Efficacy of a single low dose of esketamine after childbirth for mothers with symptoms of prenatal depression: randomised clinical trial

BMJ, Journal Year: 2024, Volume and Issue: unknown, P. e078218 - e078218

Published: April 10, 2024

Abstract Objective To determine whether a single low dose of esketamine administered after childbirth reduces postpartum depression in mothers with prenatal depression. Design Randomised, double blind, placebo controlled trial two parallel arms. Setting Five tertiary care hospitals China, 19 June 2020 to 3 August 2022. Participants 364 aged ≥18 years who had at least mild as indicated by Edinburgh postnatal scale scores ≥10 (range 0-30, higher indicating worse depression) and were admitted hospital for delivery. Interventions randomly assigned 1:1 receive either 0.2 mg/kg or infused intravenously over 40 minutes once the umbilical cord been clamped. Main outcome measures The primary was prevalence major depressive episode 42 days post partum, diagnosed using mini-international neuropsychiatric interview. Secondary outcomes included score seven partum 17 item Hamilton rating 0-52, depression). Adverse events monitored until 24 hours childbirth. Results A total (mean age 31.8 (standard deviation 4.1) years) enrolled randomised. At observed 6.7% (12/180) participants group compared 25.4% (46/181) (relative risk 0.26, 95% confidence interval (CI) 0.14 0.48; P<0.001). lower (median difference −3, CI −4 −2; P<0.001) (−3, also (−4, −6 −3; overall incidence adverse (45.1% (82/182) v 22.0% (40/182); P<0.001); however, symptoms lasted less than day none required drug treatment. Conclusions For depression, decreases episodes about three quarters. Neuropsychiatric more frequent but transient did not require intervention. Trial registration ClinicalTrials.gov NCT04414943 .

Language: Английский

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

Journal of Affective Disorders, Journal Year: 2024, Volume and Issue: 351, P. 720 - 728

Published: Jan. 28, 2024

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

Language: Английский

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Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(3), P. e240953 - e240953

Published: March 6, 2024

Importance Postpartum depression (PPD) is one of the most common mental health conditions during perinatal and postpartum periods, which can have adverse effects on both mother infant. Objective To investigate efficacy perioperative adjunctive esketamine administration after cesarean deliveries in prevention PPD. Design, Setting, Participants A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to 2023, at Fujian Provincial Hospital among 298 women aged 18 40 years, with an American Society Anesthesiologists grade I III classification singleton full-term pregnancies who were scheduled for elective deliveries. Primary analyses performed a modified intention-to-treat basis. Interventions Patients randomly assigned (n = 148) control 150) groups. Those group received single intravenous injection 0.25 mg/kg immediately fetal delivery, followed by 50 mg as adjuvant patient-controlled analgesia 48 hours surgery. Saline given patients. Main Outcomes Measures The primary outcome assessments PPD symptoms using Edinburgh Postnatal Depression Scale (EPDS) day 7. Positive screening defined score 10 or more points EPDS. In addition, EPDS analyzed continuous variable evaluate depressive symptoms. Secondary outcomes included Numeric Rating (NRS) postoperative pain, along safety evaluations including events days 14, 28, 42. Results total pregnant included, 150 (median age, 31.0 years [IQR, 29.0-34.0 years]) 148 28.0-34.0 years]). prevalence significantly lower patients compared controls (23.0% [34 148] vs 35.3% [53 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P .02) also showed change scores (difference least-squares means [SE], −1.17 [0.44]; −2.04 −0.31; effect size, 0.74; .008). However, there no differences between groups incidence positive results changes baseline There NRS rest movement except 72 postoperatively, when (median, 3.0 2.0-3.0] 3.0-3.5]; median difference, 0 [95% 0-0]; .03). Conclusions Relevance These suggest that period delivery improve early period. this antidepression may not be universally applicable low scores. Trial Registration Chinese Clinical Registry Identifier: ChiCTR2100054199

Language: Английский

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Efficacy of esketamine for the treatment of postpartum depression and pain control following cesarean section: a randomized, double-blind, controlled clinical trial

BMC Anesthesiology, Journal Year: 2024, Volume and Issue: 24(1)

Published: Feb. 6, 2024

Abstract Background Postpartum depression (PPD) following a cesarean delivery is frequently seen complication. Despite the prophylactic effects of ketamine, impact esketamine on PPD in women undergoing section remains uncertain. This study aimed to assess effectiveness as an adjunct patient-controlled intravenous analgesia (PCIA) preventing caesarean section. Methods A total 275 parturients and subsequent were randomly assigned receive either control treatment (sufentanil 2 µg/kg + tropisetron 10 mg) or experimental with additional (1.5 mg/kg). The primary outcome measured was incidence postpartum (PPD), classified by Edinburgh Postnatal Depression Scale (EPDS) scores equal greater than 13 indicating PPD. Secondary outcomes included cumulative sufentanil consumption during specific time periods (0–24 h, 24–48 0–48 h) after surgical procedure numerical rating scale (NRS) at rest movements. Results final analysis 246 who had undergone delivery. On postoperative day 42, among group 17.6%, which significantly higher compared rate 8.2% ( P = 0.02). EPDS also showed significant difference between two groups, mean score 9.02 ± 2.21 6.87 2.14 p < 0.0001). In terms pain management, lower 0–24 h (42.5 4.58 µg vs. 50.15 5.47 µg, 0.04) (87.40 9.51 95.10 9.36 group. Differences movement observed groups 24 48 Sect. (3.39 1.57 4.50 0.80, 0.02; 2.43 0.87 3.56 0.76, It worth noting that frequency side both comparable. Conclusions Esketamine dose 1.5 mg/kg, when used supplement PCIA, has been shown reduce occurrence within 42 days. Additionally, it found decrease over 48-hour period operation, all without increasing adverse effects. Trial registration Registered Chinese Clinical Registry (ChiCTR2200067054) December 26, 2022.

