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Perioperative administration of sub-anesthetic ketamine/esketamine for preventing postpartum depression symptoms: A trial sequential meta-analysis

Author

Listed:
  • Kuo-Chuan Hung
  • Chia-Li Kao
  • Yi-Chen Lai
  • Jen-Yin Chen
  • Chien-Hung Lin
  • Ching-Chung Ko
  • Chien-Ming Lin
  • I-Wen Chen

Abstract

Objective: Postpartum depression (PPD) is a major mental health issue affecting 10%–15% of women globally. This meta-analysis synthesized updated evidence on sub-anesthetic ketamine/esketamine’s efficacy in preventing PPD. Methods: Randomized controlled trials (RCTs) comparing ketamine/esketamine to a placebo for PPD prevention were searched without language restriction. Primary outcomes were PPD risk at 1- and 4–6-week postpartum. Secondary outcomes included the difference in depression scores and risk of adverse events. Trial sequential analysis (TSA) was conducted to validate the reliability. Results: A meta-analysis of 22 RCTs (n = 3,463) showed that ketamine/esketamine significantly decreased PPD risk at 1- (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.3–0.57) and 4–6-week (RR, 0.47; 95%CI, 0.35–0.63) follow-ups. Consistently, participants receiving ketamine/esketamine had lower depression-related scores at 1- (standardized mean difference [SMD], −0.94; 95%CI, −1.26 to −0.62) and 4–6-week (SMD, −0.89; 95%CI, −1.25 to −0.53) follow-ups. Despite potential publication bias, TSA confirmed the evidence’s reliability. Subgroup analysis showed that ketamine/esketamine’s preventive effect on 1-week PPD was consistent, regardless of administration timing, type of agents, or total dosage (

Suggested Citation

  • Kuo-Chuan Hung & Chia-Li Kao & Yi-Chen Lai & Jen-Yin Chen & Chien-Hung Lin & Ching-Chung Ko & Chien-Ming Lin & I-Wen Chen, 2024. "Perioperative administration of sub-anesthetic ketamine/esketamine for preventing postpartum depression symptoms: A trial sequential meta-analysis," PLOS ONE, Public Library of Science, vol. 19(11), pages 1-21, November.
    • Handle: RePEc:plo:pone00:0310751
    DOI: 10.1371/journal.pone.0310751
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