Esketamine reduces the risk of postpartum depression in women undergoing cesarean section: A systematic review and meta-analysis.

Abstract

<h4>Background</h4>Postpartum depression (PPD) is a prevalent and debilitating disorder that occurs in 14% of women after giving birth.<h4>Objectives</h4>We aimed to assess the efficacy and safety of perioperative esketamine for preventing PPD in women undergoing cesarean section.<h4>Search strategy</h4>We performed a systematic literature search in five medical databases - MEDLINE, Cochrane Library, Embase, Scopus, and Web of Science on the 12th of January 2025.<h4>Selection criteria</h4>We searched for trials on the efficacy and safety of esketamine for preventing PPD.<h4>Data collection and analysis</h4>We collected data on rates of PPD, Edinburgh Postnatal Depression Scale (EPDS) scores, and adverse effects. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model.<h4>Results</h4>Our systematic search provided 2681 records; we screened 1336 duplicate-free records. A total of 17 eligible studies were identified after title, abstract, and full-text selection. Esketamine administration was associated with a lower rate of PPD at postpartum days 3-7 and 28-42 (OR = 0.43; 95% CI: 0.31-0.59 and OR = 0.59; 95% CI: 0.39-0.87, respectively). Esketamine administration was associated with significantly lower EPDS scores at postpartum days 3-7 (MD = -1.32; 95% CI: 1.84 to -0.80).<h4>Conclusions</h4>Our findings suggest that perioperative administration of esketamine was associated with lower PPD rates and lower scores on the EPDS questionnaire and was considered safe compared to placebo/standard care.

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