Author: Hannah Gantt
A new study shows that a single low dose of esketamine administered after childbirth helps reduce postnatal depression in new mothers. This single dose of esketamine, given right after childbirth, reduces major depressive episodes in those with prenatal depression, according to recent findings.
When considering ketamine therapy as a treatment for postpartum depression, it’s important to determine whether the benefits outweigh the risks. There are other ways to treat postpartum depression, such as prescribing antidepressant medications.
Depression among pregnant individuals during and immediately after childbirth has become a serious health concern. Health experts are continuing to explore new avenues of treatment to manage depressive symptoms in new parents.
A new study showed that one low dose of esketamine given just after childbirth decreases major depressive episodes in new mothers who experienced prenatal depression. The findings were published on April 10 in The BMJ.
Esketamine is derived from ketamine, typically used as an anesthetic and for depression management. However, the impact on people with perinatal depression is unknown. To learn more, researchers conducted a study using a single low dose of esketamine given immediately following childbirth to mothers with pre-existing prenatal depression.
For the study, researchers examined 361 mothers with a median age of 32 and no prior history of depression. Researchers collected data from June 2020 to August 2022. They concluded that for those with prenatal depressive symptoms, a single low dose of esketamine administered right after childbirth reduces the risk of major depressive episodes at 42 days by approximately 75%.
Participants were separated into two groups: one was given esketamine and the other a placebo 40 minutes after childbirth. They were interviewed 18 to 30 hours after childbirth, later on day 7, and again on day 42. The research team found that after 42 days, just 6.7% of mothers given esketamine experienced a major depressive episode compared to 25.4% of those given placebo.
Pregnancy is accompanied by various physical, psychological, and hormonal changes. After childbirth, many women experience overwhelming emotions and sadness known as the “baby blues,” which are generally short-lived, lasting no more than two weeks. However, as many as 1 in 7 women may develop postpartum depression, which typically presents within six weeks of pregnancy.
Symptoms of postpartum depression may include:
- Dysphoria (depressed mood)
- Anhedonia (diminished interest or pleasure)
- Change in weight and/or appetite
- Change in sleep
- Fatigue
- Lassitude or tiredness
- Feeling of worthlessness
- Decreased concentration
- Psychomotor agitation
- Thoughts of death or suicidal ideation
There are two forms of ketamine treatment available. The first and most common form is Esketamine (Spravato), the nasal spray approved by the FDA for treatment-resistant depression and for depression in the context of suicide risk. Esketamine is started at a dose of 56 mg administered twice per week, usually increased to 84 mg at the end of the first month.
In the United States, ketamine infusion therapy most commonly involves the infusion of R,S-ketamine (a mixture of two mirror-image molecules: R-ketamine and S-ketamine) at a dose of 0.5 mg/kg infused intravenously over 40 minutes. The recently published clinical trial involved intravenous administration of S-ketamine at a dose of 0.2 mg/kg.
Neither R,S-ketamine nor Esketamine are approved by the FDA for the treatment of postpartum depression. The dose and frequency of dosing for R,S-ketamine and S-ketamine for postpartum depression are not yet established.
About 1 out of 3 people with depression do not respond to conventional treatments. First-line interventions include SSRI medications, which require several weeks to achieve therapeutic effects. One advantage of esketamine (and ketamine) is the rapid onset of action, which may benefit those suffering from severe depression and suicidality.
Esketamine is considered relatively safe and well-tolerated when given under medical supervision. Patients are carefully screened to determine risk prior to treatment, vital signs are monitored closely, and physicians are prepared to manage common side effects and/or initiate
appropriate protocols in the event of a rare emergency. The most common adverse effects of ketamine include:
- Nausea
- Dizziness
- Vertigo
- Increased blood pressure
- Dissociation
Aside from ketamine therapy, there are numerous antidepressant medications commonly utilized for postpartum depression. Brexanolone and zuranolone have both been approved specifically for postpartum depression. Another option is therapy, which should always be considered alone or in conjunction with other treatments.
Every treatment carries some risks or side effects. As such, the treatment decision should be personalized for each person, based on close collaboration between a specialist and the patient to assure the best results.
A new study showed that a single low dose of esketamine given immediately after childbirth reduces major depressive episodes in those with prenatal depression. Before using esketamine to treat postpartum depression, it’s important to weigh the benefits and risks. There are other alternatives available, such as antidepressant medications, to help treat postpartum depression.
