Specific Indications for Interpersonal Psychotherapy (IPT)
Interpersonal psychotherapy is specifically indicated for adolescents and adults with major depressive disorder who have identifiable interpersonal problems, particularly when these problems fall into one of four domains: grief/loss, interpersonal role disputes, role transitions, or interpersonal deficits. 1, 2
Primary Indication: Major Depressive Disorder
IPT is most strongly indicated for major depressive disorder (MDD) in both adolescents and adults, where it has demonstrated efficacy comparable to antidepressant medication. 1, 3, 4
Adolescent Depression
- For adolescents with moderate depression and interpersonal problems, IPT-A (Interpersonal Psychotherapy for Adolescents) is more effective than control therapy and addresses developmentally specific issues including separation from parents, conflicts with parental authority, peer pressures, first experiences with death, and development of romantic relationships. 1, 2
- IPT-A is particularly useful when the adolescent's depression is linked to interpersonal distress such as reactions to loss, interpersonal role disputes, role transitions (change of grade/school, moving, relationship changes), or interpersonal deficits. 1, 2
- For severe adolescent depression, combination therapy with fluoxetine plus CBT achieves superior outcomes (71% response rate), but IPT-A remains an appropriate alternative when CBT is unavailable or when interpersonal problems are the primary maintaining factor. 3
Adult Depression
- IPT is recommended as an appropriate treatment option for adult major depressive disorder (initial and recurrent episodes) based on multiple controlled clinical trials demonstrating efficacy. 4, 5, 6
- IPT can be provided in individual, couple, or group formats for adults with MDD. 4
Secondary Indications: Mood Disorder Variants
Bipolar Disorder (as IPSRT)
- Interpersonal and Social Rhythm Therapy (IPSRT), which combines IPT with social rhythm stabilization, is recommended as one of the best-supported psychosocial adjuncts to mood-stabilizing medication for bipolar disorder. 7
- IPSRT must always be combined with appropriate mood stabilizers (lithium or valproate) because medication addresses core mood symptoms whereas psychotherapy targets functional impairments and skill-building. 7
- IPSRT-A (for adolescents) is delivered in 16-20 sessions and shows improvements in general psychiatric symptom severity, depression, mania, and global functioning, though it remains classified as experimental rather than established treatment in adolescents. 1, 7
Postpartum Depression
- IPT has been successfully adapted for postpartum depression, addressing the role transition to motherhood and associated interpersonal stressors. 4, 5
Dysthymia
- IPT is a promising treatment for patients with dysthymia (persistent depressive disorder). 5
Tertiary Indications: Non-Mood Disorders
Eating Disorders
- IPT has demonstrated efficacy for bulimia nervosa, making it a reasonable alternative treatment option. 4, 5
Anxiety Disorders
Borderline Personality Disorder
- An adapted model (IPT-BPD) with extended duration (34 sessions) has been developed for borderline personality disorder, addressing the frequent comorbidity with mood disorders and relational problems, though this requires replication in larger samples. 8
Critical Contraindications and Limitations
IPT was originally developed for nonpsychotic, nonsuicidal depressed patients, and its use with actively suicidal adolescents depends entirely on the patient's ability to establish a therapeutic alliance and commit to informing the therapist about suicidal preoccupations and intent. 1, 2
Specific Exclusions
- IPT is not effective for opiate and cocaine addiction compared to standard drug programs. 5
- IPT is not indicated for psychotic depression or acute mania without concurrent medication management. 4
- Patients who cannot identify any interpersonal problems or who have severe interpersonal deficits with virtually no social contacts may have limited benefit from standard IPT protocols. 2, 6
Key Clinical Decision Points
When to Choose IPT Over CBT
- Select IPT when the patient's depression is clearly linked to interpersonal distress (recent loss, ongoing conflicts, major life transitions, or social isolation) rather than primarily cognitive distortions. 1, 2
- IPT focuses on how patients interact with others in their immediate social context, not what they think, making it distinct from CBT's focus on modifying automatic thoughts and beliefs. 2
When to Choose IPT Over Medication Alone
- For adolescents with moderate depression, IPT-A alone (without medication) is appropriate when interpersonal problems are prominent and the patient/family prefers to avoid medication. 1
- For adults with MDD, IPT is a reasonable alternative to medication as acute treatment, particularly when medication is refused or contraindicated. 5
When to Combine IPT with Medication
- For severe adolescent depression, combination therapy (SSRI + psychotherapy) should be initiated immediately, though CBT has stronger evidence than IPT in this specific context. 3
- For bipolar disorder, IPSRT must always be combined with mood stabilizers—implementing IPSRT without concurrent pharmacotherapy is ineffective and should be avoided. 7
Common Pitfalls to Avoid
- Do not use IPT for patients who cannot commit to regular attendance for 12-16 weekly sessions, as the time-limited structure is essential to its efficacy. 4, 6
- Do not apply standard IPT protocols to actively suicidal patients without first establishing a clear safety plan and therapeutic alliance with commitment to communicate suicidal intent. 1, 2
- Do not use IPT as monotherapy for bipolar disorder—this is a critical error that will result in inadequate symptom control. 7
- Do not select IPT when the patient's depression is primarily characterized by cognitive distortions without clear interpersonal precipitants—CBT would be more appropriate. 1, 2