Intraoperative esketamine linked to lower postpartum depression rates after cesarean delivery

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A new study suggests that administering esketamine during cesarean delivery may reduce the risk of postpartum depression (PPD) in new mothers. The findings, published in JAMA Network Open, highlight the potential benefits of the drug in clinical settings.

The study, conducted at The First Affiliated Hospital of Chongqing Medical University in China, included 308 pregnant women undergoing cesarean delivery.

Participants were randomly assigned to two groups: one receiving a 0.25 mg/kg infusion of esketamine and the other receiving a saline placebo. Researchers assessed the incidence of PPD at six weeks postpartum using the Edinburgh Postnatal Depression Scale.

Results showed that 10.4% of mothers in the esketamine group experienced postpartum depression compared to 19.5% in the control group. The study’s authors concluded, "Findings of this trial indicate the efficacy and safety of esketamine in preventing PPD among patients with cesarean delivery and warrant further investigation in clinical practice."

While the study found a significant difference in PPD rates at six weeks, it did not observe the same effect at one week postpartum. Researchers also noted that esketamine did not significantly impact pain levels but reduced the need for additional pain medication.

However, the study identified some short-term side effects associated with esketamine use. Patients receiving the drug reported dizziness, trance-like states, and dream-like sensations more frequently than those in the control group. The study noted that these effects were transient and diminished over time.

Postpartum depression is a significant concern, affecting millions of new mothers worldwide. Women who undergo cesarean deliveries are at an increased risk of developing the condition.

The findings suggest esketamine could be a potential preventive treatment, but the study's authors emphasized the need for further research to confirm its effectiveness and safety in broader clinical practice.

"This randomized clinical trial demonstrated esketamine’s advantage in reducing the incidence of PPD at six weeks postpartum in patients who underwent cesarean delivery," the study states. "The efficacy and safety of esketamine in preventing PPD warrant further investigation in clinical practice."

The study adds to growing research on the potential benefits of esketamine, a drug derived from ketamine, in treating depressive disorders. However, experts caution that more extensive studies are needed to determine long-term effects and establish standardized treatment protocols.

For now, the findings provide new insights into how esketamine may help mitigate postpartum depression risks for mothers undergoing cesarean deliveries, potentially improving mental health outcomes in the postpartum period.

Reference

Chen Y, Guo Y, Wu H, et al. Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(3):e240953. Published 2024 Mar 4. doi:10.1001/jamanetworkopen.2024.0953