Background Electroconvulsive therapy (ECT) is a procedure involving controlled seizures induced by electrical currents through the brain, all while a patient is under anesthesia and muscle paralysis. It is used to treat mental health conditions, including major depressive disorder, bipolar disorder, schizophrenia, and catatonia. Despite its effectiveness, ECT is underutilized, with only about 0.25% of mood disorder patients receiving it due to cost and stigma. Common anesthetics for ECT include etomidate and propofol. This research aims to further compare etomidate and propofol, and to find adequate evidence to support that etomidate is the better choice.

Methods The narrative review employed a systematic search strategy to identify relevant studies on the use of Etomidate and Propofol as anesthetic agents in ECT. The search, conducted on January 21, 2024, utilized PubMed and Web of Science databases with key terms derived from MeSH and combined using Boolean operators. Inclusion criteria encompassed studies published until January 2024, accessed through PubMed, Scopus, and Web of Science, with reference lists of selected studies reviewed for additional relevant articles. Inclusion and exclusion criteria are outlined in this section. The review adheres to reporting standards outlined in the Scale for the Assessment of Narrative Review Articles.

Results The tables present various study characteristics and results related to the use of different anesthetic agents in ECT. Table 1 outlines study details such as including medication dosages, exclusions, and patient populations across different countries and years. Table 2 provides population characteristics, including sample sizes and age ranges, mean ages, and gender distributions. Table 3 summarizes the results and conclusions of each study, highlighting findings such as induction times, seizure durations, hemodynamic stability, and incidence of myoclonus with different anesthetic agents. These tables collectively demonstrate the comparative effectiveness and safety profiles of Propofol, Etomidate, Thiopentone, and other anesthetic agents in ECT induction.

Conclusion The narrative review examined the effects of Propofol and Etomidate on ECT. Propofol showed superiority over Etomidate in terms of shorter induction time, decreased seizure duration, and improved recovery times. Additionally, Propofol was associated with stable hemodynamics, shorter induction times, decreased seizure durations, and improved recovery times, along with stable hemodynamics. However, Etomidate was found to be more suitable for elderly patients due to quicker cognitive function recovery. Despite these findings’ differences, both drugs showed similar overall efficacy, indicating a need for further research, particularly exploring combined drug approaches for optimized treatment outcomes in ECT.