Efficacy of esketamine for perinatal depression: a systematic review and meta-analysis.
Sabrina Wong, Gia Han Le, Angela T H Kwan, Kayla M Teopiz, Taeho Greg Rhee, Roger Ho, Joshua D. Rosenblat, Rodrigo B. Mansur, Roger S McIntyre
CNS Spectrums October 31, 2024 DOI: 10.1017/S1092852924000452 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 7 |
| Population | Women in randomized controlled trials of esketamine for prevention of postpartum depression |
| Intervention | esketamine |
| Topics | Esketamine Depression |
| Keywords | Mdd prevention Perinatal depression Postpartum depression ppd Postnatal depression Esketamine ketamine Perinatal psychiatry Preventive |
| Citations | 10 |
| Key findings | Esketamine was significantly associated with a decreased incidence of postpartum depression diagnosis within one week and between 4 to 6 weeks after childbirth. |
Abstract
Postpartum depression (PPD), now referred to as perinatal depression, is a prevalent and debilitating mood disorder that reduces health-related quality of life (HRQoL) and psychosocial functioning. Esketamine, which is efficacious in adults with treatment-resistant depression and individuals with depression and suicidality, is also analgesic in pain management during childbirth labour. Herein, we investigate the efficacy of prophylactic esketamine in reducing the incidence of PPD. We performed a systematic review (i.e., PubMed, Scopus, and Ovid databases; inception to January 22, 2024) of randomized controlled trials that investigated the use of esketamine for PPD. We delimited our search to studies that prespecified the prevention of PPD with esketamine as the primary outcome. A meta-analysis was performed on PPD incidence rates using a random effects model. Our analysis consisted of seven studies that met our eligibility criteria. We found that esketamine was significantly associated with a decreased incidence of PPD diagnosis within one week of childbirth (OR = 0.30, 95% CI = [0.15, 0.60], p = 0.0047). We also observed that esketamine was significantly associated with a decreased incidence of PPD diagnosis between 4 to 6 weeks post-delivery (OR = 0.33, 95% CI = [0.18, 0.59], p = 0.0034). Our results indicate that esketamine may have preventive antidepressant effects during the postpartum period. The aforementioned points have both mechanistic and clinically meaningful implications for the treatment of PPD.