Positioning of psychodynamic psychotherapy in the treatment of depression: A comparison of the RANZCP 2020 and NICE 2022 guidelines

Gin S Malhi; Erica Bell; Darryl Bassett; Philip Boyce; Philip Hazell; Malcolm Hopwood; Bill Lyndon; Roger Mulder; Richard Porter; Greg Murray

doi:10.1177/10398562231159329

Positioning of psychodynamic psychotherapy in the treatment of depression: A comparison of the RANZCP 2020 and NICE 2022 guidelines

Australas Psychiatry. 2023 Jun;31(3):322-325. doi: 10.1177/10398562231159329. Epub 2023 Feb 24.

Authors

Gin S Malhi¹, Erica Bell², Darryl Bassett³, Philip Boyce⁴, Philip Hazell⁴, Malcolm Hopwood⁵, Bill Lyndon⁴, Roger Mulder⁶, Richard Porter⁶, Greg Murray⁷

Affiliations

¹ Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, St Leonards, NSW, Australia; Department of Psychiatry, University of Oxford, Oxford, UK.
² Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, St Leonards, NSW, Australia.
³ Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.
⁴ Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁵ Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Melbourne, VIC, Australia.
⁶ Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
⁷ Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.

Abstract

Objective: To compare the 2022 NICE guidelines (NG222) and 2020 RANZCP clinical practice guidelines (MDcpg²⁰²⁰) recommendations for the treatment of depression using psychodynamic psychotherapy.

Conclusions: Both guidelines recommend psychological interventions first-line. However, only short-term psychodynamic psychotherapy (STPP) is recommended, and in the NG222 it is ranked last for less severe depression and 7th for more severe depression. In contrast, cognitive behavioural therapy and behavioural activation are deemed the more clinically effective and cost-effective psychological therapies. And antidepressants play a significant role - largely in more severe depression.

Keywords: Guidelines; depression; psychodynamic psychotherapy; treatments.

MeSH terms

Cognitive Behavioral Therapy*
Depression / therapy
Depressive Disorder* / therapy
Humans
Psychotherapy
Psychotherapy, Brief*
Psychotherapy, Psychodynamic*
Treatment Outcome