Older people losing their sight to the nation’s most common cause of blindness would likely benefit from a multidisciplinary therapy that would help them ward off the depression that often accompanies the visual disorder.
That was the conclusion of researchers at the Sidney Kimmel Medical College at Thomas Jefferson University, in Philadelphia, who have been studying a group of older people who were being treated for age-related macular degeneration at the ophthalmology practice affiliated with Wills Eye Hospital.
In an article published in the journal Ophthalmology, the researchers reported that people with AMD who received occupational and mental health therapy along with their eye treatments saw their risk of experiencing the depression that often comes with AMD cut in half.
“The depression is a response to disability, so we reasoned an effective treatment would be to reduce the disability through rehabilitation,” said Barry Rovner, a professor of psychiatry and neurology at Kimmel Medical College.
Rovner leads the Low Vision Depression Prevention Trial — known by the acronym VITAL — which was conducted by a team of psychologists, ophthalmologists, optometrists, and occupational therapists in testing an anti-depression therapy for AMD patients know as “behavior activation.”
“Behavior activation involves helping people to focus on activities they enjoy, to recognize that loss of those activities can lead to depression, and to re-engage in those activities,” said Robin Casten, a co-author of the VITAL study and an associate professor of psychiatry and human behavior at Jefferson.
Helping people maintain an active social life is an important part of the approach, she said.
The 188 participants in the National Eye Institute-funded VITAL study were, on average, 84 years old and 70 percent were women. Half of them lived alone. All of the subjects had AMD in both eyes and eyesight of 20/70 or worse.
In addition, all the study subjects showed mild depressive signs and were considered at risk of developing clinical depression based on their responses to a widely used nine-question screening subtest called PHQ-9.
The subjects eventually divided into two groups, one in which behavioral activation was used and one in which it wasn’t. After four months, the subjects in the group that received behavioral activation were 50 percent less likely to become depressed, based on PHQ-9 retesting.
“AMD is typically diagnosed and treated in primary eye care settings, where there is no defined standard of care for depression. This study was a unique and compelling effort to address that issue by strengthening teamwork between eye care professionals and mental health professionals,” said Eleanor Schron, group leader for clinical applications at the NEI, part of the National Institutes of Health.
Rovner said he hopes the study will spur multidisciplinary approaches to preventing the depression associated with AMD.
The therapy approach he and his colleagues tested was designed to be low cost, which should help it gain acceptance, Rovner said. When approved by a physician, the occupational therapy that is a part of behavioral activation is eligible for Medicare reimbursement, he said.