Inpatients with a major depressive episode have a high degree of severity and chronicity. Pharmacotherapy and psychotherapy are recommended to treat moderate to severe MDE. The efficacy of an adjunctive brief psychoanalytic psychotherapy (IBPP) for inpatients with MDE is examined. Adding IBPP to usual care decreases immediate and longer-term MDE severity. Inpatient therapy represents an opportunity to foster response and remission.