A single dose of esketamine given intravenously around the time of cesarean section, followed by 24 hours of low-dose esketamine in patient-controlled pain relief, reduced the overall incidence of postpartum depression within three months after childbirth in first-time mothers who were not already depressed. The total rate of postpartum depression was 11.59% in the esketamine group versus 20.89% in the saline control group. The benefit was most evident at 7 days postpartum, with no significant differences at 1, 2, or 3 months individually. Mild side effects like dizziness, hallucination, and dissociation occurred in some women. The treatment appears relatively safe and prevents postpartum depression in the short term.
Psychedelic drugs like psilocybin, LSD, and mescaline are increasingly used to treat mental health and pain disorders, raising safety concerns for anesthesiologists. Psilocybin activates 5HT serotonin receptors, causing sympathetic activation and haemodynamic instability, and chronic use elevates cortisol, affecting preoperative glucocorticoid dosing. LSD potentiates opioid analgesics and inhibits monoamine oxidase; historical reports suggest it may prolong neuromuscular block with depolarizing muscle relaxants. Mescaline has autonomic effects and historical associations with decreased neuromuscular transmission and malignant hyperthermia. Delaying surgery until acute intoxication subsides is recommended, and understanding management principles is vital for safe anesthesia.