The demand for Electroconvulsive Therapy (ECT) has been increasing. The aim of this study was to analyze changes in the rate of ECT use at Oulu University Hospital in Northern Finland from 2012 to 2022 and to explore factors associated with these changes. The data include all patients who received ECT between April 2012 and the end of 2022 at the neuromodulation unit in the department of psychiatry at Oulu University Hospital. The unit's catchment area covers a population of 484,400 people. The study focuses on the annual number of ECT and maintenance ECT (M-ECT) sessions, the ECT use rate per 100,000 people, and the number of individual patients and their characteristics, with a focus on yearly changes. The number of ECT sessions has increased significantly during the follow-up period. There were 1373 ECT sessions in the first full year of 2013 and 3000 sessions in 2022. The growth was particularly notable in M-ECT. ECT was performed on 96 unique patients in 2013 and 189 in 2022. The ECT use rate in 2022 was 45.7 per 100,000 population. 54.6% of the patients were female. The most common diagnosis was major nonpsychotic depression (45.9%). The results show a steady increase in the demand for ECT. The use rate in Northern Finland is higher than in the previous Finnish study and among the highest in Europe. Improved strategies to prevent post-ECT relapses and alternative treatment methods for treatment-resistant depression (TRD) are needed.
Electroconvulsive therapy (ECT) is an established treatment of major depressive disorder (MDD), particularly in severe cases and in cases resistant to pharmacological interventions. Anesthesia plays an important role in optimizing patient tolerability during ECT but may attenuate the treatment effect, as anesthetic agents elevate the seizure threshold. This review aims to examine the impact of commonly used anesthetics as well as the timing and dosing of anesthetics on seizure dynamics, patient safety and tolerability, and clinical outcomes of ECT for MDD. A systematic search was conducted in PubMed on September 23, 2024. Keywords included "anesthesia," "ECT," and "depression." Fifty-nine clinical trials, observational studies and meta-analyses were selected for in-depth analysis. We found that ketamine and etomidate are associated with longer seizures than other anesthetic agents. The use of etomidate is limited by its suppression of the adrenal synthesis of cortisol. Ketamine can, to a greater extent than other anesthetics, cause depersonalization, derealization, and audio-visual perceptual alterations. Lower doses of anesthesia and longer intervals between anesthetic administration and ECT have been related to longer seizures and also increased likelihood of response to ECT for MDD, although this has not yet been demonstrated in randomized controlled trials. Clinical outcomes are generally similar among different anesthetics, though ketamine anesthesia is associated with a more rapid effect of ECT. The choice of an anesthetic should be based on patient-specific factors such as cardiovascular health. Further research on optimized anesthetic dosing and timing is needed, especially with a focus on the clinical outcome of ECT.
The ElectroConvulsive therapy Cognitive Assessment (ECCA) was designed to monitor specific cognitive domains commonly altered in ECT. We describe the properties of a Spanish version of the ECCA (ECCA-S). The ECCA-S and the Mini-Mental State Examination (MMSE) were administered pre-ECT course, at the sixth treatment, and post-ECT course to 72 subjects with a major depressive episode undergoing acute ECT. At a single time point, the ECCA-S and MMSE were also administered to 26 healthy controls and to 59 subjects who experienced a depressive episode but did not receive ECT. Across the 3 testing time points, changes in ECCA-S scores were statistically different, whereas MMSE scores did not show statistically significant differences throughout ECT. There was poor agreement between both tests, particularly at mid-ECT and post-ECT. Informant-assessed memory, autobiographical memory, and delayed recall decreased significantly throughout treatment. Attention and subjective memory decreased at the sixth ECT (P>0.05). The number of ECT sessions influenced ECCA-S scores. ECCA-S exhibited good inter-rater reliability in depressive patients and healthy controls. The ECCA-S is a practical bedside screening tool for Spanish speakers to monitor cognitive side effects of ECT in routine clinical practice. Unlike the MMSE, the ECCA-S is sensitive to cognitive changes throughout the course of ECT, making it a valuable resource for clinicians.
