A single-site randomized clinical trial at a Chinese hospital found that administering a low dose of esketamine during cesarean delivery significantly reduced the incidence of postpartum depression at six weeks. Among 308 women, 10.4% who received esketamine developed postpartum depression compared with 19.5% who received a placebo saline infusion, a relative risk of 0.53. The authors suggest esketamine shows promise for preventing postpartum depression in this setting but call for further research in broader clinical practice.
Among women without prenatal depression who delivered by caesarean section, a single bolus injection of 0.25 mg/kg esketamine reduced the rate of postpartum depression (PPD) at six weeks to 9.15%, compared with 19.33% in the saline placebo group. Continuous infusion of the same dose produced a PPD rate of 11.54%, which did not differ statistically from the bolus group. Pain scores were similar across all three groups. The bolus route caused fewer intraoperative adverse events—45.75% versus 65.38% with infusion—especially less dizziness and nausea or vomiting. For preventing PPD, bolus and continuous infusion appear equally effective, but bolus administration may be preferable because it is better tolerated.