Journal Article Annotations
2024, 2nd Quarter

Neuromodulation/Interventional Psychiatry

Annotations by Liliya Gershengoren, MD
July, 2024

Effects of ketamine and esketamine on preventing postpartum depression after cesarean delivery: A meta-analysis.

PUBLICATION #1 — Neuromodulation/Interventional Psychiatry

Effects of ketamine and esketamine on preventing postpartum depression after cesarean delivery: A meta-analysis.

Shuying Li, Wenqin Zhou, Ping Li, Rongqian Lin.

Abstract: J Affect Disord. 2024 Apr 15:351:720-728. doi: 10.1016/j.jad.2024.01.202. Epub 2024 Jan 28.

Background:
Ketamine and esketamine has been suggested to have potential efficacy in preventing postpartum depression (PPD) recent years. The aim of this meta-analysis was to evaluate the effectiveness of ketamine and esketamine on PPD after cesarean delivery.

Methods:
We systematically searched PubMed, Embase, and the Cochrane Library for studies investigating the efficacy of ketamine and esketamine in preventing PPD. The primary outcomes of this study were risk ratios (RRs) and EPDS scores (Edinburgh Postnatal Depression Scale) in relation to PPD after ketamine and esketamine. The second outcomes were the postoperative adverse events.

Results:
Thirteen randomized controlled trials (RCTs) and one retrospective study including 2916 patients were analyzed, including six on the use of ketamine and eight on the use of esketamine. The risk ratios and EPDS scores of PPD were significantly decreased in the ketamine/esketamine group compared to those in the control group in one week and four weeks postoperative periods. Subgroup analyses showed that high dosage, administrated in patient controlled intravenous analgesia (PCIA) method and only esketamine exhibited a significant reduction in the incidence and EPDS scores of PPD in one week and four week postoperative. However, the incidences of postoperative adverse events, such as dizziness, diplopia, hallucination, and headache were significantly higher in the ketamine/esketamine group than that in the control group.

Conclusion:
Ketamine and esketamine appear to be effective in preventing PPD in the one week and four week postoperative periods after cesarean delivery with moderate certainty of evidence. But they can also lead to some short-term complications too. Future high-quality studies are needed to confirm the efficacy of ketamine and esketamine in different countries.

Annotation

The finding:
Ketamine and esketamine were shown to significantly reduce post-partum depression incidence and Edinburgh Postnatal Depression Scale (EPDS) scores. Higher dosages and patient-controlled intravenous analgesia (PCIA) methods were also particularly effective. However, the use of ketamine and esketamine also led to increased short-term adverse effects such as dizziness, diplopia, hallucination, and headache.

Strength and weaknesses:
The study’s strengths include a thorough analysis that combined data from 14 different studies, involving 2916 patients, which provides strong evidence that ketamine and esketamine can help prevent postpartum depression (PPD). The authors also conducted subgroup analyses to identify specific factors that enhance treatment efficacy, such as dosage and administration method. However, a notable weakness is the predominance of studies conducted in China, which may limit the generalizability of the findings to other populations. Additionally, the study reported considerable heterogeneity among the included studies, potentially affecting the reliability of the overall conclusions.

Relevance:
This study provides robust evidence supporting the use of ketamine and esketamine to prevent postpartum depression (PPD) in patients undergoing cesarean deliveries. As a result, the study offers practical insights for clinical interventions aimed at reducing PPD incidence. Additionally, understanding the associated short-term side effects can help psychiatrists weigh the benefits and risks when considering these treatments for their patients.