Electroconvulsive therapy (ECT) is an effective and safe treatment for severe or treatment-resistant psychiatric disorders, but transient asystole and arrhythmias can occur during the treatment. Reports have shown that bifrontal electrode placement may reduce these adverse events. Our clinic changed the preferred electrode placement from bitemporal (BT) to bifrontal (BF) in May 2022. We wanted to evaluate whether this transition reduced the duration of asystole and the incidence of arrhythmias, and whether this resulted in similar remission rates. We retrospectively reviewed the records of 69 patients who had BF ECT between May 2022 and October 2025, and the same number of consecutively treated patients who had received BT ECT before May 2022. We had data on arrhythmias for all patients, on ECG recordings for 69 BF and 42 patients with BT, and ratings for remission on all but 4 patients. Regression analysis controlling for age, sex, and concomitant medications was used to assess differences in the duration of the longest heart interbeat intervals, the rates of arrhythmia, and of clinical remission. Patients treated with BF ECT had a much shorter duration of interbeat intervals [0.74 s (SD=0.18) vs. 1.32 s (SD=0.57), P=1.5×10-14]. The rates of arrhythmias were reduced, but the difference was not significant (15.9% vs. 27.5%, P=0.082). Remission rates were not significantly different (BF=59.7%, BT=63.6%, P=0.49). BF ECT had a marked effect on reducing the rate of asystole and possibly the rate of arrhythmias during ECT, without reducing clinical effectiveness. This electrode placement could be preferable for older people and those at increased risk of heart complications.
This study aims to evaluate the safety and efficacy of bifrontal electroconvulsive therapy (ECT) in managing psychiatric disorders, focusing on the occurrence and progression of adverse effects across treatment sessions. A retrospective review was conducted using medical records of 2130 patients who underwent ECT between 2019 and 2023 at a major psychiatric center in Türkiye. Sociodemographic characteristics, clinical data, and treatment-related adverse events were analyzed. Bifrontal ECT was administered according to standardized protocols, with continuous monitoring of vital signs and adverse effects. The majority of patients (86%) underwent ECT due to failure of pharmacotherapy. The mean age of the cases was 30.95±10.15 years, with schizophrenia (30.7%) and bipolar mania (26.9%) being the most common diagnoses. Adverse event rates decreased from 13.7% in the first session to 1.2% in the tenth. Prolonged seizures (9.1% in session 1, 0.8% by session 10) and mild cognitive effects, such as confusion (0.2% to 0.4%), were observed but were managed effectively. Rare complications included hypersalivation (0.2% to 1.3%) and dental trauma (0.1%). No severe or life-threatening events were reported. Overall, bifrontal ECT achieved full remission in 57.6% and partial remission in 28.9% of patients. Bifrontal ECT demonstrates a favorable safety profile and clinical efficacy, particularly in cases unresponsive to pharmacological treatments. The low rates of cognitive and physiological adverse effects underscore its utility as a balanced therapeutic approach. Future studies are warranted to expand on these findings and refine treatment protocols.
Electroconvulsive therapy (ECT) is an effective and lifesaving treatment for severe mental illnesses. It is also considered safe with limited side effects and few deaths. Cardiac deaths occur in <30% of all ECT-related deaths and primarily occur in the elderly. It is unusual for a young man with no previous cardiac history to experience cardiac comorbidities while undergoing ECT. We present the case of a 23-year-old man who presented with treatment-resistant catatonia. He had undergone a series of bifrontal ECT with limited improvement and was then trialed on bitemporal ECT. During his second round of ECT, he developed left ventricular diastolic dysfunction and a resultant nonischemic cardiomyopathy. This cardiomyopathy resolved with the cessation of ECT treatments. We hypothesize that paroxysmal sympathetic hyperactivity syndrome following concussion may have predisposed him to cardiomyopathy. This case is unique given the rarity of cardiac effects of ECT, and especially in cardiac stable individuals. In our discussion, we will touch on physiological effects of ECT on the parasympathetic and sympathetic systems, compounded with paroxysmal sympathetic hyperactivity syndrome that likely caused the left ventricular dysfunction.
