Perioperative adjunctive esketamine during cesarean delivery mitigates depressive symptoms: JAMA

Postpartum depression (PPD) is a prevalent mental health condition affecting numerous women during the perinatal and postpartum periods which poses significant risks to both maternal and infant well-being. A recent study published in the Journal of American Medical Association revealed that esketamine administration significantly decreased the postpartum depression incidence and improved depressive symptoms during the initial postpartum period.

The study was conducted at Fujian Provincial Hospital from January 2022 to January 2023 and involved a total of 298 women. The participants of this study were aged 18 to 40 years who were undergoing elective cesarean deliveries. This single-center, double-blind, placebo-controlled, randomized clinical trial investigated the effectiveness of esketamine with emerging antidepressant properties in controlling PPD symptoms.

The participants were randomly assigned to receive either esketamine or a placebo following cesarean delivery. The esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after delivery, this was followed by additional doses as an adjuvant in patient-controlled intravenous analgesia for 48 hours post-surgery, while the control group received saline.

The primary outcomes were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7 with positive screening for PPD defined as a score of 10 or more points on the EPDS. The results indicated a significant reduction in depression symptoms among patients who were administered esketamine when compared to the control group at postpartum day 7.

While the esketamine group expressed lower depression symptom scores and reduced pain levels, these benefits did not extend uniformly across all the postpartum assessments. There were no significant differences in PPD screening results or changes in EPDS scores between the groups at later follow-up points. The outcomes of this study emphasized the potential of esketamine as a perioperative intervention for preventing early postpartum depression.

Reference:

Chen, Y., Guo, Y., Wu, H., Tang, Y.-J., Sooranna, S. R., Zhang, L., Chen, T., Xie, X.-Y., Qiu, L.-C., & Wu, X.-D. (2024). Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery. In JAMA Network Open (Vol. 7, Issue 3, p. e240953). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.0953