Efficacy of esketamine after cesarean section for women with symptoms of prenatal depression: A randomized controlled trial.
Psychiatry research – November 16, 2025
Source: PubMed
Summary
A new approach shows promise in preventing postpartum depression for women undergoing Cesarean section. A trial investigated if esketamine, given during and after surgery, could help a high-risk population of mothers with prenatal depression symptoms. Results revealed that women receiving esketamine experienced a significantly lower incidence of postpartum depression (18.8% vs. 39.3%) at six weeks. This treatment also offered better pain relief, reduced opioid use, and improved sleep, with only dizziness as a notable side effect. This suggests a positive impact for mothers.
Abstract
Postpartum depression (PPD) is a major global health issue. Although esketamine shows promise for PPD, its preventive effect in cesarean patients with prenatal depression remains unclear. The aim of this trial was to evaluate the effect of perioperative esketamine treatment on PPD incidence in this high-risk population. This dual-center, double-blind, randomized, placebo-controlled trial enrolled 174 pregnant women with Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 10 undergoing cesarean section. Participants were randomized 1:1 to esketamine or control groups. After umbilical cord clamping, the esketamine group received 0.25 mg/kg esketamine, the control group normal saline placebo. Postoperative patient-controlled intravenous analgesia (PCIA) included 100 μg sufentanil in both groups, with 1.25 mg/kg esketamine added in the esketamine group. The primary outcome was PPD incidence (EPDS≥10) at 6 weeks postpartum. Secondary outcomes included the prevalence of postpartum anxiety (PPA) risk, postoperative pain, opioid consumption, postoperative sleep duration and adverse events. PPD occurred in 18.8 % of participants (n = 85) in the esketamine group and 39.3 % (n = 84) in the control group (odds ratio, 0.36 [95 % CI, 0.18-0.72]; P = 0.004). Early benefits were observed at 3 days postoperatively, with reduced PPD and PPA risks. Esketamine provided better early analgesia, with lower pain scores and reduced sufentanil use within 48 h postoperatively. Longer sleep duration was reported in the esketamine group. Dizziness incidence was higher with esketamine both intraoperatively and postoperatively. Perioperative esketamine reduces PPD incidence in women with prenatal depression, with added benefits on early anxiety, pain, opioid use, and sleep. Dizziness was the only notable side effect.