Design: Systematic review and meta-analysis of randomised trials, GRADE-rated
Population: 16 trials, 1,992 adults with depression
Primary outcome: Depressive symptoms at treatment completion
Effect: SMD 0.34 (95% CI 0.20 to 0.47) vs all comparators; 0.27 (0.10 to 0.45) vs active treatment

This pre-registered meta-analysis, published 23 September, pooled 16 randomised trials with 1,992 participants of long-term psychodynamic psychotherapy — at least nine months and 30 sessions — for depression.

At the end of treatment it reduced depressive symptoms against all comparators (SMD 0.34, 95% CI 0.20 to 0.47; high-certainty evidence) and against active treatments specifically (SMD 0.27, 0.10 to 0.45; moderate certainty). Effects were generally sustained at follow-up. A larger effect against active controls (SMD 0.61) came with high heterogeneity and very low certainty.

The authors grade this as a strong recommendation for symptom reduction, but note thin evidence on function, cost and long-term maintenance. For a patient with chronic or recurrent depression who has not responded to short-term therapy, it is a legitimate evidence-based option, not a luxury.

Consider long-term psychodynamic therapy for chronic or recurrent depression after short-term therapy has failed.
Expect a small-to-moderate symptom benefit, sustained after treatment ends.
Evidence on work, function and cost-effectiveness is still limited.
The effect against other active therapies is smaller than against usual care.

Why it matters

Puts a longer-term therapy on an evidence footing that commissioners and sceptical colleagues often assume it lacks.

The statistics, in plain English

An SMD of 0.34 is a small-to-moderate effect — noticeable on average, but many individuals will not differ from comparison treatment. The larger 0.61 figure comes from a subgroup with very uncertain evidence and should not be quoted as the headline.