PHQ-9 to document baseline depression severity and establish a quantitative benchmark for measuring treatment response after each ECT session.

Documenting baseline depression severity is appropriate but is not the most critical pre-procedure assessment. Medical safety evaluation takes priority.

Cardiac and anesthesia risk assessment, including EKG, screening for raised intracranial pressure, and establishing a cognitive baseline.

ECT is a procedure requiring general anesthesia, and the most critical pre-procedure assessment is medical safety — particularly cardiac risk and anesthesia clearance. Raised intracranial pressure (from a space-occupying lesion, for example) is often considered an absolute contraindication due to the risk of herniation during the procedure. A cognitive baseline (MoCA or similar) is also important for monitoring ECT-related cognitive effects, which is a common concern for patients.

MRI of the brain to screen for structural abnormalities or space-occupying lesions that could increase procedural risk during ECT.

Brain MRI is indicated if there is suspicion of a space-occupying lesion (new focal neurological signs, papilledema) but is not universally required for all ECT candidates.

Baseline EEG to map the patient's seizure threshold and guide initial stimulus dosing parameters for the first ECT treatment.

Baseline EEG is not a standard pre-ECT requirement. Seizure threshold is determined during the procedure through dose titration.