Effect of esketamine and etomidate anesthesia on neuroplasticity in electroconvulsive therapy for treatment-resistant depression.

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.