Ketamine and Postpartum Depression

She doesn’t want to get out of bed, she’s not the woman you knew, worse off she doesn’t want to hold her new baby. She is your wife, girlfriend, sister, or daughter. She is a new mother, and she has postpartum depression (PPD).  She knows something is off, but she is so deep in the weeds she doesn’t know where to begin.

Here are some of the symptoms of postpartum depression:

    • Crying more often than usual.

    • Feelings of anger.

    • Withdrawing from loved ones.

    • Feeling numb or disconnected from your baby.

    • Worrying that you will hurt the baby.

This form of depression is unique since bonding between mom and baby is critical to healthy development of the child.  Moreover, postpartum depression may result in suboptimal cognitive and emotional development in the child. This can actually increase the vulnerability to depression and other psychiatric disorders in the child.

According to the Center for Disease Control & Prevention (CDC), about 1 out of 10 women in the United States experience symptoms of depression. Postpartum depression can be as high as 1 in 5 women. Furthermore, the disorder isn’t limited to mothers - up to 10 percent of new fathers may experience postpartum depression too.  Unfortunately, traditional treatment for depression (such as cognitive behavior therapy and selective-serotonin receptor reuptake inhibitors) can take weeks to months to see an incremental change.

Ketamine’s role in treating postpartum depression is extrapolated from the evidence behind treating treatment resistant depression (TRD).  Ketamine works by blocking the N-Methyl-D-Aspartate (NMDA) receptor from activation by the glutamate neurotransmitter. Furthermore, it reduces activity of the default mode network and increases brain-derived neurotrophic factor (BDNF) allowing for neuroplasticity. Now, some doctors are beginning to use it in patients with postpartum depression because of how quickly and effectively ketamine works in treatment-resistant depression.

One factor to consider for new mothers and factor is breastfeeding. Ketamine is frequently used during delivery of of the baby. According to the World Health Organization (WHO), ketamine is compatible with breastfeeding when it is used for general anesthesia. However, there are currently no studies looking at ketamine transfer to breast milk. To err on the side of safety, we recommend pumping for 2 days prior to the infusion and storing this milk. Then for 2 days after the ketamine infusion, to “pump & dump” to clear ketamine and it’s metabolites from breast milk.

If you or someone you know is suffering from postpartum depression, please consider ketamine infusion as part of the treatment.  Contact us now if you have any questions or if you want a consultation.

References:

American Psychological Association, American Psychological Association, www.apa.org/pi/women/resources/reports/postpartum-depression.aspx.

Benjamin, C., Renyu, L., Elizabeth, V., & Onyi, O. (2015). Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk. Translational Perioperative and Pain Medicine, 2(2). doi:10.31480/2330-4871/023

Glasser, S, and L Lerner-Geva. “Focus on Fathers: Paternal Depression in the Perinatal Period.” Perspectives in Public Health, 2018, p. 175791391879059., doi:10.1177/1757913918790597.

Mcewen, Alyssa M, et al. “Increased Glutamate Levels in the Medial Prefrontal Cortex in Patients with Postpartum Depression.” Neuropsychopharmacology, vol. 37, no. 11, 2012, pp. 2428–2435., doi:10.1038/npp.2012.101.

“Reproductive Health.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 June 2018, www.cdc.gov/reproductivehealth/depression/index.htm.

Wu, Ruyan, et al. “Transgenerational Impairment of Hippocampal Akt-MTOR Signaling and Behavioral Deficits in the Offspring of Mice That Experience Postpartum Depression-like Illness.” Progress in Neuro-Psychopharmacology and Biological Psychiatry, vol. 73, 2017, pp. 11–18., doi:10.1016/j.pnpbp.2016.09.008.