CLINICAL QUESTION

Does a single dose of esketamine reduce the likelihood of postpartum depression development in at-risk patients?

BOTTOM LINE

When esketamine is given immediately after delivery to patients at risk for postpartum depression, it seems to decrease the likelihood of depression compared with placebo. Transient adverse effects are common. (Level of Evidence = 1b)

SYNOPSIS

The researchers enrolled 364 pregnant patients who presented for delivery and had mild or more severe depression identified at the time of admission (a median score of 10 out of a possible 30 on the Edinburgh Postnatal Depression Scale). The participants were randomized, using concealed allocation, to receive intravenous esketamine, 0.2 mg/kg, or saline placebo as a single dose immediately after delivery once the umbilical cord was clamped. In the esketamine group, 6.7% of patients had a major depressive episode as diagnosed by the Mini-International Neuropsychiatric Interview within 42 days after birth compared with 25.4% of patients who received placebo (number needed to treat [NNT] = 6; 95% CI, 4.6 to 7.6). Patients in the esketamine group also had Edinburgh Postnatal Depression Scale scores that were lower at 7 and 42 days. The Hamilton Rating Scale for Depression scores were lower at 42 days in the esketamine group, with 71.1% of these patients scoring in the no depression range compared with 39% of those who received placebo. Neuropsychiatric adverse effects, mainly dizziness, occurred in 33.5% of participants while or after receiving esketamine compared with 11% of participants while or after receiving placebo (NNT = 5).