The potential of ketamine to mitigate postpartum depression

The potential of ketamine to mitigate postpartum depression | Image Credit: © grooveriderz - © grooveriderz - stock.adobe.com.

According to a poster featured at the 2023 Society of OB/GYN Hospitalists Annual Clinical Meeting, held in Chicago, Illinois, the potential for ketamine as an anesthetic in labor and its potential role to mitigate postpartum depression (PPD) was investigated.

PPD symptoms of PPD include depressed moods, loss of interest in activities, sleep disturbance, irritability, and lack of energy. Treatment for PPD, which has a worldwide prevalence of 14% (higher in primiparous women compared to multiparous women), includes various forms of psychotherapy and antidepressants, wrote the authors.

According to the study, ketamine has dual effects on the brain and serves as an inhibitor of the NMDA receptor, “a key player in the brain’s pain perception and memory formation pathways, effectively reducing the sensation of pain,” wrote the authors. Ketamine also amplifies AMPA receptors, which are integral to long-term potentiation. This process “is believed to be essential for neural plasticity and long-term memories.” The interplay leads to the distinctive anesthetic and dissociative effects of ketamine.

The poster included a case presentation, highlighting a 31-year-old female (Grivada 4 Para 4004) with a history of depression and asthma. The female presented 30 days postpartum with psychomotor agitation and disorganized behavior. She delivered her fourth child via cesarean section, without ketamine administration. After her second and third deliveries, where ketamine was used, she exhibited positive postpartum adaptation. She scored a 24 out of 30 on the Edinburgh Postnatal Depression Scale, and routine diagnostic assessments at admission were normal. The woman was started on antidepressant medication and saw improvements within 2 weeks of treatment initiation.

Her vital signs and laboratory results were consistently within normal limits during the prenatal period, prenatal courses were uncomplicated, and she took daily supplements of a multivitamin, iron, and folate. Out of 4 deliveries, the second and third were complicated by fetal distress and hypotension. These deliveries were managed with ketamine and resulted in no depressive symptoms. In contrast, symptoms of postpartum depression followed the first and fourth deliveries, in which ketamine was not used, respectively.

Often sharing symptom structures with other major depressive disorders, PPD is both common and impactful, impeding women’s functional capability and negatively impacting health outcomes of the child. As a result, the authors noted, women with PPD are less likely to go to well-child visits, use home safety devices, and complete immunizations.

Ketamine has emerged as a potential alternative to traditional antidepressants for PPD treatment, because of its anesthetic, analgesic, “and potential antidepressant properties.” The authors noted that ketamine’s potential role in PPD prevention is under-researched, though there are promising indications and documented benefits in improving PPD symptoms.

The findings in this study, “though preliminary and specific to one individual, indicate the need for randomized controlled trials to substantiate these observations,” the authors concluded.

Reference:

McAllister V, Ramallo M, Benjamin C, Atalay R, Michael M. Exploring the efficacy of ketamine as an anesthetic and antidepressant in postpartum depression: a case study analysis. 2023 Society of OB/GYN Hospitalists Annual Clinical Meeting. September 9-13. Chicago, Illinois.