Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2024; 12(36): 6883-6886
Published online Dec 26, 2024. doi: 10.12998/wjcc.v12.i36.6883
Merits and demerits of administering esketamine in preventing postpartum depression following cesarean section
Takahiko Nagamine
Takahiko Nagamine, Department of Psychiatric Internal Medicine, Sunlight Brain Research Center, Hofu 7470066, Yamaguchi, Japan
Author contributions: Nagamine T conceptualized the editorial and was solely responsible for the investigation, writing of the original draft, and all subsequent review and editing activities.
Conflict-of-interest statement: All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takahiko Nagamine, MD, PhD, Chief Doctor, Department of Psychiatric Internal Medicine, Sunlight Brain Research Center, 4-13-18 Jiyugaoka, Hofu, Yamaguchi, Hofu 7470066, Yamaguchi, Japan. anagamine@yahoo.co.jp
Received: August 14, 2024
Revised: September 1, 2024
Accepted: September 10, 2024
Published online: December 26, 2024
Processing time: 77 Days and 23.4 Hours
Abstract

Emergency cesarean section is associated with the development of postpartum depression. Esketamine has been demonstrated to have a rapid onset of antidepressant effects. Randomized controlled trials and meta-analyses have demonstrated the efficacy of esketamine in preventing postpartum depression after cessarean section. However, the data included in these analyses were derived from elective cesarean sections and differed in the dose and timing of esketamine administration. Esketamine is a dissociative anesthetic with a dose-dependent risk of inducing psychotic symptoms, including hallucinations. In the setting of cesarean section, esketamine should be administered with caution and only if the potential benefits outweigh the risks.

Keywords: Esketamine; Cesarean section; Depression; Adverse event; Medial prefrontal cortex

Core Tip: Emergency cesarean section is a risk factor for postpartum depression. Esketamine is effective in preventing postpartum depression after cesarean section. However, esketamine carries a risk of inducing psychotic symptoms, such as hallucinations and dissociation. The use of esketamine during cesarean section should be restricted to appropriate patients, taking into account its benefits and drawbacks.