Abstract
The purpose of this review is to discuss the safety and therapeutic effects of electroconvulsive therapy (ECT), research advances in neurobiology of depression and antidepressant mechanisms of general anesthetics, and make recommendations applicable to anesthesia practice in the ECT suite. Recent epidemiological studies reported 0.08–0.75% 30-day mortality after ECT, with falls and cardiopulmonary complications as the most frequent adverse events. Advanced age (65 years and older) and ischemic heart disease are risk factors for adverse events after ECT. Animal and human research proposed two novel hypotheses of depression: a neurotrophic one and one of impaired connectivity. Studies utilizing biomarkers and functional imaging suggest that the antidepressant effect of ECT and ketamine is a result of the improved neuroplasticity in the brain via stimulation of brain-derived neurotrophic factor. Recent randomized controlled studies evaluating various doses of ketamine for anesthesia for ECT are inconclusive. One well-designed study did not demonstrate the beneficial effect of ketamine on depression and cognition. Ketamine as a sole anesthetic in ECT seems to be safe, but its effect on long-term outcomes after ECT is unclear. Risks and benefits of ECT should be carefully considered, particularly in patients older than 65 years, and with ischemic heart disease. Anesthesia should be adjusted to assure a good- quality seizure during ECT. Along with previously recommended methohexital and etomidate, ketamine may be also safely used for anesthesia in ECT.
Published Version
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