Efficacy and safety of ketamine and esketamine in reducing the incidence of postpartum depression: an updated systematic review and meta-analysis.
Study Goal
The researchers aimed to evaluate the efficacy and safety of ketamine and esketamine in preventing postpartum depression (PPD) in women after childbirth.
Results Summary
Both ketamine and esketamine significantly reduced the incidence of short-term PPD, while only esketamine was effective for long-term PPD. However, higher rates of side effects like dizziness, blurred vision, vomiting, and hallucinations were reported in the ketamine/esketamine groups.
Population
Pregnant women after cesarean or vaginal delivery.
Effective Dosage
Doses less than 0.5 mg were noted as significantly effective.
Duration
Not specified in the abstract.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
ketamine | decrease | short-term postpartum depression | pregnant women | RR = 0.72, 95% CI [0.56, 0.93], P = 0.01 | significantly effective in reducing the incidence | #1 |
esketamine | decrease | short-term postpartum depression | pregnant women | RR = 0.43, P < 0.0001 | significantly effective in reducing the incidence | #2 |
esketamine | decrease | long-term postpartum depression | pregnant women | RR = 0.44, P < 0.00001 | significantly reduced the incidence | #3 |
high dose ketamine/esketamine | decrease | short-term postpartum depression | pregnant women | RR = 0.48, P = 0.0005 | effective in reducing the incidence | #4 |
low dose ketamine/esketamine | decrease | short-term postpartum depression | pregnant women | RR = 0.46, P = 0.002 | effective in reducing the incidence | #5 |
high dose ketamine/esketamine | decrease | long-term postpartum depression | pregnant women | RR = 0.54, P < 0.0001 | effective in reducing the incidence | #6 |
low dose ketamine/esketamine | decrease | long-term postpartum depression | pregnant women | RR = 0.61, P = 0.009 | effective in reducing the incidence | #7 |
ketamine/esketamine | increase | dizziness | women in the Ketamine/esketamine group | P = 0.0007 | showed statistically significant higher rates of developing | #8 |
ketamine/esketamine | increase | blurred vision | women in the Ketamine/esketamine group | P = 0.02 | showed statistically significant higher rates of developing | #9 |
ketamine/esketamine | increase | vomiting | women in the Ketamine/esketamine group | P = 0.004 | showed statistically significant higher rates of developing | #10 |
ketamine/esketamine | increase | hallucinations | women in the Ketamine/esketamine group | P = 0,002 | showed statistically significant higher rates of developing | #11 |
BACKGROUND: Postpartum depression (PPD) is categorized by the Disorders-Fifth Edition as depression that begins during pregnancy or within the first month after giving birth. Ketamine and esketamine have shown promising results in the treatment of several depressive disorders, which suggests that they may have a role in the prevention of PPD. This systematic review and meta-analysis aim to update evidence about the efficacy and safety of using ketamine and esketamine to reduce PPD incidence. METHODS: We searched four databases, PubMed, Scopus, Web of Science, and Cochrane, to collect relevant studies. We included studies which investigated the preventive effect of ketamine or esketamine on PPD among women after giving birth through caesarean or vaginal delivery. We extracted PPD occurrence rate, PPD score, pain score and side effects. Finally, a meta-analysis was conducted using RevMan software. RESULTS: Twenty-one eligible studies were incorporated in the current systematic review and meta-analysis involving 4,389 pregnant women. Esketamine was the intervention in 14 studies, and ketamine was used in 7 studies. In subgroup analysis, both ketamine and esketamine were significantly effective in reducing the incidence of short-term PPD (ketamine: RR = 0.72, 95% CI [0.56, 0.93], P = 0.01; esketamine: RR = 0.43, P < 0.0001). Esketamine only significantly reduced the incidence of long-term PPD (RR = 0.44, P < 0.00001). Low doses and high doses were effective in reducing the incidence of both short-term (high dose: RR = 0.48, P = 0.0005; low dose: RR = 0.46, P = 0.002) and long-term PPD (high dose: RR = 0.54, P < 0.0001; low dose: RR = 0.61, P = 0.009). Regarding the risk of side effects, patients in the Ketamine/esketamine group showed statistically significant higher rates of developing dizziness (P = 0.0007), blurred vision (P = 0.02), vomiting (P = 0.004) and hallucinations (P = 0,002) than women in the control group. CONCLUSION: Both ketamine and esketamine are effective in lowering the incidence of short-term PPD. On the other hand, only esketamine is effective in reducing the incidence of long-term PPD. It is recommended to use smaller doses for a more tolerable treatment period since doses less than 0.5 mg are significantly effective. Temporary side effects such as dizziness, blurred vision, vomiting and hallucinations were reported.