Postpartum psychosis is a severe psychiatric condition that emerges shortly after childbirth. Electroconvulsive therapy provides rapid symptom relief, particularly in severe and treatment-resistant cases. Despite evidence supporting its effectiveness, the use of electroconvulsive therapy in postpartum psychosis remains limited and unstandardized. This systematic review evaluates the clinical effectiveness of electroconvulsive therapy in treating postpartum psychosis. A comprehensive search of PubMed/MEDLINE, Cochrane, SciELO, SCOPUS, and Web of Science identified 255 studies, of which 7 met the inclusion criteria. Electroconvulsive therapy was used exclusively in severe cases that did not respond to pharmacological treatment, leading to symptom improvement in all cases, with most achieving complete remission. The total number of electroconvulsive therapy sessions ranged from 5 to 15, with symptom improvement observed after 1 to 6 sessions and remission after 5 to 11 sessions. Reported side effects, including memory loss, mild cognitive deficits, and pain, were transient. These findings highlight the effectiveness of electroconvulsive therapy as a rapid and safe intervention for postpartum psychosis, particularly when pharmacological treatments are insufficient. However, small sample sizes and variability in treatment protocols limit the generalizability of results. Further prospective studies are needed to establish standardized guidelines and consider electroconvulsive therapy as a first-line treatment for postpartum psychosis.
Sleep plays a critical role in mood regulation, yet the mechanisms linking sleep to mood improvement remain unclear. Electroencephalographic (EEG) slow-wave activity (SWA) during non-rapid eye movement (NREM) sleep is reduced in patients with major depressive disorder. Here, we examined sleep architecture in patients with depression undergoing electroconvulsive therapy (ECT). Sleep EEG data were collected using wireless Dreem devices before and after each ECT session serially throughout the ECT course. Sleep stages were manually scored into rapid eye movement (REM) and NREM stages (N1-N3) according to modified American Academy of Sleep Medicine guidelines. Depression severity was assessed using the 16-Item Quick Inventory of Depressive Symptomatology-Self Report (QIDS). SWA was quantified as the average 0.5-4 Hz frontal EEG power per minute during N2 and N3 sleep. Across 214 sleep records from 22 subjects (median 9 per patient), the percentage of time in N3 sleep increased over the course of therapy in the responders' group (P=0.030). SWA increased throughout the ECT course across all participants (P=0.001), and it was negatively correlated with the QIDS score (P<0.001). Mediation analysis revealed that SWA mediated the effect of treatment on QIDS only in the responders' group (P=0.037). Our findings demonstrate that ECT increases N3 sleep and SWA in the responders' group, with SWA changes mediating improvements in depressive symptoms. These findings highlight SWA as a biomarker of antidepressant response and a potential target for sleep-based strategies to augment brain stimulation therapies for depression.
Neurogenic pulmonary edema (NPE) is a life-threatening complication of severe central nervous system (CNS) injury. Carbon monoxide (CO) poisoning causes significant CNS insults, including direct neurotoxicity and autonomic dysfunction, creating a high-risk neurological state. Electroconvulsive therapy (ECT), while an effective treatment for severe depression, induces profound physiological stress that can exacerbate underlying neuropathology, thereby increasing the risk of NPE. We present the case of a 62-year-old male with severe depression who was hospitalized after a suicide attempt through CO poisoning, who developed NPE after undergoing his first ECT session. Shortly after the first ECT treatment, the patient became hypertensive, agitated and developed respiratory distress. NPE was diagnosed based on clinical findings and radiographic evidence of prominent pulmonary vasculature. Despite medical management, the patient required emergent intubation and intensive care unit (ICU) management. The patient's condition improved with supportive care, and he was successfully extubated the following day. ECT was discontinued. This case highlights a rare but severe complication of ECT in a patient with pre-existing CNS vulnerability from CO poisoning. The physiological stress from ECT likely precipitated the sympathetic surge leading to NPE. This report underscores the potential dangers of performing ECT after recent CO poisoning and, when considered with the related research discussed herein, suggests that recent CO poisoning should be considered a relative contraindication for ECT. Clinicians must be vigilant about this complication and be prepared for its management.
