Relationships between reduction in symptoms and restoration of function and wellbeing: Outcomes of the Oral Ketamine Trial on Suicidality (OKTOS)
This open-label trial (n=30) examined the effects of weekly oral ketamine treatment over six weeks on functional recovery in adults with chronic suicidality. It finds that while depression and suicidality scores improved, effect sizes for social functioning and wellbeing were smaller, suggesting that symptom reduction alone may not restore full functioning.
Authors
- Monique Jones
- Jim Lagopoulos
Published
Abstract
Recovery of functioning is integral to successful treatment outcomes in depressive illness. Optimal antidepressant treatment results in both symptomatic remission and functional recovery. Oral ketamine rapidly reduces suicidality and depression; however, reports of functional and wellbeing outcomes are lacking. This study examines participants' social and occupational functioning and wellbeing outcomes in the Oral Ketamine Trial on Suicidality (OKTOS). Thirty adults with chronic suicidality participated in the trial over 10 weeks. Functional recovery and wellbeing were assessed using the Social and Occupational Functioning Scale (SOFAS) and World Health Organization Well-Being Index (WHO-5). Suicidality and depressive symptoms were assessed using the Beck Scale for Suicidal ideation (BSS) and Montgomery-Asberg Depression Rating Scale (MADRS). Relationships between the four treatment outcomes were analysed. Forty-three percent of participants achieved healthy function (SOFAS ≥ 80) and 27% reported healthy wellbeing (WHO-5 > 60%) at the four-week post-treatment follow-up. Wellbeing was revealed as the data-derived treatment endpoint for the sample. Effect sizes for functioning and wellbeing outcomes were smaller than for suicidality and depression outcomes. Results suggest that reduction in depressive symptoms and suicidal ideation may be necessary but not sufficient for full restoration of function and wellbeing in antisuicidal and antidepressant therapy, including clinical trials.
Research Summary of 'Relationships between reduction in symptoms and restoration of function and wellbeing: Outcomes of the Oral Ketamine Trial on Suicidality (OKTOS)'
Introduction
Suicide is a major global cause of death and is frequently accompanied by major depressive disorder (MDD), which impairs mood, cognition and social/occupational functioning. Ketamine has demonstrated rapid reductions in suicidal ideation and depressive symptoms, but there is limited evidence on whether such symptomatic improvements extend to positively valenced outcomes such as functioning and subjective wellbeing. The authors situate this gap against patient-reported priorities: people with depression commonly value return to normal functioning and improvements in wellbeing as core indicators of recovery. Beaudequin and colleagues set out to examine how oral ketamine treatment for chronic suicidality affects both negatively valenced outcomes (suicidal ideation and depressive symptoms) and positively valenced outcomes (social/occupational functioning and wellbeing). Using data from the Oral Ketamine Trial on Suicidality (OKTOS), they applied Bayesian network (BN) modelling to quantify interactions among these four outcome domains and to explore which endpoint(s) best capture treatment effects in this sample.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- Authors
- APA Citation
Beaudequin, D., Can, A. T., Jones, M., Yang, C., Scherman, J. K., Dutton, M., Schwenn, P., Forsyth, C. G. G., Jensen, E., Hermens, D. F., & Lagopoulos, J. (2021). Relationships between reduction in symptoms and restoration of function and wellbeing: Outcomes of the Oral Ketamine Trial on Suicidality (OKTOS). Psychiatry Research, 305, 114212. https://doi.org/10.1016/j.psychres.2021.114212
References (4)
Papers cited by this study that are also in Blossom
Ballard, E. D., Luckenbaugh, D. A., Walls, T. S. et al. · Journal of Psychiatric Research (2015)
Basso, L., Bönke, L., Aust, S. et al. · Journal of Psychiatric Research (2020)
Can, A. T., Hermens, D. F., Dutton, M. et al. · Translational Psychiatry (2021)
Murrough, J. W., Iosifescu, D. V., Chang, L. C. et al. · American Journal of Psychiatry (2013)
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