Low-dose Ketamine and Postpartum Depression in Parturients With Prenatal Depression

Effects of Intraoperative Low-dose Ketamine on Incidence of Postpartum Depression in Parturients With Prenatal Depression Undergoing Cesarean Delivery: Blind Test, Randomized, Placebo-controlled Trial

Postpartum depression is common in mothers early after childbirth and produces harmful effects not only on mothers, but also on infants and young children. Parturients with prenatal depression are at increased of postpartum depression. Low-dose ketamine can be used for antidepressant therapy. We hypothesize that low-dose ketamine has a therapeutic effect on parturients with prenatal depression. This study is designed to investigate whether low-dose ketamine administered during cesarean delivery can decrease the incidence of postpartum depression in parturients with prenatal depression.

Postpartum depression refers to maternal depression developed early after childbirth, with reported incidences varied from 15% to 20%. The development of postpartum depression produces harmful effects not only on mothers, but also on infants and young children. Prenatal depression or high depression score is an independent risk factor for the development of postpartum depression.

Ketamine is commonly used as an general anesthetic. In addition, low-dose ketamine is recommended for antidepressant therapy. We hypothesize that low-dose ketamine has a therapeutic effect on parturients with prenatal depression. However, evidences in this aspect are insufficient. The purpose of this study is to investigate whether low-dose ketamine administered during cesarean delivery can decrease the incidence of postpartum depression in parturients with prenatal depression.

Inclusion Criteria:

• Parturients with age from 18 to 45 years and scheduled for elective cesarean delivery;
• Prenatal depression score (EPDS) of 10 or higher;
• Provide written informed consents.

Exclusion Criteria:

• Refused to participate in the study;
• History of schizophrenia or other disease that prevent normal communication before delivery;
• Presence of contraindications to neuraxial anesthesia, including central nervous system diseases (such as poliomyelitis), spinal diseases (such as spinal canal tumor, lumbar disc prolapse, history of spinal trauma), systemic infection (such as sepsis, bacteremia), local infection in the site of puncture, or coagulopathy;
• Severe complications during pregnancy (such as severe preeclampsia, placenta accreta, HELLP syndrome);
• Severe comorbidity before pregnancy (such as severe cardiac dysfunction);
• Scheduled to undergo cesarean delivery under general anesthesia;
• Other reasons that are considered unsuitable for study participation.