Clozapine-resistant schizophrenia (CRS) is a severe condition with limited therapeutic options. Electroconvulsive therapy (ECT) has been proposed as augmentation, but its efficacy remains uncertain due to methodological limitations and inconsistent findings. This meta-analysis assessed the efficacy and safety of ECT as an adjunctive treatment in CRS. A systematic review and meta-analysis of RCTs was conducted following PRISMA guidelines. Databases were searched up to March 2025. The primary outcome was clinical response, defined in each RCT as a ≥40% to 50% reduction in positive psychotic symptoms. Secondary outcomes included response at ≥20% reduction, changes in negative/general symptoms, adverse effects, and dropouts. Three RCTs (102 participants) were included, two with sham-ECT controls. ECT significantly increased response compared with control for the primary outcome (RR = 5.63; 95% CI: 1.00 to 31.57; P = 0.04; I² = 0%), but showed no difference at the ≥20% threshold (RR = 1.96; 95% CI: 0.45 to 8.44; P = 0.36; I² = 55%). Other secondary outcomes were not pooled due to heterogeneity. ECT was generally well tolerated, with a low dropout rate. The primary outcome was driven by one large-effect study without sham-ECT and using clozapine monotherapy as control, while sham-controlled studies showed no significant benefit. The absence of differences at the ≥20% response threshold likely reflects the sham-ECT effects. Although underpowered, this outcome was reported to discuss active placebo effects. Given CRS severity and limited options, ECT may still be considered in selected cases, but further high-quality sham-controlled RCTs with standardized protocols are required.
Evidence about nonvoluntary electroconvulsive therapy (ECT) is limited. Observational studies have suggested that nonvoluntary ECT is equally effective as voluntary ECT in treating psychotic and mood disorders. However, prior studies with short follow-up periods of ∼6 months have been inconclusive regarding long-term clinical outcomes following nonvoluntary ECT, particularly in patients with schizophrenia-spectrum disorders. We conducted a retrospective chart review and included patients who received ECT treatment between 2016 and 2023 at our hospital. The patients were assigned to the nonvoluntary and voluntary groups. We compared the short-term and long-term outcomes between the 2 groups over a 1-year period. In total, 227 patients were included in this study: 58 in the nonvoluntary group and 169 in the voluntary group. No significant intergroup differences were observed in short-term outcomes, such as the clinical global impressions-improvement scale score, number of discharged patients, and duration of admission. Furthermore, the Cox proportional hazard model found that the nonvoluntary group was not significantly associated with treatment failure 1 year after discharge (hazard ratio: 0.94, 95% CI: 0.55-1.61). However, 6 patients in the nonvoluntary ECT group underwent the procedure again, representing a statistically significant difference. Nonvoluntary ECT may be an effective treatment option for patients with life-threatening conditions when no alternative is available. However, further investigation is needed to explore ways to improve patient acceptance of future treatments.
