Optimizing esketamine administration for postoperative depression: a comprehensive study on laparoscopic bariatric surgery patients.
Jiabao Dai, Yanfeng Lu, Zhiqing Zou, Zhouquan Wu
Psychopharmacology February 1, 2025 DOI: 10.1007/s00213-024-06673-y (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Double-blind Peer reviewed |
|---|---|
| Sample size | 120 |
| Population | Patients undergoing laparoscopic bariatric surgery |
| Intervention | Esketamine |
| Dose | 0.2 mg/kg |
| Topics | Esketamine Depression |
| Keywords | Laparoscopic bariatric surgery Anesthesia anaesthesia Anesthetic Antidepressants depression medication Mood stabilizers Esketamine ketamine Obesity surgery Metabolic |
| Citations | 11 |
| Key findings | Esketamine given before anesthesia reduced postoperative depression symptoms and increased BDNF levels, while esketamine given after anesthesia did not improve depression symptoms. |
Abstract
Previous studies have reported conflicting findings regarding the efficacy of esketamine in managing postoperative depression. While the positive effects of subanesthetic doses esketamine have been observed in treatment-resistant depression, the response to this medication in patients experiencing depression following surgery has not been consistent. Building upon the known impact of anesthesia on brain function, we have formulated a hypothesis suggesting that the timing of esketamine administration in relation to anesthesia may significantly affect its efficacy in managing postoperative depression. The aim of this study was to investigate the effect of esketamine administered at different time points before and after anesthesia. Our randomized, double-blind, controlled study involved 120 patients undergoing laparoscopic bariatric surgery, randomly divided into three groups. Group Post- ESK received an intravenous injection of esketamine at a dose of 0.2 mg/kg after anesthesia induction. Group Pre- ESK received the same esketamine dosage 2 h prior to anesthesia induction. Group Placebo served as the control group and received a 0.9% saline solution after induction. The primary outcome measures of the study were depression scores as measured by Patient Health Questionnaire-9 (PHQ-9) and plasma brain-derived neurotrophic factor (BDNF) levels. On the first postoperative day, the PHQ-9 scores, incidence and severity of postoperative depression in the Pre-ESK group were significantly lower than those in the Post-ESK and placebo groups (P < 0.05). Additionally, plasma BDNF levels in the Pre-ESK group were significantly higher than those in the Post-ESK and placebo groups (P < 0.05). Notably, there was a negative correlation between PHQ-9 scores and plasma BDNF levels. Our study supports the potential for subanesthetic dose esketamine to alleviate postoperative depression symptoms following laparoscopic bariatric surgery, and anesthetic drugs have a significant effect on its efficacy. The use of subanesthetic dose esketamine after anesthesia does not improve postoperative depression symptoms in patients undergoing laparoscopic bariatric surgery, while the use of sub-anesthetic dose esketamine before anesthesia can improve postoperative depression symptoms.
Comparable studies
Other randomized controlled trials on esketamine for depression, most cited first.