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Background <p>Electroconvulsive therapy (ECT) is a widely used and effective treatment for refractory depression. Patients hospitalized for ECT regularly take antidepressants or adjuvant antipsychotics, both can influence the quality of seizures. Adaptation of the seizure threshold during an ECT series necessitates adjustments in treatment parameters to ensure adequate seizure quality.</p> Methods <p>We report the case of a&#xa0;46-year-old man with treatment-resistant depression treated with bupropion and ECT, who developed a&#xa0;spontaneous seizure after first-time etomidate anesthesia induction, as previously induced seizures under thiopental were considered insufficient. Serendipitously, an electroencephalogram (EEG) of the seizure was recorded.</p> Results <p>The characteristics of the EEG captured after this spontaneous seizure were similar to those of regular ECT seizures under thiopental anesthesia in this patient. After returning to thiopental anesthesia, the remaining ECT course was unremarkable, and the patient’s depressive symptoms improved partially.</p> Conclusion <p>Accordingly, the use of etomidate as an anesthesia induction agent for ECT in patients who are concomitantly using bupropion needs to be cautiously considered. The case of a&#xa0;documented etomidate-induced seizure could indicate the relatively benign course of such events.</p>

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Recorded spontaneous seizure prior to electroconvulsive therapy after etomidate induction in a patient treated with bupropion: a case report

  • 期刊论文

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  • 发表日期：

    2025年10月13日

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  • Evelyn Romina Pircher Nöckler,
  • Laurin Mauracher,
  • Lukas Gasteiger,
  • Imrich Blasko

摘要

Background

Electroconvulsive therapy (ECT) is a widely used and effective treatment for refractory depression. Patients hospitalized for ECT regularly take antidepressants or adjuvant antipsychotics, both can influence the quality of seizures. Adaptation of the seizure threshold during an ECT series necessitates adjustments in treatment parameters to ensure adequate seizure quality.

Methods

We report the case of a 46-year-old man with treatment-resistant depression treated with bupropion and ECT, who developed a spontaneous seizure after first-time etomidate anesthesia induction, as previously induced seizures under thiopental were considered insufficient. Serendipitously, an electroencephalogram (EEG) of the seizure was recorded.

Results

The characteristics of the EEG captured after this spontaneous seizure were similar to those of regular ECT seizures under thiopental anesthesia in this patient. After returning to thiopental anesthesia, the remaining ECT course was unremarkable, and the patient’s depressive symptoms improved partially.

Conclusion

Accordingly, the use of etomidate as an anesthesia induction agent for ECT in patients who are concomitantly using bupropion needs to be cautiously considered. The case of a documented etomidate-induced seizure could indicate the relatively benign course of such events.