Electroconvulsive therapy (ECT) is a highly effective intervention for treatment-resistant catatonia and severe neuropsychiatric disorders. We present the case of a 67-year-old patient with a long-standing diagnosis of schizophrenia who developed catatonic symptoms in the context of Parkinson disease (PD) and neuroborreliosis. After a medication switch from risperidone to quetiapine the patient rapidly deteriorated, displaying psychotic symptoms, disorganized behavior, and aggression. Multiple pharmacological interventions, including clozapine, high-dose risperidone, and benzodiazepines, were ineffective despite therapeutic plasma levels. The patient required seclusion over 50 times due to persistent agitation. Subsequently, he became increasingly withdrawn, refusing food and fluids, and developed pronounced catatonic features (mutism, echopraxia). After 3 months of unsuccessful pharmacotherapy, bilateral ECT was initiated. Within 6 sessions, the patient showed marked clinical improvement. A total of 18 ECT sessions led to full remission of catatonic and psychotic symptoms, with no further need for coercive measures. The patient was discharged home and continues to receive maintenance ECT. This case highlights the efficacy of ECT in managing complex catatonic states in patients with comorbid neuropsychiatric and neuroinflammatory conditions. It also emphasizes the importance of early ECT consideration when pharmacological approaches fail in multifactorial clinical scenarios.
Electroconvulsive therapy (ECT) is recognized as an effective treatment for patients with schizophrenia. However, it is sometimes followed by adverse effects that are usually self-limiting. Postictal delirium (PID) is an adverse effect that is difficult to predict and requires further study. An observational cross-sectional study was conducted on patients with schizophrenia receiving ECT. The selected patients underwent the Delirium Observation Scale and Mini-Mental State Examination. Also, clinical characteristics and ECT-related variables were included in the study. A total of N=69 patients were included in the study. The ages ranged from 18 to 55 years, with a mean age of 34.5 years; 60.8% (N=42) were males. Among males, just over half (54.7%) smoked tobacco. BMI indicated that most participants fell within the normal to overweight range. There were no significant differences between patients with and without PID in terms of age, BMI, medical comorbidity, either first-generation or second-generation antipsychotics, and ECT stimulus dose. However, use of clozapine, anticholinergic medications, a combination of first-generation and second-generation antipsychotics, presence of catatonia, smoking, longer seizure duration, and a 1-day gap between sessions were associated with PID. Regression analysis identified several clinical and treatment features associated with PID development. Prevention strategies may be targeted to these factors.
The study aimed to evaluate the effect of modified electroconvulsive therapy (ECT) on cerebral oxygen saturation (rSO2), heart rate (HR), mean blood pressure (MBP), and peripheral oxygen saturation (SpO2) in adolescents both within and across multiple ECT sessions and compare those with adults. We prospectively recruited adolescents (less than 18 y) and gender-matched adults (18 to 24 y) undergoing ECT and monitored rSO2, SpO2, HR, and MBP up to 15 minutes during each session, from the second to the sixth session (T2 to T6). Linear mixed-effect models were used to analyze. Twenty-five adolescents and 20 adults were included. Within an individual ECT session, adolescents exhibited a significant increase in rSO2 at the first and second minutes following ECT (P<0.001), and the increase was greater in adolescents than adults. Post-ECT, SpO2 and MBP showed an initial rise followed by a gradual decline in both groups, while HR remained elevated till the 15th minute in both groups. Relative to the T2 session, rSO2 values remained stable across the sessions and did not differ between groups. No clinically relevant changes were noted in SpO2 and MBP across the ECT sessions. Compared with the T2, the HR consistently increased in the T4 to T6 sessions in both groups (all P<0.001). Both adolescents and adults demonstrated an acute increase (a significantly greater increase in adolescents), followed by a gradual decline in rSO2, SpO2, and MBP during a single ECT session, except for HR, which remained elevated. Across the ECT sessions, these variables remained stable in both groups.
