Prevention of Recurrent Cases of Emergence Delirium in Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is an effective treatment for severe and treatment-resistant depression but may be complicated by postictal/emergence delirium. We report the case of a 56-year-old woman with psychotic, treatment-resistant depression who developed severe emergence delirium after each of her first four ECT sessions performed under thiopental anesthesia, with the need for repeated administration of benzodiazepines and propofol to terminate symptoms. Concurrently, her lithium medication dose was gradually reduced. After switching the anesthetic agent from thiopental to propofol at the fifth session, emergence delirium ceased, and subsequent treatments were well tolerated with adequate seizures in all but one session. This case suggests propofol anesthesia may help prevent emergence delirium after ECT, though its independent effect remains uncertain, and further studies are needed to investigate this.