Electroconvulsive therapy (ECT) remains the most effective method of treating acute mental conditions in psychiatry. The progress that has been made in anesthesiology in recent years allows for the personalization and optimization of electroconvulsive therapy through purely anesthetic interventions. There are few procedures in medicine where anesthesia would have such a direct impact on the effectiveness, or even success, of a given procedure. A key aspect of electroconvulsive therapy is a selection of the appropriate anesthetic. In Polish conditions, we have a choice of thiopental, propofol, etomidate, and ketamine – each with different, unique properties and a different impact on the generated epileptic seizure and the patient’s hemodynamic safety. From the psychiatrist’s perspective, etomidate and ketamine seem to be optimal, as they have no anti-epileptic effect and allow the use of lower energy values, which translates into a lower risk of cognitive dysfunction. However, their use is associated with more frequent cases of hypertension and tachycardia. Ketofol, a mixture of ketamine and propofol, helps to alleviate excessive increases in blood pressure and pulse rate through the hemostabilizing property of propofol. Another important issue is the dose of the anesthetic used, i.e., the depth of anesthesia, which can be monitored using the bispectral index. Too deep anesthesia will result in less effectiveness of the procedure itself. The flow of the electric current requires the patient’s muscles to be fully relaxed. Succinylcholine, which is a depolarizing muscle relaxant, remains the drug of choice. In the case of contraindications to its use, non-depolarizing agents, such as mivacurium or rocuronium, turn out to be useful, although the duration of the procedure is definitely longer. Sugammadex allows for full abolition of rocuronium-induced relaxation, but it remains a drug that is usually unaffordable.