Effect of Dexmedetomidine on Postpartum Depression in Women With Prenatal Depression

Abstract

ImportancePostpartum depression (PPD) is emerging as a major public health problem worldwide. Although the particular period and context in which PPD occurs provides an opportunity for preventive interventions, there is still a lack of pharmacologic prevention strategies for PPD.ObjectiveTo assess the efficacy and safety of dexmedetomidine for prevention of PPD among women with prenatal depression undergoing cesarean delivery.Design, Setting, and ParticipantsThis randomized clinical trial enrolled 338 women who screened positive for prenatal depression at 2 hospitals in Hunan, China from March 28, 2022, to April 16, 2023. Women with an Edinburgh Postnatal Depression Scale score of more than 9 who were 18 years of age or older and were scheduled for elective cesarean delivery were eligible.InterventionsEligible participants were randomly assigned in a 1:1 ratio to either the dexmedetomidine group or the control group via centrally computer-generated group randomization. Dexmedetomidine, 0.5 μg/kg and 0.9% saline were intravenously infused for 10 minutes after delivery in the dexmedetomidine and control groups, respectively. After infusion, sufentanil or dexmedetomidine plus sufentanil was administered via patient-controlled intravenous analgesia for 48 hours in the control group and dexmedetomidine group, respectively.Main Outcomes and MeasuresThe primary outcome was positive PPD screening results at 7 and 42 days post partum, defined as a postpartum Edinburgh Postnatal Depression Scale score of more than 9. Analysis was on an intention-to-treat basis.ResultsAll 338 participants were female, with a mean (SD) age of 31.5 (4.1) years. Positive PPD screening incidence at 7 and 42 days post partum in the dexmedetomidine group vs the control group was significantly decreased (day 7, 21 of 167 [12.6%] vs 53 of 165 [32.1%]; risk ratio, 0.39 [95% CI, 0.25-0.62]; P < .001; day 42, 19 of 167 [11.4%] vs 50 of 165 [30.3%]; risk ratio, 0.38 [95% CI, 0.23-0.61]; P < .001). The dexmedetomidine group showed no significant difference in adverse events vs the control group (46 of 169 [27.2%] vs 33 of 169 [19.5%]; P = .10), but the incidence of hypotension increased (31 of 169 [18.3%] vs 16 of 169 [9.5%]; risk ratio, 2.15 [95% CI, 1.13-4.10]; P = .02).Conclusions and RelevanceDexmedetomidine administration in the early postpartum period significantly reduced the incidence of a positive PPD screening and maintained a favorable safety profile.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2200057213

Dexmedetomidina: Um Fármaco Versátil da Anestesia Moderna

“…Segundo Zhou e colaboradores, em estudo clínico randomizado e duplo cego, mostraram que a dexmedetomidina reduziu significativamente a ideação suicida 7 dias após o parto (sendo partos cesariano eletivos), bem como redução em escores de dor pós-operatória, qualidade do sono e manteve bom perfil de segurança. 10 Esses resultados benéficos são postulados pelo aumento significativo de BDNF (fator neurotrófico derivado do cérebro) que está intimamente relacionado à patogênese e prognóstico da depressão pós-parto.…”

“…Diminui o fluxo simpático do sistema nervoso central (SNC) de maneira dose-dependente e possui efeitos analgésicos melhor descritos como poupadores de opioides. 3 Existem alguns trabalhos associando o uso da dexmedetomidina à prevenção de delirium pós-operatório, [4][5][6][7] prolongamento no tempo da analgesia em bloqueios periféricos com redução pós-operatória do consumo de opioides, 8 melhora no período da extubação, 9 possível fator de proteção sobre a depressão pós-parto em gestantes com diagnóstico prévio de depressão no pré-natal, 10 possível impacto positivo no processo de recuperação intestinal pós-operatório, 11 medicação adequada para procedimentos cirúrgicos que requeiram colaboração do paciente. 12 Farmacocinética (Figura 1) A p ó s i n j e ç ã o i n t r a v e n o s a ( I V ) , a dexmedetomidina tem início de ação após aproximadamente 15 minutos.…”