Effects of Esketamine on Post-Partum Depression in Patients With Different Personality Types Undergoing Caesarean Section: Randomised Controlled Trial

Abstract

Background: As an intravenous general anaesthetic, esketamine has rapid and evident antidepressant effects and therefore helps prevent post-partum depression (PPD). This study aimed to observe the effect of intraoperative esketamine application on patients with PPD undergoing caesarean section and to explore whether this effect varies among patients with different personality types. 

Methods: A total of 280 patients who underwent elective caesarean section under spinal anaesthesia were randomly divided into esketamine and control groups. On the day before the surgery, each patient was assessed using the Edinburgh Post-partum Depression Scale (EPDS), Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale (SDS) and Eysenck Personality Questionnaire. Additionally, the pressure–pain threshold was measured. The esketamine group received a single intravenous injection of esketamine at a dose of 0.25 mg/kg (diluted to 5 mL and administered intravenously within 10 min after foetus removal). The control group received 5 mL of 0.9% normal saline. The primary outcome was PPD incidence, assessed using the EPDS on the 3rd post-operative day. The secondary outcomes included post-operative pain score and esketamine safety assessment. 

Results: Statistically significant differences in PPD incidence were observed among patients with different personality types (introverted unstable, 66.70%; extroverted unstable, 45.50%; extroverted stable, 19.40%; and introverted stable, 15.00%, p < 0.05). The patients with an extroverted-stable personality in the esketamine group had a lower PPD incidence than those in the control group (11.90% vs. 25.70%, p < 0.05). No statistical difference in total PPD incidence was observed between the two groups (35.7% vs. 29.3%, p > 0.05). Pain scores in the esketamine group were lower than those in the control group while at rest (4, 24 and 48 h) and during movement (4 and 8 h) after surgery (p < 0.05). The mean arterial pressure and heart rate in the esketamine group were higher than those in the control group during surgery (p < 0.05). 

Conclusion: A single intravenous administration of esketamine had no apparent effect on the overall PPD incidence among patients undergoing caesarean section. It may have a beneficial effect in reducing PPD incidence in patients with an extroverted-stable personality. 

Trial Registration: Chinese Clinical Trial Registry, ChiCTR2100050976, 09/09/2021, http://www.chictr.org.cn.