Esketamine prevents postpartum depression after cesarean section: a Meta-analysis
Yao Wenzhuang, Zhang Hanyun, Liu Suman, Lyu Jieping
Yixue xinzhi zazhi April 2, 2026 DOI: 10.12173/j.issn.1004-5511.202505094 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Meta-analysis Peer reviewed |
|---|---|
| Sample size | 2,801 |
| Population | Women undergoing cesarean section |
| Intervention | Esketamine |
| Topics | Esketamine Depression |
| Keywords | Cesarean section Postpartum depression Patient-controlled intravenous analgesia Meta-analysis |
| Key findings | Perioperative esketamine reduces the incidence of postpartum depression after cesarean section but is associated with transient intraoperative neuropsychiatric symptoms. |
Abstract
Objective To systematically evaluate the efficacy and safety of Esketamine on postpartum depression (PPD) in cesarean section women.Methods Databases including PubMed, Embase, Web of Science, The Cochrane Library, CBM, CNKI, WanFang and VIP were searched from inception to March 2025 for RCTs investigating the impact of Esketamine on PPD in cesarean section parturients. RevMan 5.4 and Stata 18.0 software was used for Meta-analysis.Results A total of 15 RCTs involving 2,801 patients were included, with 1,516 in the Esketamine group and 1,285 in the control group. The Meta analysis showed that the incidence of PPD in the Esketamine group at 1 week postoperatively [RR=0.46, 95%CI (0.37, 0.57)] and at 6 weeks postoperatively [RR=0.63, 95%CI (0.51, 0.78)] was significantly lower than that in the control group. Futhermore, the EPDS scores were also significantly lower in the Esketamine group within 1 week postoperatively [MD=−2.52, 95%CI (−3.53, −1.50)] and at 6 weeks post-operatively [MD=−2.60, 95%CI (−4.09, −1.10)] was significantly lower than those in the control group. However, the incidence of intraoperative dizziness [RR=10.10, 95%CI (5.42, 18.84)] and hallucinations [RR=8.70, 95%CI (3.11, 24.34)] was significantly higher in the Esketamine group. There was no statistically significant difference in the incidence of postoperative nausea and vomiting [RR=0.87, 95%CI (0.62, 1.24)] and dizziness [RR=1.48, 95%CI (0.93, 2.34)] between the two groups.Conclusion Perioperative use of Esketamine reduces the incidence of PPD after cesarean section but is associated with transient neuropsychiatric symptoms during surgery, without increasing postoperative adverse reactions.
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 |