Impact of Low-Dose Esketamine on Anxiety and Depression in Post-Surgical Breast Cancer Patients

Overview

This double-blind randomized controlled trial evaluated the effects of subanesthetic esketamine administered perioperatively on anxiety and depression in breast cancer surgery patients. Esketamine significantly reduced depressive symptoms at 30 days post-surgery and decreased anxiety scores at both 7 and 30 days postoperatively compared to placebo.

Background

Breast cancer surgery patients frequently experience heightened anxiety and depression due to chemotherapy side effects, altered body image, and prognosis uncertainty. These psychological comorbidities negatively impact wound healing, pain sensitivity, treatment adherence, and quality of life. Current treatments for perioperative mood disorders have delayed onset and adverse effects, highlighting the need for rapid and well-tolerated interventions. Esketamine, an NMDA receptor antagonist with analgesic and antidepressant properties, shows promise for improving perioperative mood but has been insufficiently studied in breast cancer surgical populations.

Data Highlights

Key Findings

• Esketamine administered at 0.2 mg/kg induction plus 0.1 mg/kg/h infusion reduced depressive symptoms at 30 days post-surgery compared to placebo.
• Significant reductions in anxiety scores were observed at both 7 and 30 days postoperatively in the esketamine group.
• Esketamine's analgesic properties may contribute to improved perioperative mood outcomes.
• The intervention was well tolerated with adverse events monitored within 24 hours postoperatively.
• Randomization and double-blinding ensured unbiased assessment of esketamine's effects.

Clinical Implications

Perioperative administration of low-dose esketamine may offer a rapid and sustained reduction in anxiety and depressive symptoms in breast cancer surgery patients. Its dual analgesic and antidepressant effects could improve postoperative recovery and quality of life. Clinicians should consider esketamine as a potential adjunct to standard anesthesia protocols for mood management in this population.

Conclusion

Subanesthetic esketamine administered perioperatively significantly improves medium-term anxiety and depression outcomes in breast cancer surgery patients, representing a promising strategy for addressing psychological comorbidities in this vulnerable group.

References

1. Background references [1-7]
2. PHQ-9 validation references [8,9]
3. SAS validation references [10,11]
4. Pain assessment reference [12]