Caesarean Section and the Risk of Postpartal Depression: Is There a Possible Role of Heat Shock Proteins?

Data on the potential connection between surgical stress during caesarean section and the role of heat shock proteins in development of postpartal depression is lacking in the literature. This is a narrative review with a goal to establish the potential role of heat shock proteins during caesarean section and development of postpartal depression. Systemic hyperinflammatory state, such as the one that occurs during surgery, may trigger protective cell reaction, which is usually called the heat shock response. Results of several researches bring strong evidence of correlation between expression of genes coding for family of heat shock proteins with the onset of depressive symptoms. Also, a recent meta-analysis established caesarean section as a risk factor for development of postpartal depression. It is obvious that heat shock proteins play a certain role in development of psychiatric disorders. However, a role of heat shock proteins in development of postpartal depression remains open for debate. We emphasise the need for a randomised control trial which would enable an answer to the mentioned issue.

Therapeutic Mechanisms of Ketamine.

Major depressive disorder is the greatest burden of developed countries in the context of morbidity caused by mental disorders. Until recent, ketamine has been mostly used for anesthesia, analgesia, sedation and treatment of chronic pain syndromes. However, unique pharmacodynamic properties of ketamine have increased interests in it's use for treatment of depression. It is assumed that ketamine reverses synaptic chronic stress pathology within one day of administration by postsynaptic glutamate activation, providing synaptic connectivity restoration that last for days or weeks. Potential glutamatergic agents, in context of treatment of major depressive disorder are not entirely novel phenomenon. Considering the aforementioned, current neurobiological view of depression as a solely monoaminergic phenomenon should be reassessed in order to prompt discovery of putative antidepressant drugs of novel generation. Acute side effects, such as increased salivation, increase in heart rate, systemic arterial pressure and intracranial pressure necessitate careful monitoring during intravenous administration of ketamine, even in subanesthetic doses. However, major burden of ketamine administration lies in it's ability to produce psychotomimetic side effects and emergence delirium. Esketamine nasal spray has now been widely approved and is considered safe in terms of acute side effects, tolerability and consistent therapeutic benefit.