Optimizing esketamine administration for postoperative depression: a comprehensive study on laparoscopic bariatric surgery patients.

IF 3.5 3区医学 Q2 NEUROSCIENCES Psychopharmacology Pub Date : 2024-08-22 DOI:10.1007/s00213-024-06673-y

Jiabao Dai, Yanfeng Lu, Zhiqing Zou, Zhouquan Wu

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Abstract

Background: Previous studies have reported conflicting findings regarding the efficacy of esketamine in managing postoperative depression. While the positive effects of subanesthetic doses esketamine have been observed in treatment-resistant depression, the response to this medication in patients experiencing depression following surgery has not been consistent. Building upon the known impact of anesthesia on brain function, we have formulated a hypothesis suggesting that the timing of esketamine administration in relation to anesthesia may significantly affect its efficacy in managing postoperative depression. The aim of this study was to investigate the effect of esketamine administered at different time points before and after anesthesia.

Methods: Our randomized, double-blind, controlled study involved 120 patients undergoing laparoscopic bariatric surgery, randomly divided into three groups. Group Post- ESK received an intravenous injection of esketamine at a dose of 0.2 mg/kg after anesthesia induction. Group Pre- ESK received the same esketamine dosage 2 h prior to anesthesia induction. Group Placebo served as the control group and received a 0.9% saline solution after induction. The primary outcome measures of the study were depression scores as measured by Patient Health Questionnaire-9 (PHQ-9) and plasma brain-derived neurotrophic factor (BDNF) levels.

Results: On the first postoperative day, the PHQ-9 scores, incidence and severity of postoperative depression in the Pre-ESK group were significantly lower than those in the Post-ESK and placebo groups (P < 0.05). Additionally, plasma BDNF levels in the Pre-ESK group were significantly higher than those in the Post-ESK and placebo groups (P < 0.05). Notably, there was a negative correlation between PHQ-9 scores and plasma BDNF levels.

Conclusions: Our study supports the potential for subanesthetic dose esketamine to alleviate postoperative depression symptoms following laparoscopic bariatric surgery, and anesthetic drugs have a significant effect on its efficacy. The use of subanesthetic dose esketamine after anesthesia does not improve postoperative depression symptoms in patients undergoing laparoscopic bariatric surgery, while the use of sub-anesthetic dose esketamine before anesthesia can improve postoperative depression symptoms.

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针对术后抑郁优化埃斯卡胺用药：一项针对腹腔镜减肥手术患者的综合研究。

背景：以往的研究报告显示，埃斯氯胺酮在治疗术后抑郁症方面的疗效并不一致。虽然亚麻醉剂量的艾司氯胺酮对治疗耐药抑郁症有积极作用，但手术后抑郁症患者对这种药物的反应并不一致。基于麻醉对大脑功能的已知影响，我们提出了一个假设，即与麻醉相关的艾司氯胺酮给药时机可能会显著影响其治疗术后抑郁症的疗效。本研究旨在探讨在麻醉前后不同时间点服用埃斯卡胺的效果：我们的随机、双盲、对照研究将 120 名接受腹腔镜减肥手术的患者随机分为三组。麻醉后 ESK 组在麻醉诱导后静脉注射埃斯卡胺，剂量为 0.2 毫克/千克。ESK 前组在麻醉诱导前 2 小时注射相同剂量的埃斯卡胺。安慰剂组作为对照组，在麻醉诱导后接受 0.9% 生理盐水。研究的主要结果指标是患者健康问卷-9（PHQ-9）测量的抑郁评分和血浆脑源性神经营养因子（BDNF）水平：结果：术后第一天，术前ESK组的PHQ-9评分、术后抑郁的发生率和严重程度均显著低于术后ESK组和安慰剂组（P 结论：我们的研究证实了亚安宁治疗的潜力：我们的研究支持亚麻醉剂量的艾司卡胺缓解腹腔镜减肥手术后抑郁症状的潜力，麻醉药物对其疗效有明显影响。在麻醉后使用亚麻醉剂量的艾司卡胺并不能改善腹腔镜减肥手术患者的术后抑郁症状，而在麻醉前使用亚麻醉剂量的艾司卡胺则能改善术后抑郁症状。

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来源期刊

Psychopharmacology 医学-精神病学

CiteScore

7.10

自引率

5.90%

发文量

257

审稿时长

2-4 weeks

期刊介绍： Official Journal of the European Behavioural Pharmacology Society (EBPS) Psychopharmacology is an international journal that covers the broad topic of elucidating mechanisms by which drugs affect behavior. The scope of the journal encompasses the following fields: Human Psychopharmacology: Experimental This section includes manuscripts describing the effects of drugs on mood, behavior, cognition and physiology in humans. The journal encourages submissions that involve brain imaging, genetics, neuroendocrinology, and developmental topics. Usually manuscripts in this section describe studies conducted under controlled conditions, but occasionally descriptive or observational studies are also considered. Human Psychopharmacology: Clinical and Translational This section comprises studies addressing the broad intersection of drugs and psychiatric illness. This includes not only clinical trials and studies of drug usage and metabolism, drug surveillance, and pharmacoepidemiology, but also work utilizing the entire range of clinically relevant methodologies, including neuroimaging, pharmacogenetics, cognitive science, biomarkers, and others. Work directed toward the translation of preclinical to clinical knowledge is especially encouraged. The key feature of submissions to this section is that they involve a focus on clinical aspects. Preclinical psychopharmacology: Behavioral and Neural This section considers reports on the effects of compounds with defined chemical structures on any aspect of behavior, in particular when correlated with neurochemical effects, in species other than humans. Manuscripts containing neuroscientific techniques in combination with behavior are welcome. We encourage reports of studies that provide insight into the mechanisms of drug action, at the behavioral and molecular levels. Preclinical Psychopharmacology: Translational This section considers manuscripts that enhance the confidence in a central mechanism that could be of therapeutic value for psychiatric or neurological patients, using disease-relevant preclinical models and tests, or that report on preclinical manipulations and challenges that have the potential to be translated to the clinic. Studies aiming at the refinement of preclinical models based upon clinical findings (back-translation) will also be considered. The journal particularly encourages submissions that integrate measures of target tissue exposure, activity on the molecular target and/or modulation of the targeted biochemical pathways. Preclinical Psychopharmacology: Molecular, Genetic and Epigenetic This section focuses on the molecular and cellular actions of neuropharmacological agents / drugs, and the identification / validation of drug targets affecting the CNS in health and disease. We particularly encourage studies that provide insight into the mechanisms of drug action at the molecular level. Manuscripts containing evidence for genetic or epigenetic effects on neurochemistry or behavior are welcome.