The effect of ketamine on preventing postpartum depression

This double-blind study (n=134) suggests that the usage of ketamine in the induction of a caesarian section may be helpful in preventing postpartum depression.

Abstract

“Postpartum depression is a common disabling psychosocial disorder that could have adverse effects on the life of the mother, infant, and family. The present study was conducted to evaluate the effect of ketamine on preventing postpartum depression in women undergoing caesarian sections considering the relatively known positive effect of ketamine on major depression. The present double-blind, randomized clinical trial was conducted on 134 women undergoing scheduled caesarian sections. Participants were randomly allocated into two groups of control and intervention. To induce anesthesia, 1-2 mg/kg of body weight of Nesdonal and 0.5 mg/kg of body weight of ketamine were used in the intervention group, while only 3-5 mg/kg of body weight Nesdonal was administered in the control group. Data were gathered using the Edinburgh Postnatal Depression Scale (EPDS) in three stages: before the caesarian section and two and four weeks after the caesarian section. Data were analyzed using variance analysis with repeated measures and the Chi-square test. Results of the present study showed that the mean (± standard deviation) of the depression score in the intervention and control groups were 13.78±3.87 and 13.79±4.78(p = 0.98) before the caesarian section, 11.82±3.41 and 14.34±4.29 (p < 0.001) two weeks after and 10.84±3.48 and 13.09±3.79 (p = 0.001) four weeks after the caesarian section, respectively. Using ketamine in the induction of general anesthesia could be effective in preventing postpartum depression. However, further studies are required to strengthen these findings.”

Authors: Mina Alipoor, Marzeyeh Loripoor, Majid Kazemi, Farshid Farahbakhsh & Ali Sarkoohi

Summary

Dates

A double-blind, randomized clinical trial was conducted on 134 women undergoing scheduled caesarian sections to evaluate the effect of ketamine on preventing postpartum depression. The results showed that ketamine was effective in preventing postpartum depression, but further studies are required to strengthen these findings.

INTRODUCTION

Depression is the most common complication of delivery and is more common than gestational diabetes and preterm delivery. It requires hospitalization more frequently than in any other period of life in women.

Postpartum depression has destructive effects on the mother, neonate, and family. It would expose the mother to the risk of social isolation, and would threaten the couple’s married life.

Postpartum depression affects the mother-neonatal relationship all around the world, and has negative effects on cognitive and emotional growth during the neonatal period and afterward.

Many patients do not seek treatment for depression because they feel ashamed, are labeled as mental health patients, or are unaware. Furthermore, most patients prefer not to consume psychotropic drugs during breastfeeding.

Ketamine is considered an inexpensive, accessible anesthetic medicine that prevents severe hemodynamic changes and appropriate analgesia induction during caesarian sections. It has a rapid anti-depressant effect in many patients resistant to treatment, although its level and stability of response is not predictable.

MATERIAL AND METHODS

The present double-blind clinical trial included 35 pregnant women who were a candidate for caesarian section at the educational centers of the Rafsanjan University of Medical Sciences.

The inclusion criteria were having a low-risk pregnancy, being 18 to 35 years old, being ASA class 1 or 2, and not having a history of drug abuse.

After receiving the approval of the University’s Ethics Committee, data were gathered using a demographic characteristics questionnaire and the Edinburgh Postnatal Depression Scale. Mothers who gained a score of 13 or higher were probably suffering from depression.

After written informed consent was obtained, eligible participants were divided into two groups (intervention and control) and completed demographic characteristics forms and Edinburgh scales. Ketamine was intravenously injected during the induction of anesthesia in the intervention group.

RESULTS

In total, 67 participants were studied in both groups. The mean age of the mothers was 27.44.09 years in the Nesdonal group and 28.244.81 years in the Ketamine-Nesdonal group, and both groups were similar regarding the number of pregnancies, having wanted or unwanted pregnancy, education, history of depression, and satisfaction with life.

The mean score of depression was significantly lower in the Ketamine-Nedonal group four weeks after the caesarian section compared to two weeks afterward, and also significantly lower two weeks after the caesarian section than before caesarian section.

DISCUSSION

The present study showed that the depression scores of the intervention group were significantly lower than the control group at two and four weeks after the caesarian section, except for before the caesarian section.

Researchers found that ketamine improved postpartum depression in rats and prevented behavioral flaws, and improved molecular signaling disorder, compared to chronic fluoxetine treatment. This was a notable point because SSRIs are potentially capable of affecting the development process of the neonate.

CONCLUSION

In women who are a candidate for a caesarian section, a single dose of intravenous ketamine may be effective in preventing postpartum depression. However, extensive clinical trials should be conducted before using ketamine for this purpose.