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Psychoanalysts have long celebrated the ameliorative effects of talk therapy on individual patients. Early practitioners of psychoanalysis relied primarily on case studies to demonstrate their treatment's efficacy: that Bertha Pappenheim regained her motor and sensory functions to become a prominent social worker and activist, for example, or that Herbert Graf conquered his fear of horses to produce world-class operas. Subsequent skeptics have challenged the purported benefits of psychoanalysis by suggesting that other interventions—or possibly no intervention at all—might have yielded similar outcomes. Meanwhile, advocates of newer treatment modalities such as cognitive-behavioral therapy (CBT) have relied increasingly on quantitative measures to illustrate their success. Now, in an article published in the American Journal of Psychiatry, Driessen and colleagues have reported a randomized controlled trial demonstrating that time-limited psychodynamic therapy is at least as effective as CBT.
Driessen et al. measured the benefit of sixteen sessions of individual manualized CBT or short-term psychodynamic supportive therapy for 341 Dutch adults, randomly assigned to a treatment condition, who met DSM-IV criteria for a major depressive episode and had Hamilton Depression Rating Scale (HAM-D) scores ≥ 14. The primary outcome measure was post-treatment remission rate (HAM-D score ≤ 7). Secondary outcome measures included HAM-D and depressive self-report (IDS-SR) scores at the end of treatment and one year post-treatment. HAM-D assessors were not blind to treatment condition but displayed no significant biases on sensitivity analysis of their treatment expectations. Severely depressed individuals (HAM-D score > 24) were also given pharmacological treatment with extended-release venlafaxine at daily doses of 75 to 225 mg, followed by citalopram or nortryptilline for adverse effects or non-response, at rates that did not differ significantly between treatment groups.