A new study funded by the National Eye Institute (NEI) has found that behavior activation and low-vision occupational therapy can reduce the risk of depression by 50% in patients with age-related macular degeneration (AMD). The results were published in the journal Ophthalmology.
The Low Vision Depression Prevention Trial (VITAL) enrolled 188 patients with bilateral AMD, a best-corrected vision of <20/70, mild depressive symptoms, and risk for developing clinical depression based on a nine-item depression subtest of the Patient Health Questionnaire (PHQ-9). The average age of the patients was 84 years and 70% were female. The trial participants were prescribed low-vision devices like handheld magnifiers after two visits with an optometrist and then randomly assigned to two groups.
One group received behavior activation from a specially training occupational therapist to assist in guidance on using the low-vision devices, making changes around the home (such as using brighter lights and high-contrast tape), increasing social activities, and helping set personal goals split into manageable steps. The control group discussed their difficulties with a therapist but did not receive behavior activation or low-vision occupational therapy. All participants engaged in six one-hour therapy sessions in their homes over a two-month period and were permitted to take antidepressants, although <10% did so. All received AMD medical management from their primary eye care providers.
After 4 months, 12.6% of those in the behavior activation group developed clinical depression vs. 23.4% in the control group. Among those with vision <20/100, the greatest benefits of behavior activation were seen with a 60% reduction in risk of clinical depression compared to controls. After adjusting for vision status, physical health, and baseline PHQ-9 score, behavior activation lowered the risk of depression by 50% vs. the control treatment.
The authors hope that these findings will lead to similar approaches in the prevention and treatment of depression in patients with AMD.
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