Key result
Etomidate induction associated with spontaneous seizure in a bupropion-treated patient undergoing ECT.
Why the study?
Patients hospitalized for electroconvulsive therapy often take antidepressants or antipsychotics that influence seizure quality, requiring adjustments in treatment parameters to ensure adequate seizures.
Case Report (n=1)
No
The use of etomidate as an anesthesia induction agent for ECT in patients concomitantly using bupropion should be cautiously considered due to the risk of spontaneous seizures.
Etomidate with bupropion in ECT may raise seizure risk; this case report leaves open the need for prospective safety data.
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.
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Nöckler et al. (2025) conducted a case report in Treatment-resistant depression (n=1). Etomidate vs. Thiopental was evaluated on Spontaneous seizure occurrence. A 46-year-old man treated with bupropion developed a spontaneous generalized tonic-clonic seizure after anesthesia induction with etomidate prior to electroconvulsive therapy.