# Effect of low-dose esketamine combined with labor analgesia on postpartum depressive symptoms following spontaneous labor: a randomized controlled trial

## TL;DR

This study found that adding low-dose esketamine to labor analgesia did not significantly reduce postpartum depressive symptoms compared to analgesia alone in a low-risk group.

## Contribution

The study evaluates the effectiveness of low-dose esketamine in reducing postpartum depressive symptoms in a randomized controlled trial setting.

## Key findings

- No significant difference in EPDS scores at 42 days postpartum between esketamine and analgesia-only groups.
- Low baseline depressive symptoms in the cohort limited detection of potential benefits from esketamine.
- All groups showed improvement in depressive symptoms and pain scores over time.

## Abstract

Postpartum depression (PPD) poses significant risks to maternal and infant well-being. This study aimed to assess the effect of low-dose epidural esketamine combined with labor analgesia on postpartum depressive symptoms and pain scores in women undergoing spontaneous labor.

A randomized controlled trial was conducted with 299 participants assigned to three groups: Group A (esketamine 0.5 mg/kg + labor analgesia), Group B (labor analgesia alone), and Group C (no analgesia). The primary outcome was the Edinburgh Postnatal Depression Scale (EPDS) score at 42 days postpartum. Secondary outcomes included Visual Analogue Scale (VAS) pain scores and serum hormone levels.

Overall, EPDS scores were low across the cohort. At 42 days postpartum, no statistically significant difference in EPDS scores was observed between the esketamine group and the analgesia-only group (Group A: 1.97 ± 1.74 vs. Group B: 2.01 ± 1.68). The mean difference was −0.03 (95% CI: −0.46 to 0.39, p = 0.88). The incidence of screen-positive depression (EPDS ≥10) was also comparable among groups (4% vs. 2% vs. 6%). Longitudinally, all groups showed temporal improvements in depressive symptoms and pain scores, which coincided with the physiological decline in estrogen and rise in cortisol levels post-delivery.

In this low-risk cohort with low baseline depressive symptoms, the addition of low-dose esketamine to labor analgesia did not result in a significant reduction in EPDS scores at 42 days compared to labor analgesia alone. These findings suggest that the potential benefits of esketamine might be limited in populations with a low risk of PPD, and future studies focusing on high-risk groups are warranted.

https://www.chictr.org.cn/showproj.html?proj=247161, identifier ChiCTR2500104037.