Pragmatic randomized controlled trial of long‐term psychoanalytic psychotherapy for treatment‐resistant depression: the Tavistock Adult Depression Study (TADS)
Open accessAbstract
This pragmatic randomized controlled trial tested the effectiveness of long‐term psychoanalytic psychotherapy (LTPP) as an adjunct to treatment‐as‐usual according to UK national guidelines (TAU), compared to TAU alone, in patients with long‐standing major depression who had failed at least two different treatments and were considered to have treatment‐resistant depression. Patients (N=129) were recruited from primary care and randomly allocated to the two treatment conditions. They were assessed at 6‐monthly intervals during the 18 months of treatment and at 24, 30 and 42 months during follow‐up. The primary outcome measure was the 17‐item version of the Hamilton Depression Rating Scale (HDRS‐17), with complete remission defined as a HDRS‐17 score ≤8, and partial remission defined as a HDRS‐17 score ≤12. Secondary outcome measures included self‐reported depression as assessed by the Beck Depression Inventory ‐ II, social functioning as evaluated by the Global Assessment of Functioning, subjective wellbeing as rated by the Clinical Outcomes in Routine Evaluation ‐ Outcome Measure, and satisfaction with general activities as assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire. Complete remission was infrequent in both groups at the end of treatment (9.4% in the LTPP group vs. 6.5% in the control group) as well as at 42‐month follow‐up (14.9% vs. 4.4%). Partial remission was not significantly more likely in the LTPP than in the control group at the end of treatment (32.1% vs. 23.9%, p=0.37), but significant differences emerged during follow‐up (24 months: 38.8% vs. 19.2%, p=0.03; 30 months: 34.7% vs. 12.2%, p=0.008; 42 months: 30.0% vs. 4.4%, p=0.001). Both observer‐based and self‐reported depression scores showed steeper declines in the LTPP group, alongside greater improvements on measures of social adjustment. These data suggest that LTPP can be useful in improving the long‐term outcome of treatment‐resistant depression. End‐of‐treatment evaluations or short follow‐ups may miss the emergence of delayed therapeutic benefit.
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There is limited evidence of efficacy for long-term PDT for acute MDD treatment.
“there is limited evidence of efficacy for acute MDD treatment.74”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [74]
The paper's introductory discussion (indexed under Abstract; page not supplied) says evidence-gathering on longer-term psychoanalytic treatments is in its early stages, supporting the claim that evidence is limited. But the trial studies treatment-resistant depression and does not establish that evidence is limited specifically for acute MDD treatment. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThere is only weak evidence, and only after prolonged treatment, for efficacy of long-term PDT for acute treatment of MDD.
“However, there is only weak evidence, and only after prolonged treatment, for efficacy of long-term PDT for acute treatment of MDD.74,109”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [74]
The Abstract says evidence for longer-term psychoanalytic treatment was at an early stage and suggests benefits particularly over longer follow-up. The Outcomes section reports no significant difference in partial remission at the end of treatment, with differences emerging during follow-up. However, this trial studied treatment-resistant depression, not acute treatment of MDD generally, so it does not support that broader setting. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPDT (up to 60 sessions over 18 months) did not significantly increase the likelihood of remission.
“In contrast, PDT (up to 60 sessions over 18 months) did not significantly increase the likelihood of remission.74”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [74]
The Treatments section describes 60 sessions over 18 months, and the Outcomes section reports no significant increase in complete remission at the end of treatment or at 42 months. But the unqualified claim overlooks significant increases in partial remission during follow-up and in remission of the major-depression diagnosis at 18 months (Outcomes; Table 2). Page numbers are unavailable in our copy. (LLM, conf=0.88)
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- Authors
- Fonagy, P., Rost, F., Carlyle, J., McPherson, S., Thomas, R., Pasco Fearon, R. M., Goldberg, D., & Taylor, D.
- Affiliations
- University College London (GB)
- The Tavistock and Portman NHS Foundation Trust (GB)
- Adult Department, Tavistock & Portman NHS Foundation Trust London UK
- University of Essex (GB)
- Research Department of Clinical, Educational and Health Psychology University College London London UK
- King's College London (GB)
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2015-09-25
- Volume
- 14
- Issue
- 3
- Pages
- 312-321
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC4592654
- OpenAlex
- W2113367546
- Cited by
- 237
- References
- 49
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 18 · 2023: 17 · 2022: 12 · 2021: 52 · 2020: 21 · 2019: 26 · 2018: 29 · 2017: 22 · 2016: 16 · 2015: 5
- FWCI
- 29.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- World Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Staff Publications Online (The Tavistock and Portman) (acceptedVersion)
- Open Access at Essex (University of Essex) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Open Research Online (The Open University) (submittedVersion)
- Funders
- Wellcome Trust (095844/Z/11/Z, 095844)
- National Institute for Health and Care Research (NF-SI-0510-10228, NF-SI-0514-10157)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- treatment-resistant depression, major depressive disorder, adjunctive psychotherapy, treatment remission, long-term follow-up, social functioning, quality of life, primary care depression
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