Integrated therapies cut depression rates in AMD patients

July 10 2014

Incorporating behavioural therapies into treatments for patients with low vision could help to cut rates of depression by half, according to research published online in the journal Ophthalmology. The findings come from the first clinical trial of an integrated approach for patients with low vision due to age-related macular degeneration (AMD).

For patients with AMD, deteriorating vision can have a negative impact on their lifestyle, leading to increased anxiety and isolation. It is estimated that up to 30% of patients living with AMD experience moderate-to-severe depressive symptoms due to vision loss.
In the UK, low vision patients are treated for the visual aspects of the condition, including visual assessment and prescription of glasses and contact lenses, but the psychological aspects of vision loss are not typically addressed. However, a recent multicentre trial carried out in the US has found that incorporating behavioural therapies into treatment can prevent depression in high risk patients with AMD-related low vision. 
Researchers from Thomas Jefferson University, Dartmouth Medical School and John Hopkins School of Medicine enrolled 188 patients with AMD who displayed the early signs of depression. Patients were split into two groups and received standard low vision rehabilitation therapy along with six one-hour sessions of either behavioural activation therapy (BA), or supportive therapy (ST), over an eight-week period.
BA is a method of counteracting social withdrawal and improving mood in patients with depressive symptoms. It involves setting goals in order to limit task avoidance and isolation associated with the condition. The supportive therapy involved counselling and discussion about the patient’s vision loss and served as a control.
After four months, the researchers found that the rate of depression in the ST group was similar to that of patients without treatment (23.7%), but the integrated approach of BA and low vision rehabilitation was found to be half (12.6%). There was also a reported association with improved visual outcome in the BA group, but this was not found to be statistically significant.
Integrated approach
Dr Barry W Rovner, of Jefferson Medical College and lead researcher, said: “Our findings demonstrate that referring patients with AMD-related low vision for optometric rehabilitation alone does not fully meet the patients’ rehabilitative needs.
“Although low vision occupational therapists do not currently receive training in mental health care, our results indicate that interdisciplinary care like this could significantly help reduce the incidence of depression in patients with AMD.”
The findings serve to further highlight the aims of mental health and vision loss charities in the UK, to create a holistic approach to treating patients. 
Sam Challis, information manager at UK mental health charity Mind, told OT: “Health professionals should consider the impact that a serious and long-term condition like AMD has on an individual’s emotional and mental health. It is vital that people are offered appropriate treatment and support not just for their physical health problem but also for any mental health problems, such as depression, which they may experience as a secondary problem.”
“We know that, worryingly, people with mental health problems have more difficulty in accessing physical health services and have worse outcomes for physical health conditions. Traditionally mental health services have been given less funding and priority than services for physical health problems. This research paper highlights what Mind has long been calling for ¬– the need for a more holistic approach to treatment and better integration of mental and physical health services, so that people are treated as a whole and taken seriously.”
Commenting on the research, Tony Rucinski, chief executive of the Macular Society, added: “Sight loss affects more than just a person’s vision, it affects emotions as well. That’s why we support the whole person. 
“[The Macular Society] provides free counselling and telephone befriending services for anyone affected by macular conditions. Many of our counsellors and volunteer befrienders are affected by sight loss. Regularly talking to someone who understands can make a real difference.”
Tagged with: Low Vision, NHS, Research

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