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 benefit after treatment a clinical priority. We evaluated the long-term outcomes of psychodynamic psychotherapy (PDP) for MDD. Methods: Systematic review of randomised controlled trials in adults with MDD comparing PDP with treatment-as-usual (TAU) or other active care with long-term follow-up at 12 months or more following the treatment. Outcomes were clinician-rated and self-rated depressive symptom severity and relapse rate. Random-effects pairwise meta-analyses at 12 months used standardized mean differences (symptom severity) and risk ratios (relapse). Intention-to-treat was primary with completer sensitivity analyses. Trials not eligible for pooling were narratively synthesised. Results: Five RCTs (n=624 randomised) met inclusion criteria. Three RCTS contributed to pooled 12-month estimates. PDP was associated with greater efficacy compared to TAU measured by clinician-rated depressive symptom scales (SMD −0.40, 95% CI [−0.72, −0.07]), but not with self-rated symptom scales (SMD −0.32, 95% CI [−0.83, 0.19]). PDP was associated with lowered relapse risk at 12 months (RR 0.78, 95% CI [0.68, 0.90]), with an estimated number needed-to-treat of 5-6. Conclusion: PDP was associated with greater long-term improvements in clinician-assessed depressive symptoms reduced risk of relapse at 12 months, while self-rated depressive symptom outcomes were less consistent.