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In 23 randomized trials (3,202 participants) that gave ketamine or esketamine only while patients were unconscious under general anesthesia for surgery or cesarean delivery, depressive symptoms 1 to 3 days after the procedure were lower than with an inert control (Hedges' g −0.61, 95% CI −0.81 to −0.40; Holm-adjusted p < 0.001), and the difference remained among the 15 of these trials that passed the pre-registered integrity screen (g −0.48, −0.65 to −0.31), among the 16 left when trials whose last dose could still act at waking are set aside (g −0.64, −0.93 to −0.34), and with any single trial left out (largest p < 0.001). · sciencejournal.ai