One ketamine injection could reduce postnatal depression

Ketamine in a syringe

A single ketamine injection could reduce postnatal depression, a study in the BMJ journal has found.

Researchers from the United States and China found that the jabs reduced major depressive episodes by three quarters.

Postnatal depression is extremely common, with about one in 10 women in the UK suffering it within a year of childbirth.

The study involved women who had been found to suffer depressive symptoms in pregnancy – putting them at higher risk of depression after birth.

They were given a low dose of a jab called esketamine, made from ketamine, used for treatment-resistant depression, anxiety and PTSD, as well as an anaesthetic.

Ketamine is widely known as an illegal street drug, which can cause hallucinations.

Researchers said that the results suggest that low dose esketamine should be considered in new mothers with prenatal depressive symptoms.

Their study, which involved Peking University First Hospital and Cleveland Clinic, Ohio, USA, enrolled 361 mothers from five Chinese hospitals.

Researchers set out to explore if a single low-dose injection of esketamine given just after childbirth might reduce subsequent depression in mothers with pre-existing prenatal depression.

None of the women in the study had a medical history of depression or a diagnosis of depression in pregnancy, but all had scores on a scale consistent with mild prenatal depression and were preparing for childbirth.

At 42 days after giving birth, 6.7 per cent of mothers given esketamine experienced a major depressive episode compared with 25.4 per cent of those given placebo – a relative risk reduction of three quarters.

Based on these figures, the researchers estimate that for every five mothers given esketamine, one major depressive episode would be prevented.

Women given esketamine were twice as likely to suffer neuropsychiatric adverse events such as dizziness and diplopia (double vision), with 45 per cent suffering such effects, compared with 22 per cent given a placebo.

However, symptoms lasted less than a day and none needed drug treatment.

Dr Rupert McShane, a consultant psychiatrist at Oxford Health NHS Foundation Trust and an associate professor at the University of Oxford’s department of psychiatry, said:

“This study is an important, well designed replication of previous work, all of which has come from China.  A single dose of intravenous esketamine (which is the active component of ketamine) is extraordinarily safe, effective and cheap for women at risk of worsening depression after childbirth.

“Intravenous ketamine, when administered to younger people in hospitals, is as effective and safer for resistant depression than ECT [electroconvulsive therapy].

“At-home oral treatment, however, is unsafe unless closely supervised and formally monitored because it can cause tolerance and craving: it should not be ‘normalised’.

“The challenge for us in the UK is to find the funding for monitoring so that the benefit can be maximised and the risks brought to a minimum.”

Researchers said that there were some limitations to the study, including the exclusion of mothers with pre-pregnancy mood disorders, while the short follow-up period may have led to under-reporting of neuropsychiatric symptoms and other adverse events.

Most participants in the research had only mild prenatal depressive symptoms, leaving it unclear whether esketamine is equally effective in those with more severe depressive symptoms, they said.

However, they concluded: “For mothers with prenatal depressive symptoms, a single low dose of esketamine given shortly after childbirth decreases major depressive episodes at 42 days postpartum by about three quarters.”

They said that the results were consistent with research which gave low dose ketamine or esketamine on postpartum depression, mainly in mothers after caesarean delivery,

And they said that any roll out of drugs should consider targeting women with pre-existing prenatal depression, given their high risk of postnatal depression.

Dr Camilla Nord, an assistant professor of cognitive neuroscience and the programme leader at the MRC cognition and brain sciences unit, University of Cambridge, said: “This is a well-powered study that shows convincing evidence for the use of esketamine in the prevention of postpartum depression in mothers with some depression symptoms before birth.

Particularly notable is the strength of the effect: a reduction in rates of postpartum depression from a quarter of the sample (mothers given placebo) to 6 per cent (mothers given esketamine).”

Highlighting the limitations to the research, she said: “Overall, however, this study provides a strong indication that esketamine has treatment potential for preventing postpartum depression in mothers with mild prenatal depression.”

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