Language: Английский

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Ketamine and its two enantiomers in anesthesiology and psychiatry: A historical review and future directions

Journal of Anesthesia and Translational Medicine, Journal Year: 2024, Volume and Issue: 3(3), P. 65 - 75

Published: July 11, 2024

Ketamine, a dissociative anesthetic, is widely utilized in both human and veterinary anesthesia. Its (S)-enantiomer, esketamine, similarly employed for anesthesia analgesia. The anesthetic effects of ketamine esketamine arise from their antagonism the N-methyl-D-aspartate receptor (NMDAR). In field psychiatry, rapid-acting antidepressant properties severe depression have generated significant interest, resulting its increased off-label usage United States (U.S.). 2019, nasal spray received approval use U.S. Europe. However, concerns emerged regarding potential adverse effects, including long-term efficacy, addiction risks, suicide risk clinical settings. contrast, arketamine, (R)-enantiomer ketamine, exhibits superior longer-lasting rodent models depression, with fewer side compared to esketamine. Nevertheless, research on efficacy safety arketamine patients remains limited. This article provides concise exploration historical two enantiomers while also delving into future directions application these fields.

Language: Английский

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Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail

BMC Anesthesiology, Journal Year: 2024, Volume and Issue: 24(1)

Published: Jan. 10, 2024

Abstract Background Postpartum depression (PPD) is a common mental disease in postpartum women, which has received more and attention society. Ketamine been confirmed for its rapid antidepressant effect women with PPD. We speculate that esketamine, an enantiomer of ketamine, pretreatment during cesarean can also reduce the incidence Methods All parturients enrolled study were randomly assigned to two groups: esktamine group (0.2 mg/kg esketamine) control (a same volume saline). drugs pumped 40 min started from beginning surgery. The Amsterdam Anxiety Information Scale (APAIS) scores before surgery, Edinburgh postnatal scale (EPDS) at 4 d 42 after Pain Numerical Rating (NRS) 6 h, 12 24 h 48 post-operation evaluated, as well adverse reactions recorded. Results A total 319 analyzed study. PPD (EPDS score > 9) esketamine was lower than days surgery (13.8% vs 23.1%, P = 0.0430) but not ( 0.0987). Esketamine 0.2 could NRS h,12 use vasoactive < 0.05). incidences maternal dizziness (17.0%), blurred vision (5%), illusion (3.8%) drowsiness higher those Conclusions Intraoperative injection mg/kg) prevented occurrence delivery days. reduced side effects such dizziness, vision, hallucination increased. Trial registration Registered Chinese Clinical Registry (ChiCTR2100053422) on 20/11/2021.

Language: Английский

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Association between esketamine interventions and postpartum depression and analgesia following cesarean delivery: a systematic review and meta-analysis

American Journal of Obstetrics & Gynecology MFM, Journal Year: 2024, Volume and Issue: 6(3), P. 101241 - 101241

Published: Jan. 21, 2024

Language: Английский

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Perioperative esketamine combined with butorphanol versus butorphanol alone for pain management following video-assisted lobectomy: a randomized controlled trial

International Journal of Clinical Pharmacy, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 3, 2025

Language: Английский

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Effects of epidural esketamine versus sufentanil on labor analgesia and postpartum depression: a retrospective cohort study

BMC Anesthesiology, Journal Year: 2025, Volume and Issue: 25(1)

Published: Jan. 7, 2025

There is a lack of research on epidural esketamine for labor analgesia. The purpose this to compare the efficacy and sufentanil analgesia postpartum depression. A total 187 cephalic full-term parturients with single-fetus vaginal delivery were collected in retrospective study from Jan 2022 2023. Parturients categorized into two groups according anesthetics: group (Group KR, n = 97) patient-controlled 0.3 mg/ml 0.083% ropivacaine 240 ml normal saline Sufentanil SR, 90) µg/ml saline. Visual Analogue Scale, Ramsay Sedation Modified Bromage Score recorded before, 5, 10, 30 min after analgesia, when uterine orifice was fully opened, delivery. Edinburgh Postnatal Depression Scale(EPDS) scores at 3 42 days recorded. maternal infant outcomes occurrence adverse reactions VAS 5,10,30 cervix opened higher Group KR than SR (all P < 0.05). RSS lower Compared significant decreases shown EPDS incidence depression has considerably decreased rates pruritus compared (P other effects showed no difference > neonatal not significantly different between In comparison sufentanil, may exhibit better sedative effect, low pruritus, but limited analgesic effect. It be associated risk Further exploration optimal regimen dosage would necessary.

Language: Английский

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Esketamine reduces the risk of postpartum depression in women undergoing cesarean section: a systematic review and meta-analysis

Journal of Psychiatric Research, Journal Year: 2025, Volume and Issue: 183, P. 164 - 173

Published: Feb. 14, 2025

Language: Английский

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