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.