The efficacy of antidepressant medication versus interpersonal psychotherapy for depression in middle-aged women: a systematic review and individual participant data meta-analysis.

PURPOSE: Depression is highly prevalent in middle-aged women (MAW), but head-to-head comparisons of first-line interventions in this population are scarce. This systematic review and individual participant data (IPD) meta-analysis examined the comparative efficacy of antidepressant medication (ADM) and interpersonal psychotherapy (IPT) for MAW (aged 40-64) versus other adults (men and non-MAW) on depression, quality of life, and interpersonal problem measures.

METHODS

PubMed, PsycINFO, Embase, and the Cochrane Library were searched January 1, 2025 to identify randomized trials comparing ADM and IPT for adults with depression. IPD were requested and analyzed using mixed-effects models.

RESULTS

IPD were obtained from 9 of the 15 (60%) identified studies, comprising 1,490 participants (527 MAW, 963 other adults). MAW status did not significantly moderate ADM versus IPT comparative efficacy on depression (p = .10) and interpersonal problems (p = .29) outcomes. The two treatments did not significantly differ in treatment effect in the MAW group (depression: b = -0.03, p = .76; interpersonal problems: b = -0.20, p = .31). MAW status significantly moderated comparative efficacy on quality of life measures (b = 0.37, p = .02). Whereas IPT was non-significantly more efficacious than ADM for MAW (b = -0.18, p = .15), ADM were non-significantly more efficacious than IPT for other adults (b = 0.19, p = .051).

CONCLUSION

This is the first IPD meta-analysis directly comparing depression treatments in MAW. The absence of treatment effect differences indicates that other factors (e.g., patient preference) may guide choice between IPT and ADM in this population.