). Individual participant data meta-analyses compared with meta-analyses based on aggregate data. Cochrane Database of Systematic Reviews, (9). https://doi.org/10.1002/14651858.MR000007.pub3
World Health Organization. (2022). World mental health report: Transforming mental health for all. Geneva: World Health Organization