Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
PLoS One. 2024 Nov 18;19(11):e0310751. doi: 10.1371/journal.pone.0310751. eCollection 2024.
Postpartum depression (PPD) is a major mental health issue affecting 10%-15% of women globally. This meta-analysis synthesized updated evidence on sub-anesthetic ketamine/esketamine's efficacy in preventing PPD.
Randomized controlled trials (RCTs) comparing ketamine/esketamine to a placebo for PPD prevention were searched without language restriction. Primary outcomes were PPD risk at 1- and 4-6-week postpartum. Secondary outcomes included the difference in depression scores and risk of adverse events. Trial sequential analysis (TSA) was conducted to validate the reliability.
A meta-analysis of 22 RCTs (n = 3,463) showed that ketamine/esketamine significantly decreased PPD risk at 1- (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.3-0.57) and 4-6-week (RR, 0.47; 95%CI, 0.35-0.63) follow-ups. Consistently, participants receiving ketamine/esketamine had lower depression-related scores at 1- (standardized mean difference [SMD], -0.94; 95%CI, -1.26 to -0.62) and 4-6-week (SMD, -0.89; 95%CI, -1.25 to -0.53) follow-ups. Despite potential publication bias, TSA confirmed the evidence's reliability. Subgroup analysis showed that ketamine/esketamine's preventive effect on 1-week PPD was consistent, regardless of administration timing, type of agents, or total dosage (<0.5 vs. ≥0.5 mg/kg). For the 4-6-week period, PPD risk was favorably reduced only with postoperative administration or the use of esketamine, with the total dosage having no observed influence. Participants on ketamine/esketamine experienced more frequency of hallucinations (RR, 4.77; 95%CI, 1.39-16.44) and dizziness (RR, 1.36; 95%CI, 1.02-1.81).
Our findings advocate for the postoperative administration of low-dose ketamine/esketamine to avert PPD, which needed additional research for confirmation.
产后抑郁症（PPD）是一种严重的心理健康问题，影响着全球 10%-15%的女性。本荟萃分析综合了亚麻醉剂量氯胺酮/艾司氯胺酮预防 PPD 的最新证据。
无语言限制地检索了比较氯胺酮/艾司氯胺酮与安慰剂预防 PPD 的随机对照试验（RCT）。主要结局为产后 1 至 4-6 周的 PPD 风险。次要结局包括抑郁评分差异和不良事件风险。进行试验序贯分析（TSA）以验证可靠性。
对 22 项 RCT（n=3463）的荟萃分析表明，氯胺酮/艾司氯胺酮可显著降低产后 1 周（风险比 [RR]，0.41；95%置信区间 [CI]，0.3-0.57）和 4-6 周（RR，0.47；95%CI，0.35-0.63）随访时的 PPD 风险。一致的是，接受氯胺酮/艾司氯胺酮治疗的患者在产后 1 周（标准化均数差 [SMD]，-0.94；95%CI，-1.26 至 -0.62）和 4-6 周（SMD，-0.89；95%CI，-1.25 至 -0.53）随访时的抑郁相关评分较低。尽管存在潜在的发表偏倚，但 TSA 证实了证据的可靠性。亚组分析表明，氯胺酮/艾司氯胺酮对 1 周 PPD 的预防作用是一致的，无论给药时机、药物类型还是总剂量（<0.5 与≥0.5mg/kg）如何。对于 4-6 周的时间段，仅在术后给药或使用艾司氯胺酮时，PPD 风险才会降低，而总剂量则没有观察到影响。接受氯胺酮/艾司氯胺酮治疗的患者更频繁出现幻觉（RR，4.77；95%CI，1.39-16.44）和头晕（RR，1.36；95%CI，1.02-1.81）。
我们的研究结果主张术后给予低剂量氯胺酮/艾司氯胺酮以预防 PPD，但需要进一步的研究来证实。
