Department of Anesthesiology, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, No. 199, Jiefang South Road, Xuzhou , Jiangsu, 221009, China.
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Jiangsu, China.
BMC Anesthesiol. 2024 Aug 19;24(1):293. doi: 10.1186/s12871-024-02681-9.
The development of postpartum depression has been linked to fluctuations in the levels of neurotransmitters in the human body, such as 5-hydroxytryptamine (5-HT), dopamine (DA), noradrenaline (Norepinephrine, NE), and brain derived neurotrophic factor (BDNF). Research has indicated that the antidepressant effect of esketamine are mediated by monoamine transmitters and neurotrophic factors. Therefore, we postulate that intravenous administration of esketamine in patients with postpartum depression may alter the serum concentrations of these neurotransmitters.
Three hundred fifteen patients with postpartum depression were selected and divided into two groups based on randomized numerical expression: esketamine (E) group (0. 25 mg/kg esketamine) and control (C) group (a same volume of 0.9% saline), all the drugs were pumped for 40 min. After the end of drug pumping, all patients were continuously observed for 2 h. Changes in serum levels of 5-HT, DA, NE, BDNF were recorded before drug administration and on the 3rd day after drug administration. The scores of Edinburgh Postnatal Depression Scale (EPDS) were calculated before drug administration, and on the 3rd day and on the 30th day after drug administration. Dizziness, headache, nausea, vomiting, drowsiness, and feeling of detachment occurred were recorded within 2 h after drug administration.
Before drug administration, the serum concentrations of 5-HT,DA,BDNF,NE in Group E and Group C were namely (0. 91 ± 0. 19 vs. 0. 98 ± 0. 21, P = 0. 181), (2. 38 ± 0. 35 vs. 2. 32 ± 0. 32, P = 0. 491), (3. 07 ± 0. 89 vs 3. 02 ± 0. 88, P = 0. 828), (39. 79 ± 7. 78 vs 41. 34 ± 10. 03, P = 0. 506). On the third day post-medication, the serum concentrations of 5-HT,DA,BDNF,NE in Group E and Group C were namely (1. 42 ± 0. 35 vs. 0. 96 ± 0. 24, P < 0. 001), (3. 99 ± 0. 17 vs. 2. 41 ± 0. 28, P < 0. 001),(5. 45 ± 0. 81 vs 3. 22 ± 0. 76, P < 0. 001),(44. 36 ± 9. 98 vs 40. 69 ± 11. 75, P = 0. 198). Before medication, the EPDS scores were (16. 15 ± 3. 02 vs 17. 85 ± 3. 89, P = 0. 064). on the third day after medication, the Group E had significantly reduced scores (12. 98 ± 2. 39 vs 16. 73 ± 3. 52, P < 0. 001). On the 30rd day after medication, EPDS scores between the two groups were (16. 34 ± 3. 43 vs 16. 91 ± 4. 02, p = 0. 203). Within 2 h of medication, the rate of adverse events was similar between the two groups.
Small doses of esketamine can increase the serum concentration of 5-HT,DA,BDNF, and in the short term, decrease EPDS scores, and improve postpartum depressive symptoms.
Retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2300078343, 2023/12/05).
产后抑郁症的发展与人体神经递质水平的波动有关，如 5-羟色胺（5-HT）、多巴胺（DA）、去甲肾上腺素（去甲肾上腺素，NE）和脑源性神经营养因子（BDNF）。研究表明，氯胺酮的抗抑郁作用是通过单胺递质和神经营养因子介导的。因此，我们推测静脉注射氯胺酮治疗产后抑郁症患者可能会改变这些神经递质的血清浓度。
选择 315 例产后抑郁症患者，根据随机数字表达式分为两组：氯胺酮（E）组（0.25mg/kg 氯胺酮）和对照组（C）组（相同体积的 0.9%生理盐水），所有药物均泵注 40min。药物输注结束后，所有患者均连续观察 2h。记录药物输注前和药物输注后第 3 天的血清 5-HT、DA、NE、BDNF 水平。记录药物输注前、第 3 天和第 30 天的爱丁堡产后抑郁量表（EPDS）评分。记录药物输注后 2h 内出现的头晕、头痛、恶心、呕吐、嗜睡和分离感。
药物输注前，E 组和 C 组的血清 5-HT、DA、BDNF、NE 浓度分别为（0.91±0.19 vs. 0.98±0.21，P=0.181）、（2.38±0.35 vs. 2.32±0.32，P=0.491）、（3.07±0.89 vs. 3.02±0.88，P=0.828）、（39.79±7.78 vs. 41.34±10.03，P=0.506）。药物输注后第 3 天，E 组和 C 组的血清 5-HT、DA、BDNF、NE 浓度分别为（1.42±0.35 vs. 0.96±0.24，P<0.001）、（3.99±0.17 vs. 2.41±0.28，P<0.001）、（5.45±0.81 vs. 3.22±0.76，P<0.001）、（44.36±9.98 vs. 40.69±11.75，P=0.198）。药物前 EPDS 评分分别为（16.15±3.02 vs. 17.85±3.89，P=0.064）。药物输注后第 3 天，E 组评分显著降低（12.98±2.39 vs. 16.73±3.52，P<0.001）。药物输注后第 30 天，两组 EPDS 评分分别为（16.34±3.43 vs. 16.91±4.02，P=0.203）。药物输注后 2h 内，两组不良反应发生率相似。
小剂量氯胺酮可增加 5-HT、DA、BDNF 血清浓度，短期降低 EPDS 评分，改善产后抑郁症状。
在中国临床试验注册中心（ChiCTR2300078343，2023/12/05）进行了回顾性注册。
