Predicting therapeutic response to oral ketamine for chronic suicidal ideation: a Bayesian network for clinical decision support

Abstract

Background The glutamatergic modulator ketamine has been shown to result in rapid reductions in both suicidal ideation (SI) and depressive symptoms in clinical trials. There is a practical need for identification of pre-treatment predictors of ketamine response. Previous studies indicate links between treatment response and body mass index (BMI), depression symptoms and previous suicide attempts. Our aim was to explore the use of clinical and demographic factors to predict response to serial doses of oral ketamine for chronic suicidal ideation. Methods Thirty-two participants completed the Oral Ketamine Trial on Suicidality (OKTOS). Data for the current study were drawn from pre-treatment and follow-up time-points of OKTOS. Only clinical and sociodemographic variables were included in this analysis. Data were used to create a proof of concept Bayesian network (BN) model of variables predicting prolonged response to oral ketamine, as defined by the Beck Scale for Suicide Ideation (BSS). Results The network of potential predictors of response was evaluated using receiver operating characteristic (ROC) curve analyses. A combination of nine demographic and clinical variables predicted prolonged ketamine response, with strong contributions from BMI, Social and Occupational Functioning Assessment Scale (SOFAS), Montgomery-Asberg Depression Rating Scale (MADRS), number of suicide attempts, employment status and age. We evaluated and optimised the proposed network to increase the area under the ROC curve (AUC). The performance evaluation demonstrated that the BN predicted prolonged ketamine response with 97% accuracy, and AUC = 0.87. Conclusions At present, validated tools to facilitate risk assessment are infrequently used in psychiatric practice. Pre-treatment assessment of individuals’ likelihood of response to oral ketamine for chronic suicidal ideation could be beneficial in making more informed decisions about likelihood of success for this treatment course. Clinical trials registration number ACTRN12618001412224, retrospectively registered 23/8/2018.

Spectral Changes of EEG Following a 6-Week Low-Dose Oral Ketamine Treatment in Adults With Major Depressive Disorder and Chronic Suicidality

“…The primary clinical outcome measure was reduction in suicidality with ketamine treatment, and this was determined by Beck Scale for Suicide Ideation (BSS) ( Can et al, 2021 ). Secondary clinical measures used in this study included the Depression Anxiety Stress Scale 21 (DASS-21) ( Beaudequin et al, 2020 ; Dutton et al, 2022 ). In total, assessments at each major timepoint required approximately 8 hours.…”

Ketamine and esketamine in suicidal thoughts and behaviors: a systematic review

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Analysis of Factors That Influenced the Mental Health Status of Public Health Workers During the COVID-19 Epidemic Based on Bayesian Networks: A Cross-Sectional Study

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