Role of Anesthesia in ECT for Major Depressive Disorder.
Jennifer Sjödin, Karin Zimmer, Max Bell, Mikael Tiger
The Journal of ECT March 19, 2026 DOI: 10.1097/yct.0000000000001259 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Peer reviewed |
|---|---|
| Population | MDD patients undergoing ECT |
| Topics | Depression |
| Keywords | Ect Anesthesia |
| Key findings | Ketamine and etomidate are associated with longer seizures than other anesthetics, and lower doses or longer intervals between anesthesia and ECT may improve seizure duration and response, though clinical outcomes are generally similar across agents. |
Abstract
Electroconvulsive therapy (ECT) is an established treatment of major depressive disorder (MDD), particularly in severe cases and in cases resistant to pharmacological interventions. Anesthesia plays an important role in optimizing patient tolerability during ECT but may attenuate the treatment effect, as anesthetic agents elevate the seizure threshold. This review aims to examine the impact of commonly used anesthetics as well as the timing and dosing of anesthetics on seizure dynamics, patient safety and tolerability, and clinical outcomes of ECT for MDD. A systematic search was conducted in PubMed on September 23, 2024. Keywords included "anesthesia," "ECT," and "depression." Fifty-nine clinical trials, observational studies and meta-analyses were selected for in-depth analysis. We found that ketamine and etomidate are associated with longer seizures than other anesthetic agents. The use of etomidate is limited by its suppression of the adrenal synthesis of cortisol. Ketamine can, to a greater extent than other anesthetics, cause depersonalization, derealization, and audio-visual perceptual alterations. Lower doses of anesthesia and longer intervals between anesthetic administration and ECT have been related to longer seizures and also increased likelihood of response to ECT for MDD, although this has not yet been demonstrated in randomized controlled trials. Clinical outcomes are generally similar among different anesthetics, though ketamine anesthesia is associated with a more rapid effect of ECT. The choice of an anesthetic should be based on patient-specific factors such as cardiovascular health. Further research on optimized anesthetic dosing and timing is needed, especially with a focus on the clinical outcome of ECT.
Comparable studies
Other systematic reviews and meta-analyses on depression, most cited first.
Citations in the library
Cites 14
- The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L’humeur Et De L’anxiété (Canmat) Concernant L’utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur The Canadian Journal of Psychiatry November 11, 2020
- Ketamine augmentation of electroconvulsive therapy to improve neuropsychological and clinical outcomes in depression (Ketamine-ECT): a multicentre, double-blind, randomised, parallel-group, superiority trial The Lancet Psychiatry May 1, 2017
- Adjunctive ketamine and electroconvulsive therapy for major depressive disorder: A meta-analysis of randomized controlled trials. Journal of Affective Disorders May 1, 2019
- Antidepressant Effect of Combined Ketamine and Electroconvulsive Therapy on Patients With Major Depressive Disorder: A Randomized Trial Iranian Journal of Psychiatry and Behavioral Sciences September 23, 2015
- Intermittent administration of low dose ketamine can shorten the course of electroconvulsive therapy for depression and reduce complications: A randomized controlled trial. Psychiatry Research November 1, 2019
and 9 more in the library