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

Background

Postpartum depression (PPD) is a prevalent and debilitating disorder that occurs in 14% of women after giving birth.

Objectives

We aimed to assess the efficacy and safety of perioperative esketamine for preventing PPD in women undergoing cesarean section.

Search strategy

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.

Selection criteria

We searched for trials on the efficacy and safety of esketamine for preventing PPD.

Data collection and analysis

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.

Results

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).

Conclusions

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.