Randomized Controlled Trial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Sep 19, 2025; 15(9): 109458
Published online Sep 19, 2025. doi: 10.5498/wjp.v15.i9.109458
Effect of esketamine and etomidate anesthesia on neuroplasticity in electroconvulsive therapy for treatment-resistant depression
Guo-Guang Zhao, Jing Zhao, Yan Kong, Ya-Ping Pang, Xiao-Nan Zheng, Yi-Wei Zhang
Guo-Guang Zhao, Xiao-Nan Zheng, Yi-Wei Zhang, Department of Anesthesiology, The Second Affiliated Hospital of Shandong First Medical University, Tai’an 271000, Shandong Province, China
Jing Zhao, Department of Dermatology, The Second Affiliated Hospital of Shandong First Medical University, Tai’an 271000, Shandong Province, China
Yan Kong, Department of Psychiatry, The Second Affiliated Hospital of Shandong First Medical University, Tai’an 271000, Shandong Province, China
Ya-Ping Pang, Department of Medical Imaging, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
Co-first authors: Guo-Guang Zhao and Jing Zhao.
Author contributions: Zhao GG and Zhao J was the guarantor and designed the study and they contribute equally to this study as co-first authors; Zhao GG, Kong Y, Pang YP, and Zheng XN participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Zhao GG and Zhang YW revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by The Second Affiliated Hospital of Shandong First Medical University.
Clinical trial registration statement: This study was not registered.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Wei Zhang, Associate Chief Physician, Department of Anesthesiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Mount Taishan Street, Tai’an 271000, Shandong Province, China. ywzhang@email.sdfmu.edu.cn
Received: May 28, 2025
Revised: June 27, 2025
Accepted: July 24, 2025
Published online: September 19, 2025
Processing time: 90 Days and 2.2 Hours
Abstract
BACKGROUND

Treatment-resistant depression (TRD) has a poor response to clinical treatment. Patients with TRD do not respond adequately to standard antidepressants. Even after receiving a full dose and sufficient duration of combined antidepressant therapy, significant improvement is still difficult to achieve. At present, electroconvulsive therapy (ECT) remains a clinically effective method for treating refractory depression. A good anesthesia regimen can enhance its clinical efficacy. Actively exploring high-quality anesthesia regimens has become a current research hotspot.

AIM

To explore the effect of esketamine and etomidate anesthesia on the clinical efficacy of ECT for TRD.

METHODS

A total of 120 patients with TRD, treated at the Department of Psychiatry, The Second Affiliated Hospital of Shandong First Medical University, China between April 2020 and April 2024, were selected for the study. The patients were allocated at random into two groups using a random number table: The combination and control groups, with 60 patients in each group. Both groups underwent ECT; the combination group received esketamine and etomidate anesthesia, while the control group received etomidate anesthesia. The following parameters were compared between the two groups: Heart rate (HR); mean arterial pressure (MAP); peripheral capillary oxygen saturation (SpO2); initial and final threshold charges; and serum brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), 5-hydroxytryptamine (5-HT), and interleukin-4 (IL-4) levels. Neurological functions, basic executive function scores, and adverse reactions were compared during the treatment process.

RESULTS

During treatment, the maximum and minimum HR and MAP values in the combination group were markedly lower than those in the control group (P < 0.05), whereas there was no significant difference in SpO2 between the two groups (P > 0.05). During the treatment, there were no significant differences in the initial threshold charge and average duration of seizures during ECT between the two groups (P > 0.05). However, the final threshold charge and total charge in the combination group were considerably lower than those in the control group (P < 0.05). After treatment, the BDNF, NGF, 5-HT, and IL-4 levels were evidently higher in the combination group than in the control group (P < 0.05). During treatment, as the number of ECT sessions increased, both BRNAS and Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB) scores increased, whereas Hamilton Depression Rating Scale (HAMD)-24 scores decreased in both groups. Starting from the third treatment session, the BRNAS and MCCB scores in the combination group were higher than in the control group, whereas the Hamilton Depression Scale-24 score was lower in the combination group than in the control group (P < 0.05). After treatment, the Wisconsin Card Sorting Test scores and Tower of Hanoi test results in the combination group were significantly better than those in the control group (P < 0.05). The occurrence of adverse reactions was compared between the two groups (P > 0.05).

CONCLUSION

Esketamine and etomidate anesthesia during ECT for patients with TRD helps maintain stable vital signs during the treatment process, improves depressive symptoms, and enhances neurological and basic executive functions.

Keywords: Depression; Electroconvulsive therapy; Esketamine; Etomidate; Neurological function; Executive function

Core Tip: This study aims to evaluate the clinical efficacy of the combined application of esketamine and etomidate in electroconvulsive therapy (ECT) anesthesia for patients with refractory depression. The preliminary study shows that during ECT anesthesia for patients with refractory depression, esketamine-etomidate helps maintain the stability of vital signs during the treatment process, improves depressive symptoms, and enhances neurological and basic executive functions.