Can the Desire for the Euphoric Effects of Propofol Promote an Inappropriate Request for Electroconvulsive Therapy?

Propofol is a short-acting intravenous anesthetic commonly used in electroconvulsive therapy (ECT). Misuse cases have been reported due to the short-lasting euphoric and dissociative effects of propofol. Here, we present a 49-year-old woman with complaints of depression and panic attacks, who underwent ECT because of poor adherence to medication and a previous positive response to the treatment. During ECT, she reported experiencing euphoria and relaxation following propofol administration, which she described as a feeling of "drunkenness" and "narcotic-like" effects. When ECT was discontinued after achieving remission, her anxious-depressive symptoms and panic attacks re-emerged within 1 to 2 months, and she reapplied with an intensive demand for ECT. When ECT was restarted and planned to be tapered gradually, each reduction in session frequency was accompanied by withdrawal-like symptoms such as anticipatory anxiety, tremors, sweating, and an intense desire for ECT, along with a persistent wish to continue treatment. She stated that she wanted to maintain twice-weekly sessions even when her symptoms had improved. Considering this clinical picture, it was suggested that the case might have been ECT misuse secondary to propofol dependence. To our knowledge, this is the first case in the literature highlighting possible ECT dependence or misuse. This report emphasizes the importance of recognizing the misuse potential of anesthetic agents in ECT practice and distinguishing psychological dependence behaviors that may emerge during treatment.