Electroconvulsive therapy (ECT) is a widely used treatment for severe and treatment-resistant depression, with high efficacy but considerable interindividual variability of response. The neurophysiological mechanisms underlying ECT's antidepressant effects, particularly the role of seizure duration, remain unclear. This exploratory study investigates how EEG-measured seizure duration influences depressive symptomatology. We retrospectively analyzed data from 53 participants with depressive symptoms (MADRS ≥21) who underwent ECT at the interventional psychiatry unit of the Lausanne University Hospital (CHUV) between November 2023 and April 2025. MADRS scores were assessed at baseline and 6 weeks after ECT. Seizure duration was categorized into 3 groups: short (25 to 39 s), medium (40 to 59 s), and long (≥60 s). Statistical tests, including the Kruskal-Wallis and multiple linear regression, were performed to assess the differences in MADRS score changes across these groups. In addition, we conducted exploratory analyses at the symptom cluster level in MADRS score changes. Participants in the medium seizure duration group (40 to 59 s) exhibited the greatest overall improvement in MADRS scores, including a significant reduction in the anxiety and vegetative symptoms cluster. In contrast, for affective and anhedonic symptoms and hopelessness symptoms, the difference between the seizure duration categories did not reach statistical significance. This study identifies an optimal seizure duration window (40 to 59 s) as most effective in reducing symptom severity, as measured by MADRS and its symptom cluster factors. Further research is needed to better understand the complex relationship between seizure dynamics and ECT outcomes.
Electroconvulsive therapy (ECT) is an effective treatment for severe and treatment-resistant bipolar depression, yet intracranial vascular malformations such as cerebral cavernous malformations raise safety concerns due to transient ECT-induced increases in blood pressure and intracranial pressure, potentially elevating the risk of hemorrhage. We report a case of a woman in her mid-60s with treatment-resistant bipolar depression and severe symptom burden (MADRS 45; HAMD-17 35; HAMD-21 39) in whom brain MRI incidentally revealed a 6×4 mm cavernous hemangioma in the left precentral gyrus without signs of prior hemorrhage. Following interdisciplinary consultation with neurosurgery and anesthesiology, an index course of ECT was initiated with careful hemodynamic monitoring and pharmacological blood pressure control. The patient received 16 sessions; initial bifrontal stimulation yielded insufficient seizure quality despite maximal stimulus intensity, prompting a switch to right unilateral electrode placement, which produced adequate seizures. Hypertensive peaks up to 210/150 mmHg were successfully managed with metoprolol and intravenous urapidil. Apart from transient anisocoria after the first session with unremarkable cranial CT findings, no neurological complications occurred. Depressive symptoms markedly improved by the end of treatment (MADRS 12; HAMD-17 15; HAMD-21 17). This case suggests that ECT can be performed safely and effectively in patients with cerebral cavernous hemangioma when multidisciplinary assessment and targeted hemodynamic management are implemented, and that the combination of metoprolol and urapidil may represent a useful strategy to mitigate blood pressure surges during ECT.
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression. However, knowledge of changes in treatment numbers and the proportion of acute versus maintenance rTMS is lacking. This study aimed to examine the number of rTMS treatments, rates of return for additional treatment, and factors associated with these patterns in Northern Finland from 2016 to 2022. Data were collected from the electronic patient registry of the Oulu University Hospital neuromodulation unit. We analyzed the number of treatment sessions given annually, the number of patients treated and retreated, and whether the main diagnosis, age, or gender were associated with retreatment. The annual number of rTMS treatment sessions increased from 549 to 2884, with a 3-fold increase in acute and a 35-fold increase in maintenance treatments. There was a 3-fold increase in patients receiving acute and a 16-fold increase in patients receiving maintenance treatments. A total of 64% were females. The most common diagnosis was recurrent depressive episode (49%). The rTMS rate was 9.5 per 100,000 in 2017 and 24 per 100,000 in 2022. In all, 23% of patients returned to acute or maintenance treatment. Female gender and recurrent depressive disorder were associated with retreatment. rTMS use increased substantially, especially in maintenance sessions, with rising retreatment rates. While access improved, demand for maintenance care is straining capacity and prolonging waiting for acute treatment. Additional resources and research on optimal treatment schedules, relapse prevention, and cost‑effectiveness are needed.
