IPT Effective for Depression, Anxiety, Eating Disorders

Nancy A. Melville

April 12, 2016

Interpersonal psychotherapy (IPT), which was developed initially for the treatment of depression, may have some efficacy in the treatment of other mental disorders, such as anxiety or eating disorders, new research shows.

"This is the largest meta-analysis ever conducted for IPT," coauthor Myrna M. Weissman, PhD, the Diane Goldman Kemper Family Professor of Epidemiology in Psychiatry at Columbia University Medical Center, in New York City, told Medscape Medical News.

"The take-home message from the analysis is that this is one of the reasonable, evidence-based treatments available, but, just as we see with drugs, the treatment works better for some patients and situations than others."

The study was published online April 1 in the American Journal of Psychiatry.

Better Efficacy With IPT?

Both IPT and cognitive-behavioral therapy (CBT) are included in psychotherapy treatment guidelines. CBT is more broadly used than IPT, which focuses on the stressful life events and interpersonal events associated with the onset of mental health symptoms. In contrast, CBT is characterized by more inward reflection.

"CBT concentrates on a person's thinking and their perceptions of the problem, whereas IPT deals with the interpersonal triggers and emotions," explained Dr Weissman, who collaborated with her late husband, Gerald L. Klerman, MD, in developing the therapy.

"Both therapies concentrate on a diagnosis, are time-limited, and have strong efficacy data."

Despite that data, there have been no meta-analyses that focus on the use of IPT for disorders other than depression.

To better assess the evidence, the investigators conducted a literature search. They identified 90 studies of IPT for all mental health problems. The studies included 11,434 participants. Among them, 4422 patients received IPT; 2906 individuals were control participants; 1823 participants took part in trials that compared IPT with other psychotherapies; 1464 took part in trials that compared IPT with pharmacotherapy; and 819 patients receiving treatment with IPT in combination with pharmacotherapy.

Approximately two thirds of the studies were focused on depression and included investigations of prevention, treatment, and prevention of relapse.

As expected, the authors found the strongest results in IPT for acute-phase depression, with moderate to large effects compared with control groups (effect size g = 0.60; 95% confidence interval = 0.45 to 0.75). There were no significant differences in comparison to other psychotherapies (g = 0.06) or to pharmacotherapy (g = -0.13).

Treatment with IPT for patients with subthreshold depression significantly prevented the onset of major depression, and maintenance with IPT also significantly reduced relapse.

Combination treatment with IPT and pharmacotherapy was more effective than IPT alone for acute-phase depression (g = 0.24). Although the combination did not appear more effective than pharmacotherapy alone, the authors caution that the finding was shown in a relatively small number of trials.

Improved outcomes of IPT in depression were associated with the number of sessions, with 10 or more sessions showing an increase of the effect size (g = 0.2).

"Although results of such metaregression analyses are not causal evidence, this may indicate that 16-session IPT is more effective than the shorter interpersonal counseling, a finding that needs confirmation in future research," the authors write.

Anxiety, Eating Disorders

Eight trials examined the use of IPT for anxiety disorders. These trials found large effects in comparison with control groups. There was no evidence suggesting that IPT is less effective than CBT for anxiety.

With regard to eating disorders, IPT showed significant treatment effect, with the effects slightly smaller than those of CBT in the acute phase of treatment.

"In eating disorders, a small but significant effect in favor of CBT was found for behavioral outcomes, but because the number of studies was small and risk of bias was high, this is uncertain, and longer-term effects are not clear," the authors write.

IPT was also found to be of some benefit for patients with other mental health problems, including addiction and distress related to general medical disorders. However, the authors again indicate that there was a high risk for bias and an insufficient number of trials involving such disorders.

Given the similar efficacy between IPT and CPT for various disorders, Dr Weissman said the choice of whether to treat patients with one or the other can come down to various factors, including the clinician's own training. IPT may be preferable in cases involving depressive symptoms that appear directly related to an interpersonal event.

"If a patient comes in and says, for instance, 'I'm fighting with my husband and have been depressed ever since,' that might be good grounds to choose IPT," she said.

Study coauthor Paula Ravitz, MD, further explained that at the start of treatment with IPT, in addition to taking a standard psychiatric history and performing a diagnostic assessment, clinicians should take an "interpersonal inventory" to learn of the patient's important relationships.

This initial phase is followed by a middle phase in which an interpersonal focus is chosen from one of four problem areas ― social role transitions, role disputes, grief, or social deficits.

The therapy has "goals of remitting symptoms by improving connections with supports and resolving triggering interpersonal stressors of loss, changes, disputes, and/or isolation," she told Medscape Medical News.

"[In contrast], CBT focuses on changing distorted ways of thinking (cognitions) with behavioral interventions that vary according to diagnosis."

She added that IPT is an excellent fit for patients for whom symptoms of mental illness are linked to stressful interpersonal life events of loss, such as the death of a significant other, a social role transition, or relationship disputes, as well for adolescents in conflict with their parents.

"As well, CBT works best when patients comply with homework assigned between sessions, and some individuals are not willing to do the written and behavioral assignments," she said.

Important, Useful Study

The analysis adds a valuable look at the comprehensive evidence on IPT and helps highlight how it is most useful, commented Jeffrey Borenstein, MD, who is president and CEO of the Brain and Behavior Research Foundation, in New York City.

"I think it's an important and useful study, because we really want to be able to have evidence-based care, and this provides good information on IPT," he told Medscape Medical News.

"In particular, the findings about the prevention of new depressive disorders and relapse, as well as improved outcome of IPT with 10 or more sessions, are especially important for clinicians interested in using IPT," he added.

Future research should strive to better define the best candidates for IPT, Dr Borenstein said.

"While the analysis provides very good information, more work needs to be done, in particular, looking at the types of patients more likely to benefit from IPT vs other modalities," he said. "Our hope is to be able to develop biomarkers or other clinical determinants that would show a greater likelihood of response of treatment A vs treatment B."

Dr Weissman receives royalties from Perseus Press and Oxford University Press. Dr Ravitz receives royalties from WW Norton. Coauthor Pim Cuijpers, PhD, has received royalties from Atheneum Publishers, HB Publishers, and Servier; speaking fees from the NVGRT, the University of Trier, Vanderbilt University, and the VGCt, and grant support from the European Commission, the NutsOhra Foundation, and ZonMw. All other authors and Dr Borenstein have disclosed no relevant financial relationships.

Am J Psychiatry. Published online April 1, 2016. Abstract

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