We included four randomised trials (total 528 participants, 5 comparisons). All used a psychodynamic approach and reported limited data.
For individual psychodynamic therapy versus medication alone we found significantly more participants in the therapy group were unable to be discharged (n=92, RR 8.35 CI 2.0 to 34.3, NNH 3 CI 2 to 6). We found no significant difference between groups in the number of participants who were re-hospitalised (n=24, RR 0.63 CI 0.3 to 1.4) during long-term analyses. At 12 months, fewer participants in the psychotherapy groups needed additional medications compared with those who did receive medication (n=74, RR 0.64 CI 0.5 to 0.8, NNT 3 CI 3 to 6), and also at three years follow up (n=87, RR 0.85 CI 0.8 to 1.0, NNT 7 CI 5 to 26).
For individual psychodynamic therapy plus medication versus medication alone we found no significant difference in suicide (n=92, RR 0.16 CI 0.01 to 2.9) or suitability for discharge (n=92, RR 1.09 CI 0.2 to 7.4). Also, we found re-hospitalisation rates in long-term analyses were equivocal (n=24, RR 1.00 CI 0.4 to 2.6). For insight-orientated psychodynamic psychotherapy versus reality adaptive psychotherapy we found no significant difference in re-hospitalisation rates (n=164, RR 1.20 CI 0.9 to 1.6), but we found study attrition favoured the insight-orientated psychodynamic psychotherapy group at 12 months (n=164, RR 0.46 CI 0.3 to 0.6, NNT 2 CI 2 to 4). For individual psychodynamic psychotherapy versus group psychotherapy we found no significant difference in global state 'not improved' (n=100, RR 1.27 CI 1.0 to 1.7). For individual psychodynamic therapy plus medication versus individual psychodynamic therapy we found rates of re-hospitalisation during long-term analyses were equivocal (n=24, RR 1.00 CI 0.4 to 2.6). There is no clear evidence of any positive effect of psychodynamic therapy and the possibility of adverse effects seems never to have been considered. We did not identify any trials using a psychoanalytic approach.
