Does intensive short-term dynamic psychotherapy work for treatment-resistant depression?

Intensive short-term dynamic psychotherapy (ISTDP) is a time-limited therapy that aims to help patients experience and work through emotions related to past attachments and trauma. For treatment-resistant depression (TRD) — depression that hasn't improved after standard treatments — ISTDP has been studied in several clinical trials. The evidence suggests that ISTDP can produce large reductions in depressive symptoms, and these benefits appear to last for months after therapy ends.

What the research says

A randomized controlled trial of 86 adults with TRD found that 20 sessions of ISTDP led to significantly lower depression scores compared to a waitlist control group. The effect was large at post-treatment (Cohen's d = 1.68) and even larger at 3-month follow-up (d = 2.50) ²¹⁰. Another trial with 60 patients showed that improvements in depression were maintained at 18 months, with moderate to large effect sizes (d = 0.64 on observer-rated scale, d = 0.70 on self-report) ¹¹. At 18 months, 40% of ISTDP patients were in remission, and 23.4% had stopped antidepressants ¹¹. The therapy also reduced emotional repression and negative affect, though these changes did not explain why depression improved — the mechanisms are still unclear ⁹¹⁰. Health economic analysis suggests ISTDP may be more cost-effective than usual community mental health care at 18 months ¹¹.

What to ask your doctor

• Could ISTDP be a suitable option for my treatment-resistant depression?
• How many sessions of ISTDP are typically needed, and what is the expected time frame for improvement?
• Are there any therapists in my area who are trained and experienced in ISTDP?
• How does ISTDP compare with other treatments I have tried or am considering?
• What are the potential risks or side effects of ISTDP, such as temporary increase in distress?