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Importance: Postpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant.
Objective: To investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD.
Design, Setting, And Participants: A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis.
Interventions: Patients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients.
Main Outcomes And Measures: The primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42.
Results: A total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], -1.17 [0.44]; 95% CI, -2.04 to -0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03).
Conclusions And Relevance: These results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores.
Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2100054199.
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Source |
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10918550 | PMC |
http://dx.doi.org/10.1001/jamanetworkopen.2024.0953 | DOI Listing |
Int J Gen Med
December 2024
Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.
Purpose: The routine perioperative use of opioids has recently been questioned due to opioid-related side effects, which can be potentially harmful in geriatric patients. This study aimed to evaluate the effects of opioid-free anesthesia in geriatric patients undergoing hip surgery.
Patients And Methods: A total of 121 patients, aged 60 years or older, undergoing elective hip surgery were randomized to receive either opioid-free anesthesia with dexmedetomidine and esketamine (OFA group) or balanced anesthesia with opioids (CON group).
BMC Anesthesiol
December 2024
Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Background: Intravenous administration of sufentanil during anesthesia induction induces cough (SIC), sometimes triggers a severe reaction. We wanted to investigate the inhibitory effect of low-dose esketamine on cough induced by sufentanil during the induction of general anesthesia, as well as its postoperative impact on mental status (MMSE score, RSS, and VAS-A).
Methods: A total of 256 adult patients were randomly allocated to receive either esketamine (Group EK) or normal saline (Group C).
Background: Few treatments are available for individuals with marked treatment-resistant depression (TRD).
Objective: Evaluate the safety and effectiveness of FDA-approved adjunctive vagus nerve stimulation (VNS) in patients with marked TRD.
Methods: This 12-month, multicenter, double-blind, sham-controlled trial included 493 adults with marked treatment-resistant major depression who were randomized to active or no-stimulation sham VNS for 12 months.
J Manag Care Spec Pharm
December 2024
Analysis Group, Inc., Montréal, Quebec, Canada.
Background: Disparities in mental health care access and health outcomes based on sociodemographic factors in the United States have been extensively documented. However, there is limited knowledge regarding these socioeconomic factors with respect to initiation of esketamine nasal spray, a novel therapy for treatment-resistant depression (TRD).
Objective: To evaluate the association of socioeconomic factors with the initiation of esketamine nasal spray.
Brain Stimul
December 2024
Medical University of South Carolina, Department of Psychiatry, Charleston, SC, USA.
Background: Depression treatments aim to minimize symptom burden and optimize quality of life (QoL) and psychosocial function.
Objective: Compare the effects of adjunctive versus sham vagus nerve stimulation (VNS) on QoL and function in markedly treatment-resistant depression (TRD).
Methods: In this multicenter, double-blind, sham-controlled trial, 493 adults with TRD and ≥4 adequate but unsuccessful antidepressant treatment trials (current episode) were randomized to active (n = 249) or sham (n = 244) VNS (plus treatment as usual) over a 12-month observation period.
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