Mental health conditions are one of the leading causes of maternal death in the UK [1]. Research in this area is limited, partly due to the difficulties (ethical, logistical and safety concerns) in conducting randomised controlled trials in pregnant women and Tan et al. are to be commended for their efforts [2]. Although they found that epidural labour analgesia did not lower the incidence of postpartum depression when compared with non-epidural analgesic options, we would like to raise a few points.

The aetiology of postpartum depression is multifactorial and includes hormonal fluctuations; previous mental disorders; prenatal depression and anxiety; stressful life events during pregnancy; excruciating pain during labour; and low levels of social support [1]. Excruciating pain during labour is also associated with the development of postpartum depression. It seems unlikely that a single intervention, such as epidural analgesia, would reduce the incidence of postpartum depression on its own.

There is growing interest in pharmacological treatments available for postpartum depression. Antidepressants such as zuranolone, a neurosteroid that is a positive allosteric modulator of the GABA_A receptor, have been shown to be efficacious in reducing postpartum depressive symptoms [3]. Prenatal depression is a strong predictor of postpartum depression. A recent randomised controlled trial of a single low-dose esketamine infusion (0.2 mg.kg^-1 over 40 min) after childbirth once the umbilical cord had been clamped, for mothers with prenatal depression, reduced major depressive episodes 42 days postpartum by about three-quarters when compared with placebo (12/180, 6.5% vs. 46/181, 25.4%, relative risk (95%CI) 0.26 (0.14–0.48), p < 0.0001) [4].

Despite no clear signal of an effect of epidural analgesia on postpartum depression, it is associated with a 35% reduction in severe maternal morbidity, with the greatest effects seen in those with a medical indication for epidural analgesia (e.g. serious cardiovascular or respiratory disease) or delivering preterm [5]. Therefore, reducing misinformation and misconceptions, and expanding access to epidural analgesia is crucial. A recent article in Anaesthesia highlighted significant disparities in epidural availability, with women from lower socio-economic backgrounds and certain geographic locations being less likely to receive one [6]. Addressing these disparities is essential to ensure all women have access to effective pain management during labour, thereby preventing unequal health outcomes. Without equitable access, any potential benefits of epidural analgesia in reducing postpartum depression would be unevenly distributed, further exacerbating existing healthcare inequalities. A comprehensive package of care, that includes both preventive measures and therapeutic interventions, in at-risk women, is likely to be the most effective strategy for improving maternal mental health. Investing in research on this topic is also essential in providing women with better support during the challenging transition to motherhood.

心理健康状况是英国孕产妇死亡的主要原因之一[ 1 ]。该领域的研究有限，部分原因是在孕妇和 Tan 等人中进行随机对照试验存在困难（伦理、后勤和安全问题）。他们的努力值得赞扬[ 2 ]。尽管他们发现与非硬膜外镇痛选择相比，硬膜外分娩镇痛并没有降低产后抑郁症的发生率，但我们想提出几点。

产后抑郁症的病因是多因素的，其中包括荷尔蒙波动。既往精神障碍；产前抑郁和焦虑；怀孕期间的压力生活事件；分娩时剧烈疼痛；社会支持水平低[ 1 ]。分娩过程中的剧烈疼痛也与产后抑郁症的发生有关。单一干预措施（例如硬膜外镇痛）似乎不太可能单独降低产后抑郁症的发生率。

人们对治疗产后抑郁症的药物治疗越来越感兴趣。抗抑郁药如 zuranolone（一种神经类固醇，是 GABA _A受体的正变构调节剂）已被证明可有效减轻产后抑郁症状 [ 3 ]。产前抑郁症是产后抑郁症的强烈预测因素。最近的一项随机对照试验显示，患有产前抑郁症的母亲在分娩后，一旦脐带被夹紧，单次低剂量艾氯胺酮输注（0.2 mg.kg ^-1 ，超过 40 分钟）可将产后 42 天的重度抑郁发作减少约 3 倍。 - 与安慰剂相比（12/180, 6.5% vs. 46/181, 25.4%，相对风险 (95%CI) 0.26 (0.14–0.48)，p < 0.0001）[ 4 ]。

尽管没有明确的信号表明硬膜外镇痛对产后抑郁症有影响，但它与严重孕产妇发病率降低 35% 相关，其中在有硬膜外镇痛医学指征（例如严重心血管或呼吸系统疾病）或导致早产 [ 5 ]。因此，减少错误信息和误解并扩大硬膜外镇痛的可及性至关重要。 《麻醉》杂志最近的一篇文章强调了硬膜外麻醉可用性的显着差异，社会经济背景较低和某些地理位置的女性接受硬膜外麻醉的可能性较小 [ 6 ]。解决这些差异对于确保所有妇女在分娩期间获得有效的疼痛管理至关重要，从而防止不平等的健康结果。如果没有公平的获取机会，硬膜外镇痛在减少产后抑郁方面的任何潜在益处将分布不均，从而进一步加剧现有的医疗保健不平等。对高危妇女实施包括预防措施和治疗干预在内的一揽子综合护理可能是改善孕产妇心理健康的最有效策略。投资这一主题的研究对于在充满挑战的母亲过渡期间为妇女提供更好的支持也至关重要。