A systematic review and meta-analysis of 18 studies found that psychedelic-assisted therapies—psilocybin, LSD, MDMA, and ayahuasca—were well tolerated and produced large reductions in depression symptoms across various diagnoses. Psilocybin showed a large effect (standardized mean difference -1.92) and MDMA a moderate-to-large effect (standardized mean difference -0.71). However, the certainty of the evidence was low to very low due to small sample sizes, blinding issues, study heterogeneity, and publication bias. The results are promising but highlight the need for larger, more rigorous studies.
Postpartum depression (PPD) is common and harmful if untreated, with few effective prevention strategies. Ketamine and esketamine are rapid-acting antidepressants showing promise for PPD. This review searched five databases for peer-reviewed randomized controlled trials, pilot studies, and observational studies examining ketamine or esketamine for PPD prevention during pregnancy or postpartum, for both cesarean and vaginal deliveries. A network meta-analysis and narrative synthesis were used. Thirty-six studies were identified; five included vaginal delivery, thirty included cesarean section, and one did not specify delivery mode. Results suggested that ketamine and esketamine were well tolerated and may reduce PPD risk. However, data quality was low to very low, so results should be interpreted cautiously. More high-quality studies are needed.