Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery: A Randomized Clinical Trial
Authors' conclusion
These results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period.
Study context
- Population
- Women aged 18 to 40 years, ASA I to III, singleton full-term pregnancies, scheduled for elective cesarean delivery; Fujian Provincial Hospital, 2022–2023
- Participants
- 298 women
- Comparison
- Perioperative esketamine vs saline
- Esketaminen = 148
- Controln = 150reference
- Primary endpoint
- PPD symptoms by Edinburgh Postnatal Depression Scale (EPDS); positive screening = EPDS score ≥10 points; EPDS also analysed as continuous variable
- Follow-up
- Postpartum day 7
Methodological detailssingle-centre, double-blind, placebo-controlled
- Single-centre
- Double-blind
- Placebo-controlled
Primary result
As reported in the abstract
Prevalence of depression symptoms (positive PPD screening)
Esketamine vs ControlOdds ratio (95% CI)P value
Prevalence of depression symptoms (positive PPD screening)
0.55(0.33–0.91)
P = 0.02Esketamine vs ControlDifference of least-squares means (95% CI)P value
Change in EPDS scores; SE 0.44; effect size 0.74
−1.17(−2.04 to −0.31)
P = 0.008Secondary outcomes
Median
| Outcome | Esketamine | Control | Median difference (95% CI) | P value | |
|---|---|---|---|---|---|
| NRS on movement · 72 hours postoperativelySignificantly lower in the esketamine group | 3.0 (IQR 2.0–3.0) | 3.0 (IQR 3.0–3.5) | 0 (0–0) | P = 0.03 | |
| 0000000Difference (linear scale) |
Positive PPD screening and change from baseline Edinburgh Postnatal Depression Scale (EPDS) scores · postpartum days 14, 28, and 42
- No differences between the groups
Postoperative pain (Numeric Rating Scale (NRS)) at rest and on movement
- No differences except on movement at 72 hours postoperatively
Original publication
Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery: A Randomized Clinical Trial. JAMA Netw Open. Published 4 March 2024. doi:10.
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