Single bolus low-dose of ketamine does not prevent postpartum depression: a randomized, double-blind, placebo-controlled, prospective clinical trial
This randomised-controlled trial (n=330) assessed the efficacy of low-dose ketamine (17.5mg/70kg diluted to 10 mL with 0.9% saline) administered during caesarean section in preventing postpartum depression (PPD). No significant differences were found in the prevalence of PPD between the active group and the placebo group at 3 days and 6 weeks after delivery. Pain scores were significantly different at 6 weeks only.
Authors
- Yang, X.
- Yuantao, L.
- Xialei, H.
Published
Abstract
Purpose
Postpartum depression is a common complication of childbirth. In the last decade, it has been suggested that subdissociative-dose ketamine is a fast-acting antidepressant. We aimed to investigate the efficacy of low-dose ketamine administered during caesarean section in preventing postpartum depression.
Methods
Using a randomized, double-blind, placebo-controlled design, 330 parturients who were scheduled to undergo caesarean section were enrolled in this trial. The parturients were randomly assigned to receive intravenous ketamine (0.25 mg/kg diluted to 10 mL with 0.9% saline) or placebo (10 mL of 0.9% saline) within 5 min following clamping of the neonatal umbilical cord. The primary outcome was the degree of depression, which was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) (a threshold of 9/10 was used) at 3 days and 6 weeks after delivery. The secondary outcome was the numeric rating scale score of pain at 3 days and 6 weeks postpartum.
Results
No significant differences were found in the prevalence of postpartum depression between the two groups at 3 days and 6 weeks after delivery. The pain scores measured at 3 days postoperatively were not significantly different between the groups, whereas the scores measured at 6 weeks postpartum were significantly reduced in the treatment group compared with the saline group (P = 0.014).
Conclusions
Intra-operative low-dose ketamine (0.25 mg/kg) does not have a preventive effect on postpartum depression.
Research Summary of 'Single bolus low-dose of ketamine does not prevent postpartum depression: a randomized, double-blind, placebo-controlled, prospective clinical trial'
Introduction
Postpartum depression is a common complication of childbirth and represents a substantial public‑health burden because it can harm mothers, disrupt mother–infant interaction and adversely affect children's emotional, behavioural and cognitive development. Reported prevalence varies by setting; the authors note rates of approximately 14.5% in developed countries and up to 22% in China. Conventional antidepressants act slowly and have limited efficacy for many patients, while more recent clinical evidence indicates that subdissociative doses of ketamine (commonly 0.5 mg/kg) can produce rapid antidepressant effects lasting up to about a week despite ketamine’s short plasma half‑life. Xu and colleagues framed two mechanistic rationales for testing perioperative ketamine to prevent postpartum depression: its rapid antidepressant actions and its potential to reduce acute and chronic postoperative pain via NMDA receptor antagonism, because perinatal acute and chronic pain are risk factors for postpartum depression. The study therefore aimed to test whether a single intra‑operative bolus of low‑dose ketamine (0.25 mg/kg) given during caesarean section reduces the subsequent incidence of postpartum depression, with pain intensity as a secondary outcome.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- APA Citation
Xu, Y., Li, Y., Huang, X., Chen, D., She, B., & Ma, D. (2017). Single bolus low-dose of ketamine does not prevent postpartum depression: a randomized, double-blind, placebo-controlled, prospective clinical trial. Archives of Gynecology and Obstetrics, 295(5), 1167-1174. https://doi.org/10.1007/s00404-017-4334-8
References (3)
Papers cited by this study that are also in Blossom
Kishimoto, T., Chawla, J. M., Hagi, K. et al. · Psychological Medicine (2016)
Monteggia, L. M., Zarate, C. A. · Current Opinion in Neurobiology (2015)
Murrough, J. W., Iosifescu, D. V., Chang, L. C. et al. · American Journal of Psychiatry (2013)
Cited By (3)
Papers in Blossom that reference this study
Li, Q., Wang, S., Mei, X. · Psychiatry Research (2022)
Muthukumaraswamy, S., Forsyth, B., Lumley, T. · Expert Review of Clinical Pharmacology (2021)
Alipoor, M., Loripoor, M., Kazemi, M. et al. · Journal of Medicine and Life (2021)
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