This application describes a randomized controlled clinical trail to evaluate the efficacy of a brief, standardized cognitive psychotherapy, Problem Solving Therapy (PST), to prevent incident depressive disorder (DSM-IV diagnoses) in elderly patients with age-related macular degeneration (AMD). AMD is the most common cause of blindness in older adults and limits the ability to read, see familiar faces, and walk independently. Almost 2 million persons (about 5 percent of the U.S. population over age 65) are now affected and their number will triple by the year 2020. We will target patients with neovascular AMD (NV-AMD), a form of AMD that can lead to sudden vision loss, substantial disability, and depression. Because depression is itself disabling and not likely to be recognized nor treated by ophthalmologists, preventing depression is clearly important. We will recruit 230 non-depressed AMD patients from the retinovascular clinic of Wills Eye Hospital with newly diagnosed NV-AMD one eye, who already have AMD in the fellow eye. Because they have recently developed bilateral vision loss they will be at high risk for depression. We will randomize subjects to PST or a usual care control condition in this 6-month clinical trial. The primary outcome measure will be a DSM-IV diagnosis of depression diagnosed by a geriatric psychiatrist masked to treatment assignment. We will evaluate subjects at baseline, month 2 (immediately post-intervention), month 6 (for the primary efficacy analysis) and month 12 (to evaluate sustained effects). Although depressive disorder is the primary outcome, we will also assess the impact of PST on levels of disability and vision-related quality of life.
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