A psychodynamic therapy outperforms CBT over the long term in a large trial
KEYPHRASE: Dynamic interpersonal therapy for major depression
STUDY: Yari-Renani H et al, Psychiatry Research 2025;354:116775
STUDY TYPE: Randomized controlled trial
FUNDING: Independent
Background
This multicenter trial compared psychodynamic therapy, cognitive behavioral therapy (CBT), and antidepressants over a year.
The Study
225 adults with major depressive disorder were randomized to 16 weeks of dynamic interpersonal therapy (DIT), CBT, or antidepressant (SSRIs) across five primary care centers in Iran. Outcomes — depression (HAM-d-17), sleep quality (PSQI), and cognition (Stroop Test) — were assessed through 12-month follow-up.
All three treatments reduced depression by week 16. But the trajectories diverged sharply after that. DIT’s HAM-d-17 scores held stable at 12 months (21.68 → 13.39). CBT partially relapsed (to 15.75). Pharmacotherapy relapsed substantially, but this was not a fair comparison as the medications were stopped after 16 weeks (the therapy was stopped then as well).
Sleep and cognitive gains followed the same pattern: DIT held, medications didn’t.
Limitations: Study comes from a single cultural context (Iran), therapist fidelity wasn’t formally measured, and the HAM-d-17 was clinician-rated without blinding. The effect sizes are large enough to raise an eyebrow.
Practice Implications
- CBT is a first-line therapy for depression, but psychodynamic therapy is catching up.
- In the psychodynamic therapy used here, the therapist takes an active role, similar to the Davanloo approach which also has evidence in depression. Both are derived from psychoanalytic traditions, focusing on how past attachment and relationship patterns create current emotional difficulties, but DIT is more structured and focused specifically on interpersonal relationships.
- Here’s a guide to the therapy.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
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