Improving Socialization and Independence Reduces Depression from AMD

July 15, 2014

Therapy that promotes independence and social activity may help prevent depression in people with low vision caused by age-related macular degeneration (AMD), which affects more than 10 million people in the United States. Known as behavior activation, the therapeutic approach reduced depression by nearly 50 percent in a clinical study of 188 people who averaged 84 years of age. Results from the research were published in the journal Ophthalmology.

Led by Barry W. Rovner, M.D., at Jefferson Hospital for Neuroscience in Philadelphia, PA, the research team found that 12.6 percent of patients who received six one-hour sessions of in-home behavior activation therapy had depression. In contrast, 23.7 percent of those who received the same amount of emotional therapy were depressed. Both groups also received low-vision rehabilitation to maximize use of their remaining eyesight.

“This research underscores the importance of maintaining a person’s independence and social activities despite vision loss,” says Stephen Rose, Ph.D., chief research officer, Foundation Fighting Blindness. “Of course, preventing or reversing vision loss is our ultimate goal. But in the cases where we can’t as of now, we need to help people live as actively as possible.”

Behavior activation in the study included environmental modifications such as improving lighting, highlighting objects with high-contrast tape and increasing magnification for vision-related tasks.

Therapy to improve social activity involved setting a goal — for example, walking with a friend three times per week — and developing an action plan outlining the steps to achieve the goal. The tasks in the plan might include: 1) call the friend; 2) pick a date and time; 3) set a meeting place; and 4) use a talking pedometer to track distance walked. The steps were recorded on a large-print calendar to help ensure compliance. 

Dr. Rovner says that a major challenge with delivering behavior action therapy is that most occupational therapists are not trained to provide it. However, he and his colleagues developed a standardized approach to facilitate its dissemination and gain Medicare reimbursement for it.

The study was funded by the National Eye Institute, one of the National Institutes of Health.