Navigating Electroconvulsive Therapy in Patients on GLP-1 Receptor Agonists

Electroconvulsive therapy (ECT) is typically performed under general anesthesia without a secured airway, placing patients with retained gastric contents at increased risk of aspiration. As more patients present for ECT while taking GLP-1 receptor agonists, standard fasting requirements pose unique safety and patient-experience challenges. A 24-hour clear-liquid diet every other day is burdensome, while frequent rapid sequence intubations may prolong treatment and recovery. To address this, ECT and anesthesia leadership developed a novel pre-ECT fasting protocol for patients on GLP-1 RAs. We report a patient with refractory major depressive disorder on tirzepatide who successfully completed 17 ECT treatments without complications.