Intraoperative esketamine infusion may reduce postpartum depression in women undergoing cesarean delivery

1. Intraoperative esketamine infusion significantly reduced the incidence of postpartum depression (PPD) at 6 weeks post partum in women undergoing cesarean delivery. 

Evidence Rating Level: 1 (Excellent)

PPD, which affects nearly 18% of women after delivery globally and can have major impacts on parent-child bonding, is more likely to affect women who undergo cesarean delivery compared to vaginal delivery. Past randomized controlled trials (RCTs) have explored the effects of esketamine on PPD in women who have undergone cesaraean delivery, but these RCTs have had conflicting results. This single-centre, double-blind pragmatic trial therefore sought to investigate the efficacy of esketamine on preventing PPD in women undergoing cesarean delivery. 308 patients from Chongqing, China were assigned to receive either esketamine infusion intraoperatively (n = 154; mean [SD] patient age, 31.57 [4.26] years) or to a control group (n = 154; mean [SD] patient age, 32.53 [7.74] years). The primary outcome of interest was the incidence of PPD 6 weeks post partum as assessed by the Edinburgh Postnatal Depression Score (EPDS). At 6 weeks post partum, the incidence of PPD was significantly lower in the esketamine group compared to the control group (10.4% [16] vs 19.5% [30]; RR, 0.53; 95% CI, 0.30-0.93; P = .02). Adverse events occurred more frequently in the esketamine group compared to the control group, such as dizziness (28 [18.2%] vs 3 [1.9%]; χ2 = 22.41; P < .001). Overall, this study found that intraoperative esketamine infusion significantly reduced the incidence of PPD at 6 weeks in women undergoing cesarean delivery.  

Click to read the study in JAMA Network Open

Image: PD

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