Emsam can safely be done with ECT. They do it here frequently and there is published research about it. They have to avoid some meds but they aren't commonly used with ECT anyway.

Emsam is really a 2 month committment to know how you feel probably. It took a bit for it to not agitate me and to let me know how it really worked and they don't like to increase the dose very quickly. I kind of cheated. I was started on it in the hospital and my pdoc was out for surgery and my family dr wound up doing my first month's care for confusing reasons involving a bad social worker who didn't care. Anyway I asked him to increase it faster and he did. Which probably enhanced my agitation (which was also up from coming off imipramine).

But yeah, you'd need to be done with ECT before starting it is my understanding.