Long-term treatment outcomes of psychodynamic psychotherapy for major depressive disorder: a systematic review and meta-analysis

Objective : Major depressive disorder (MDD) is characterised by recurrent episodes, making sustained treatment benefits a clinical priority. We evaluated the long-term outcomes of psychodynamic psychotherapy (PDP) for MDD. Methods : A systematic review of randomised controlled trials (RCTs) was conducted in adults with MDD comparing PDP with treatment-as-usual (TAU) or other active treatments, with long-term follow-up at least 12 months after treatment completion. Outcomes included clinician-rated and self-rated depressive symptom severity and relapse rates. Random-effects pairwise meta-analyses were performed at 12 months used standardized mean differences (SMD) for symptom severity and risk ratios (RR) for relapse. Intention-to-treat analyses were primary, with completer analyses as sensitivity checks. Studies not eligible for pooling were synthesised narratively Results : Five RCTs (n = 624 randomised) met inclusion criteria, of which three RCTs (n = 338) contributed to the meta-analysis. Follow-up data at 12 months was available for 255 of 338 (75.44%) randomised participants. PDP was associated with greater improvement in clinician-rated depressive symptoms compared with TAU (SMD = −0.40, 95% CI [−0.72, −0.07]), but not self-rated symptoms (SMD = −0.32, 95% CI [−0.83, 0.19]). PDP was associated with a reduced risk of relapse at 12 months (RR = 0.78, 95% CI [0.68, 0.90]), corresponding with an number needed to treat of approximately 5-6. Limitations : The meta-analysis is based on a small number of RCTs with an attrition rate of approximately 25%. Concurrent antidepressant medication was high, making it difficult to attribute long term gains solely to the psychodynamic intervention. The number of treatment sessions varied across trials (12–88 sessions), which limits comparability between trials. Conclusion : Psychodynamic psychotherapy is associated with long-term benefits in MDD, particularly in clinician-rated outcomes and relapse prevention at 12 months, though effects on self-rated symptoms were less consistent. The discrepancy between clinician-rated and self-rated outcomes highlights the complexity of capturing internal change. Improvements in observable symptoms and functioning are more readily detected, whereas changes in internal experiences may be more slowly developing and less well captured by symptom-based self-report measures.