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Efficacy of esketamine for perinatal depression: a systematic review and meta-analysis

Published online by Cambridge University Press:  31 October 2024

Sabrina Wong ,
Gia Han Le ,
Angela T.H. Kwan ,
Kayla M. Teopiz ,
Taeho Greg Rhee ,
Roger Ho ,
Joshua D. Rosenblat ,
Rodrigo Mansur Open the ORCID record for Rodrigo Mansur [Opens in a new window]  and
Roger S. McIntyre Open the ORCID record for Roger S. McIntyre [Opens in a new window]
Sabrina Wong
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON, Canada Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
Gia Han Le
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON, Canada Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
Angela T.H. Kwan
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON, Canada Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
Kayla M. Teopiz
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON, Canada
Taeho Greg Rhee
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
Roger Ho
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, ON, Canada Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore Division of Life Science (LIFS), Hong Kong University of Science and Technology, Hong Kong, China
Joshua D. Rosenblat
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Rodrigo Mansur
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Roger S. McIntyre*
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
*
Corresponding author: Roger S. McIntyre; Email: roger.mcintyre@bcdf.org.
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Abstract

Objective

Postpartum depression (PPD), now referred to as perinatal depression, is a prevalent and debilitating mood disorder that reduces health-related quality of life (HRQoL) and psychosocial functioning. Esketamine, which is efficacious in adults with treatment-resistant depression and individuals with depression and suicidality, is also analgesic in pain management during childbirth labour. Herein, we investigate the efficacy of prophylactic esketamine in reducing the incidence of PPD.

Methods

We performed a systematic review (i.e., PubMed, Scopus, and Ovid databases; inception to January 22, 2024) of randomized controlled trials that investigated the use of esketamine for PPD. We delimited our search to studies that prespecified the prevention of PPD with esketamine as the primary outcome. A meta-analysis was performed on PPD incidence rates using a random effects model.

Results

Our analysis consisted of seven studies that met our eligibility criteria. We found that esketamine was significantly associated with a decreased incidence of PPD diagnosis within one week of childbirth (OR = 0.30, 95% CI = [0.15, 0.60], p = 0.0047). We also observed that esketamine was significantly associated with a decreased incidence of PPD diagnosis between 4 to 6 weeks post-delivery (OR = 0.33, 95% CI = [0.18, 0.59], p = 0.0034).

Conclusion

Our results indicate that esketamine may have preventive antidepressant effects during the postpartum period. The aforementioned points have both mechanistic and clinically meaningful implications for the treatment of PPD.

Keywords

esketaminepostpartum depression (PPD)perinatal depressionEdinburgh perinatal depression scalemajor depressive disorder (MDD)MDD preventiontreatment resistant depression (TRD)
Type
Review
Information
CNS Spectrums , Volume 29 , Issue 5 , October 2024 , pp. 326 - 334
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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Footnotes

This article has been updated since it was originally published. A notice detailing this has been published.

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