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.
Comparable studies
Other systematic reviews and meta-analyses on esketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Comparative efficacy of racemic ketamine and esketamine for depression: a systematic review and meta-analysis Adults with unipolar or bipolar major depression | 2020 | Systematic review and meta-analysis | n = 1,877 |
| The acute antisuicidal effects of single-dose intravenous ketamine and intranasal esketamine in individuals with major depression and bipolar disorders: A systematic review and meta-analysis. Participants in randomized controlled trials of ketamine for suicidal ideation | 2020 | Systematic review and meta-analysis | n = 197 |
| Efficacy of Esketamine Augmentation in Major Depressive Disorder Patients with major depressive disorder who are treatment-resistant or acutely suicidal | 2020 | Systematic review and meta-analysis | n = 774 |
| Esketamine Treatment for Depression in Adults: A PRISMA Systematic Review and Meta-Analysis. Patients with treatment-resistant major depressive disorder | 2025 | Systematic review and meta-analysis | |
| EFFICACY AND SAFETY OF RACEMIC KETAMINE AND ESKETAMINE FOR DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS Adults with unipolar or bipolar major depression | 2022 | Systematic review and meta-analysis | n = 2,903 |
Citations in the library
Cited by 5
- Esketamine reduces the risk of postpartum depression in women undergoing cesarean section: A systematic review and meta-analysis. Journal of Psychiatric Research March 1, 2025
- Modulating tonic NMDA receptor currents: mechanistic insights into ketamine, esketamine, and dextromethorphan for major depressive disorder and implications for the discovery and development of investigational agents. Expert Opinion on Therapeutic Targets January 28, 2026
- Exploring Esketamine's Therapeutic Role for Perinatal Depression via TASK-1 Tandem Pore Potassium Channels. ACS Chemical Neuroscience July 29, 2025
- Ketamine and esketamine for the prevention of postpartum depression: A systematic review and network meta-analysis, with an integrated evidence synthesis. Psychiatry Research May 12, 2026
- Are the current safety measures for the treatment of depression with esketamine sufficient? Expert Opinion on Drug Safety February 19, 2026
Cites 5
- Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation American Journal of Psychiatry March 17, 2021
- Esketamine in treatment-resistant depression patients comorbid with substance-use disorder: A viewpoint on its safety and effectiveness in a subsample of patients from the REAL-ESK study European Neuropsychopharmacology May 4, 2023
- Investigating the Effectiveness and Tolerability of Intranasal Esketamine Among Older Adults With Treatment-Resistant Depression (TRD): A Post-hoc Analysis from the REAL-ESK Study Group American Journal of Geriatric Psychiatry July 8, 2023
- Ketamine as Potential Treatment for Postpartum Depression: A Narrative Review Annals of Clinical Psychiatry November 1, 2022
- S-ketamine as an adjuvant in patient-controlled intravenous analgesia for preventing postpartum depression: a randomized controlled trial BMC Anesthesiology December 16, 2021