Behavioral therapy may prevent sight-related depression.

An in-home program that teaches problem-solving skills to patients with age-related macular degeneration decreased the incidence of new-onset depression, a recent study suggests.

In addition, the program appeared to shorten the course of depression that did occur, Dr. Barry W. Rovner of Jefferson Medical College, Philadelphia, and his colleagues reported.

Significant gains seen at the 2-month follow-up visit had dissipated by 6 months, but the project illustrates the practicality of using behavioral therapy to prevent depression in patients with chronic illness, rather than medications to treat depression after it has occurred, they wrote (Arch. Gen. Psychiatry 2007;64:886-92).

Dr. Rovner and his associates randomized 206 patients (mean age 81 years) with age-related macular degeneration in both eyes to the problem-solving treatment or to usual care. The problem-solving therapy consisted of six in-home sessions delivered by trained therapists. The sessions focused on defining problems; establishing realistic goals; generating, choosing, and implementing solutions; and evaluating outcomes.

At the 2-month follow-up visit, 11 patients in the active group had developed depression (9 major and 2 minor depression). In the control group, however, 23 patients developed depression (14 major and 9 minor), which is a significant difference.

The lower incidence of depression appeared related to an ability to maintain favorite activities. Patients who received the therapy were almost 50% less likely to have given up a valued activity than were those who received usual care, the investigators noted.

Patients in the therapy group also reported improved scores on a scale measuring subjective visual function, despite the fact that they did not show objective improvement in visual acuity. Control patients reported a decline on the subjective visual function scale.

By 6 months, however, those differences had disappeared: Twenty percent of the treatment group and 26% of the control group had developed a depressive disorder. The difference was driven by more new-onset depression in the active group between 2 and 6 months. "This suggests that additional problem-solving therapy treatment may have been necessary to prevent depression in these subjects," Dr. Rovner and his associates said.

They did note after 6 months a significant difference in the course of depression that had developed at the 2-month visit. Only 4 of the 11 depressed patients in the active group remained depressed at 6 months, compared with 16 of the 22 depressed controls, they noted.

Rather than viewing the short-lived effects of the treatment as a failure, health care professionals should consider the study in light of the possibilities it engenders, Dr. Charles R. Reynolds III and associates wrote in an accompanying editorial (Arch. Gen. Psychiatry 2007;64:884-5). In patients with chronic illness, it may be better to prevent depression than to wait until it occurs.

"For many patients, taking an antidepressant medication to prevent depression when they don't feel depressed may be a hard sell," wrote Dr. Reynolds of the University of Pittsburgh, and his colleagues. "Teaching those more effective coping skills through the use of a brief, depression-specific, behaviorally oriented psychotherapy may be more acceptable to both patients and health care professionals."

BY MICHELE G. SULLIVAN

Mid-Atlantic Bureau