There was appreciable curiosity over the past decade in using ketamine as an antidepressant. Whereas ketamine is actually not a primary line therapy for despair, researchers have questioned whether or not ketamine administered on the time of supply might be used to both deal with or stop postpartum depressive signs. Most of those research come from China, the place ketamine is usually used for perioperative ache administration after Cesarean part. The outcomes have yielded blended outcomes; nonetheless, a current examine from Yang and colleagues (2022) means that ketamine could have a lot better results in ladies at high-risk for PPD, as in comparison with ladies at decrease danger.
IV Ketamine and Prevention of PPD
This examine really has two components – each of them attention-grabbing. Within the first a part of the examine, the researchers assessed whether or not ketamine administered on the time of supply would cut back danger for postpartum despair. Pregnant ladies receiving a cesarean part have been randomized to obtain both normal perioperative care (n=1004) or normal care plus IV ketamine (n=305). Ladies in each teams acquired postoperative analgesia with sufentanil 100 ?g. The ketamine group moreover acquired 160 mg of ketamine.
A crude evaluation of the outcomes (with out controlling for potential confounders) noticed that within the management group, 171 out of 1004 or 17.0% of the ladies developed PPD. Fewer ladies within the ketamine group developed PPD (39 out of 305, or 12.8%).
Ketamine Extra Efficient in Ladies at Increased Threat for PPD
Within the second a part of the examine, they recognized beforehand reported danger elements for PPD within the management group of girls (who didn’t obtain ketamine) to develop a predictive mannequin which might be used on the time of supply to determine ladies at excessive danger for PPD. Utilizing mathematical modeling, they recognized 5 variables which predicted PPD on this inhabitants, together with stress throughout being pregnant, temper throughout being pregnant, home violence, prenatal self-harm ideation and elevated prenatal EPDS rating. The ultimate mannequin predicted PPD with a specificity of 0.766 and a sensitivity of 0.604.
Utilizing this mannequin to estimate danger within the ladies who acquired ketamine, they divided the ketamine group into excessive and low danger subgroups after which in contrast the prevalence of PPD in ladies at low versus excessive danger for PPD. Whereas the crude evaluation of the information advised that ketamine decreased danger for PPD, it seems that ketamine diminished danger solely in ladies at excessive danger for PPD. In ladies at low danger for PPD, ketamine didn’t influence danger.
Meals for Thought
This examine contributes to our understanding of tips on how to stop postpartum despair. On this examine, researchers used IV ketamine to scale back danger for PPD in a common inhabitants of girls present process C-section, a examine that’s unlikely to be repeated in the USA. Nevertheless, there’s some helpful data on this examine.
Predictive fashions can be utilized to determine ladies at excessive danger for PPD within the common inhabitants. On this examine, mathematical modeling was used to display screen ladies for beforehand reported PPD danger elements, and the strongest predictors of danger have been used to generate a predictive mannequin. Since there are cultural variations in danger elements for PPD, it might be necessary to do the sort of modeling in numerous populations with a view to develop probably the most sturdy culturally delicate predictive fashions.
Intravenous ketamine decreases danger of PPD in high-risk ladies. Whereas a crude evaluation of the outcomes advised that ketamine diminished danger for PPD, this prophylactic impact was noticed solely in ladies at excessive danger for PPD. This parallels what we now have seen with different prophylactic interventions, together with psychotherapy and psychoeducational interventions, the place probably the most sturdy results are noticed in ladies at excessive danger for PPD.
Whereas there could also be comprehensible resistance to utilizing ketamine within the common inhabitants, one may think about that this is likely to be a gorgeous intervention for ladies at excessive danger for PPD, for instance ladies with a historical past of extreme PPD after a earlier being pregnant. A single dose of IV ketamine may simply be administered on the time of supply; nonetheless, additional research are mandatory to find out how lengthy the prophylactic results of ketamine final.
Ruta Nonacs, MD PhD
Yang ST, Yang SQ, Duan KM, Tang YZ, Ping AQ, Bai ZH, Gao Ok, Shen Y, Chen MH, Yu RL, Wang SY. The development and application of a prediction model for postpartum depression: optimizing risk assessment and prevention in the clinic. J Have an effect on Disord. 2022 Jan 1; 296:434-442.