Esketamine after childbirth reduces risk of postpartum depression by three-quarters

In a recent study published in british medical journalresearchers investigated whether low-dose esketamine administered postpartum would improve postnatal depression in women with prenatal depression.

study: Efficacy of a single low-dose esketamine administration after delivery for mothers with symptoms of prenatal depression: a randomized clinical trial. Image credit: christinarosepix / Shutterstock

background

Perinatal depression is more common in women, especially in low-income countries, and has negative effects on both mothers and children. Mothers with depression often feel anxious, less connected, and less attached. Their children are more likely to experience behavioral and emotional problems, as well as long-term psychological and developmental disabilities. Poor physical health, lack of social support, low socio-economic level, inadequate education, and history of violent exposure are all risk factors for prenatal depression.

Prenatal depression is a major predictor of postpartum depression, which may require drug treatment. Esketamine, a fast-acting antidepressant, offers potential benefits for treatment-resistant depression, but its effects on women with perinatal depression are unknown. Previous studies have primarily focused on caesarean section births and excluded mothers who suffered from or were at high risk of developing depression after giving birth.

About research

In this randomized, double-blind, placebo-controlled trial, researchers investigated whether administering low-dose esketamine immediately after birth reduces depression in mothers who have suffered from prenatal depression for 42 days. evaluated.

Researchers conducted the trial from June 19, 2020 to August 3, 2022 at five hospitals across China. Participants included pregnant women aged 18 years and older with mild, moderate, or severe antenatal depression. [defined as Edinburgh postnatal depression scale (EPDS] Score is 10 or higher. She is hospitalized for childbirth. They excluded women with pre-pregnancy mood disorders, severe pregnancy complications, physical status III or higher, or contraindications to the use of ketamine or esketamine, such as severe cardiovascular disease, refractory hypertension, or hyperthyroidism. . Exclusion criteria included American Society of Anesthesiologists (ASA) physical status III or higher.

The researchers randomly assigned subjects in a 1:1 ratio to either esketamine (0.20 mg/kg body weight) or a placebo group, and administered the drug intravenously during the first 40 minutes after birth while cutting the birth cord. The primary study outcome was a major depressive event 42 days postpartum, identified using the Mini International Neuropsychiatric Interview.

Secondary study outcomes included EPDS scores at 1 and 42 days postpartum, and Hamilton Depression Rating Scale (HDRS) scores at 42 days postpartum. Researchers monitored adverse events for up to 24 hours after delivery. They used logistic regression to determine relative risk (RR) values. They used imputed missing primary outcome data in a post hoc sensitivity analysis.

Researchers used the Zung Self-Rating Anxiety Scale to assess anxiety, the Social Support Rating Scale to assess social support, and the ENRICH (Evaluating and Nurturing Relationship Issues, Communication, and Well-Being) Scale to assess marital satisfaction. degree was measured using the Richmond Excitation-Sedation test. Sedation scale. Maternal data included receipt of epidural analgesia, delivery style, fluids, blood loss, and use of additional analgesics and sedatives. Weight, sex, Apgar scores at 1 minute and her 5 minutes postpartum, and first destination were all recorded.

result

Researchers screened 14,243 women and randomly assigned 364 to the study group. The average age of participants was 32 years. After 42 days, 12 (6.7%) of those taking esketamine and 46 (25%) of those taking placebo experienced a severe depressive episode (RR 0.3). Taking into account missing data, 14 (7.7%) of those receiving esketamine and 46 (25%) of those receiving placebo experienced a major depressive episode (RR 0.3). Protocol analysis yielded comparable results.

Women treated with esketamine had lower EPDS scores at days 7 and 42 (median difference, −3). Individuals receiving esketamine also had a decrease in their HDRS scores at 42 days postpartum (mean difference, −4). The incidence of neuropsychiatric adverse events (e.g. dizziness, diplopia, hallucinations) was higher in the esketamine group (45%, n=82) compared to 22% (n=40) in the placebo group . However, her symptoms lasted less than 24 hours and none required medication.

Esketamine-treated women had lower EPDS scores at days 7 and 42 (median difference, −3). Individuals receiving esketamine also had a decrease in their HDRS scores at 42 days postpartum (mean difference, −4). The incidence of neuropsychiatric adverse events (e.g. dizziness, diplopia, hallucinations) was higher in the esketamine group (45%, n=82) compared to 22% (n=40) in the placebo group . However, her symptoms lasted less than 24 hours and none required medication.

Overall, this study found that a single conservative dose of 0.2 mg/kg esketamine administered immediately after birth reduced major depressive events by almost three-quarters at 42 days postpartum in women with antenatal depressive symptoms. It was found that it decreased. Although esketamine increased the frequency of neuropsychiatric symptoms, the symptoms were brief, lasting less than 24 hours for her, and no medication was required. The antidepressant effects of low-dose esketamine appear to last longer in patients with prenatal depression than in depressed patients overall. Further analysis is required to see if the response continues after her 42 days.