Role of Anesthesia in ECT for Major Depressive Disorder.
The journal of ECT March 19, 2026 Jennifer Sjödin, Karin Zimmer, Max Bell et al.
Electroconvulsive therapy (ECT) is effective for severe or treatment-resistant major depressive disorder, but anesthesia may reduce its impact by raising the seizure threshold. A review of 59 studies found that ketamine and etomidate produce longer seizures than other anesthetics, though etomidate suppresses cortisol synthesis and ketamine can cause perceptual disturbances. Lower anesthetic doses and longer intervals between anesthesia and ECT are linked to longer seizures and better response, but this has not been confirmed in randomized trials. Clinical outcomes are broadly similar across anesthetics, though ketamine may speed ECT's effect. Anesthetic choice should consider patient factors like cardiovascular health.