Journal Article

Perioperative administration of sub-anesthetic ketamine/esketamine for preventing postpartum depression symptoms: A trial sequential meta-analysis

Hung, Kuo-Chuan, Chen, Jen-Yin, Kao, Chia-Li, Chen, I-Wen, Lin, Chien-Hung, Lin, Chien-Ming, Ko, Ching-Chung, Lai, Yi-Chen

2024

Overview

Postpartum depression (PPD) is a major mental health issue affecting 10%-15% of women globally. This meta-analysis synthesized updated evidence on sub-anesthetic ketamine/esketamine's efficacy in preventing PPD. Randomized controlled trials (RCTs) comparing ketamine/esketamine to a placebo for PPD prevention were searched without language restriction. Primary outcomes were PPD risk at 1- and 4-6-week postpartum. Secondary outcomes included the difference in depression scores and risk of adverse events. Trial sequential analysis (TSA) was conducted to validate the reliability. A meta-analysis of 22 RCTs (n = 3,463) showed that ketamine/esketamine significantly decreased PPD risk at 1- (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.3-0.57) and 4-6-week (RR, 0.47; 95%CI, 0.35-0.63) follow-ups. Consistently, participants receiving ketamine/esketamine had lower depression-related scores at 1- (standardized mean difference [SMD], -0.94; 95%CI, -1.26 to -0.62) and 4-6-week (SMD, -0.89; 95%CI, -1.25 to -0.53) follow-ups. Despite potential publication bias, TSA confirmed the evidence's reliability. Subgroup analysis showed that ketamine/esketamine's preventive effect on 1-week PPD was consistent, regardless of administration timing, type of agents, or total dosage (<0.5 vs. ≥0.5 mg/kg). For the 4-6-week period, PPD risk was favorably reduced only with postoperative administration or the use of esketamine, with the total dosage having no observed influence. Participants on ketamine/esketamine experienced more frequency of hallucinations (RR, 4.77; 95%CI, 1.39-16.44) and dizziness (RR, 1.36; 95%CI, 1.02-1.81). Our findings advocate for the postoperative administration of low-dose ketamine/esketamine to avert PPD, which needed additional research for confirmation.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Anesthesia / Antidepressants / Bias / Biology and Life Sciences / Depression, Postpartum - prevention & control / Dosage / Dosage and administration / Drug dosages / Female / Humans / Intervention / Ketamine / Ketamine - administration & dosage / Ketamine - therapeutic use / Medicine and Health Sciences / Mental depression / Meta-analysis / People and Places / Perioperative care / Perioperative Care - methods / Pharmacology, Experimental / Physical Sciences / Physiological aspects / Postpartum / Postpartum depression / Prevention / Randomized Controlled Trials as Topic / Reliability / Research and Analysis Methods / Science Policy / Sequential analysis / Social Sciences / Subgroups / Testing