اولین همایش بین المللی تحول خدمات سلامت: تلفیق مراقبت، درمان، بازتوانی و امیدبخشی

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کد مقاله 1702

عنوان Perioperative Ketamine and Esketamine for the Prevention of Postpartum Depression after Cesarean Delivery: A Narrative Review

نویسندگان Mohammadmahdi Sadeghi - Maryam Bahrami Hidaji

چکیده Background: Postpartum depression (PPD) affects about one in six mothers worldwide. Cesarean delivery offers a short, monitored period for a single preventive drug dose. Ketamine and its S-enantiomer esketamine are N-methyl-D-aspartate receptor antagonists with rapid antidepressant effects. This review summarizes the evidence on their use to prevent PPD. Method: PubMed and Google Scholar were searched in October 2026 for this narrative review. Randomized trials and systematic reviews published in 2017-2026 that tested ketamine or esketamine at childbirth, mainly at cesarean delivery, to prevent PPD were included. Findings were synthesized descriptively. Finding: Two large meta-analyses, of 22 trials and 21 studies, reported a lower risk of PPD in the first postpartum week, with a pooled risk ratio of about 0.4 for both drugs combined in the first and for esketamine in the second. The effect at 4 to 6 weeks was smaller and less consistent and was clearer for esketamine than for racemic ketamine. In a multicenter trial of mothers with prenatal depressive symptoms, a single 0.2 mg/kg dose of esketamine after vaginal or cesarean birth reduced major depressive episodes at 42 days from 25.4% to 6.7%. A meta-analysis of intravenous ketamine under neuraxial anesthesia found no significant effect. Pooled data showed more transient dizziness and hallucinations, although results differed between drugs. Most trials were conducted in China, relied on Edinburgh Postnatal Depression Scale cut-offs and followed women for 6 weeks or less. Conclusion: Low-dose esketamine at cesarean delivery is a promising preventive option, but routine use is not yet supported. Women with prenatal depressive symptoms are a priority group for further trials. Any use should be combined with screening, informed consent, monitoring and referral within integrated perinatal mental health care. Larger trials outside China with longer follow-up are needed.

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