Esketamine prevents postpartum depression after cesarean section: a Meta-analysis
Yao Wenzhuang, Zhang Hanyun, Liu Suman, Lyu Jieping
Yixue xinzhi zazhi April 2, 2026 DOI: 10.12173/j.issn.1004-5511.202505094 via DOAJ
Summary
A meta-analysis of 15 randomized controlled trials with 2,801 women who had cesarean sections found that perioperative use of esketamine reduced the incidence of postpartum depression at 1 week and 6 weeks after surgery, and lowered Edinburgh Postnatal Depression Scale scores within those time frames. However, esketamine increased the risk of intraoperative dizziness and hallucinations. There was no significant difference between groups in postoperative nausea, vomiting, or dizziness.
Study at a glance
| Characteristics | Meta-analysis Peer reviewed |
|---|---|
| Sample size | 2,801 |
| Population | Women undergoing cesarean section |
| Topics | Ketamine |
| Keywords | Cesarean section Postpartum depression Patient-controlled intravenous analgesia Meta-analysis |
| Key finding | Perioperative esketamine reduces the incidence of postpartum depression after cesarean section but is associated with transient intraoperative neuropsychiatric symptoms. |
Abstract
Objective To systematically evaluate the efficacy and safety of Esketamine on postpartum depression (PPD) in cesarean section women.Methods Databases including PubMed, Embase, Web of Science, The Cochrane Library, CBM, CNKI, WanFang and VIP were searched from inception to March 2025 for RCTs investigating the impact of Esketamine on PPD in cesarean section parturients. RevMan 5.4 and Stata 18.0 software was used for Meta-analysis.Results A total of 15 RCTs involving 2,801 patients were included, with 1,516 in the Esketamine group and 1,285 in the control group. The Meta analysis showed that the incidence of PPD in the Esketamine group at 1 week postoperatively [RR=0.46, 95%CI (0.37, 0.57)] and at 6 weeks postoperatively [RR=0.63, 95%CI (0.51, 0.78)] was significantly lower than that in the control group. Futhermore, the EPDS scores were also significantly lower in the Esketamine group within 1 week postoperatively [MD=−2.52, 95%CI (−3.53, −1.50)] and at 6 weeks post-operatively [MD=−2.60, 95%CI (−4.09, −1.10)] was significantly lower than those in the control group. However, the incidence of intraoperative dizziness [RR=10.10, 95%CI (5.42, 18.84)] and hallucinations [RR=8.70, 95%CI (3.11, 24.34)] was significantly higher in the Esketamine group. There was no statistically significant difference in the incidence of postoperative nausea and vomiting [RR=0.87, 95%CI (0.62, 1.24)] and dizziness [RR=1.48, 95%CI (0.93, 2.34)] between the two groups.Conclusion Perioperative use of Esketamine reduces the incidence of PPD after cesarean section but is associated with transient neuropsychiatric symptoms during surgery, without increasing postoperative adverse reactions.