Electroconvulsive therapy (ECT) remains one of the most effective treatments for catatonia, but its use in patients with implantable airway stimulation devices, such as the Inspire device for obstructive sleep apnea (OSA), is very rare, with only 2 prior cases described in the literature: one for major depressive disorder and one without a specified indication. There is no practical guidance for safely administering ECT with an implanted Inspire device. We describe a 32-year-old male with autism spectrum disorder (ASD), epilepsy, and OSA treated with an Inspire device who developed Down syndrome regression disorder (DSRD) and catatonia. DSRD is characterized by the acute loss of previously acquired skills in language, social engagement, and executive functioning. Standard medication approaches were either poorly tolerated or ineffective, leaving ECT as the best remaining option. Following the Inspire manufacturer's safety recommendations, which included turning the device off during each session and carefully positioning electrodes, the patient underwent 30 ECT treatments over 11 months. Gradually, his speech and ability to manage daily activities improved, the aggressive outbursts stopped, and no serious complications occurred. Our experience shows that, with thoughtful planning and precautions, ECT can be delivered safely and effectively for catatonia in DSRD with an implanted Inspire device. As more patients receive implantable airway stimulators, awareness of how to manage these cases will become increasingly important.
Electroconvulsive therapy (ECT) is a procedure to treat complex psychiatric conditions and requires serial treatments. Patients may undergo twelve or more treatments acutely and many continue maintenance ECT for longer-term management. Intravenous (IV) access is necessary to administer medications during ECT, including those for anesthesia, muscle relaxation, and blood pressure management. Peripheral IV access can become challenging over time due to repeated IV insertions and/or poor venous access. Many patients in our ECT cohort are recommended to have a port, a totally implantable venous-access device, placed to facilitate IV access during their treatment course. We conducted a 5-year chart review to evaluate the demographics of patients who received a port in our ECT cohort and to better understand the possible complications of port placement. Thirty-nine ECT patients were identified as having IV port placement during the 5-year study period. Port placement was more common in females, younger patients, those with catatonia, and patients receiving longer-term or maintenance ECT. There was a low rate of serious complications, and no fatalities were associated with having a port. We conclude that the use of ports is a safe and important option for IV access, especially in patients receiving maintenance ECT.
Electroconvulsive therapy (ECT) triggers a pronounced sympathetic surge that may increase cardiovascular risk, especially in susceptible patients. Dexmedetomidine, an α2-adrenergic agonist with sympatholytic properties, has been proposed to blunt this response, but its overall clinical impact and optimal dosing remain unclear. We conducted a systematic review and meta-analysis of double-blind randomized controlled trials evaluating dexmedetomidine administered before anesthesia induction in adult ECT. Primary outcomes were heart rate (HR) and mean arterial pressure (MAP). Secondary outcomes included seizure duration, recovery parameters, and adverse events. Random-effects models were applied, with prespecified subgroup analyses by dosage and anesthetic regimen. Twenty trials involving 1526 participants met eligibility criteria. Dexmedetomidine significantly attenuated the sympathetic response to ECT, reducing HR and MAP at most peri-procedure time points. The largest effects occurred 0 to 4 minutes after the electrical stimulus (mean difference for HR: -17.28 bpm; mean difference for MAP: -19.44 mmHg). Hemodynamic attenuation persisted for up to 30 minutes. Dexmedetomidine did not reduce seizure duration, prolong recovery milestones (spontaneous breathing, eye opening, following commands), or increase the incidence of hypotension or bradycardia. Subgroup analyses indicated that intermediate doses (0.25 to 0.5 µg/kg) provided the most consistent benefit, with no additional advantage at doses >0.5 µg/kg and stable effects across propofol-based induction regimens. Dexmedetomidine seems to be a safe and effective adjunct for mitigating the autonomic surge associated with ECT without compromising seizure quality or delaying recovery. Variability in dosing strategies and anesthetic protocols highlights the need for standardized approaches and further high-quality trials.