In a recent study, researchers have discovered that the intraoperative use of esketamine, an enantiomer of ketamine, may significantly reduce the incidence of postpartum depression (PPD) in women undergoing cesarean section. This study was published in the journal BMC Anesthesiology by Shixia Xu and colleagues. The study, which involved 319 parturients, compared the effects of esketamine with a control group receiving a saline solution.

The randomized trial administered 0.2 mg/kg of esketamine to the study group during the cesarean section, while the control group received an equivalent volume of saline. The drugs were pumped for 40 minutes starting from the beginning of the surgery.
Results from the study demonstrated a noteworthy decrease in the incidence of PPD, as measured by Edinburgh Postnatal Depression Scale (EPDS) scores, at 4 days post-surgery in the esketamine group compared to the control group (13.8% vs. 23.1%, P = 0.0430). However, this positive effect was not sustained at 42 days after surgery (P = 0.0987).
Furthermore, the study found that esketamine had a notable impact on reducing pain, as evidenced by lower Pain Numerical Rating Scale (NRS) scores at 6 h, 12 h, and 24 h post-operation. Additionally, the use of vasoactive drugs during surgery was significantly reduced in the esketamine group (P < 0.05), indicating potential benefits in pain management.
Despite the promising outcomes, researchers noted an increase in maternal side effects associated with esketamine. The incidence of dizziness (17.0%), blurred vision (5%), illusion (3.8%), and drowsiness (3.8%) was higher in the esketamine group compared to the control group (P < 0.05).

The findings suggest that intraoperative injection of esketamine at a dose of 0.2 mg/kg may offer a protective effect against postpartum depression during the immediate postoperative period. However, the observed side effects underscore the importance of carefully weighing the risks and benefits of esketamine administration in this context.
Reference:
Xu, S., Yang, J., Li, J., Zhang, M., Sun, J., Liu, Q., & Yang, J. Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail. BMC Anesthesiology,2024;24(1). https://doi.org/10.1186/s12871-023-02398-1