Esketamine Plus Propofol Compared to Methohexital Anesthesia for Electroconvulsive Therapy in Depression: A Randomized, Double Blind, Controlled Study

What this Trial Is About

Researchers are evaluating anesthesia options for patients undergoing electroconvulsive therapy (ECT) to treat severe uni- or bipolar depression. This Phase 4 randomized trial compares a combination of esketamine and propofol (called ketofol) with methohexital, the current standard anesthetic used during ECT at the Medical University of Vienna. The study aims to assess whether ketofol is not inferior to methohexital in terms of anesthesia effects, treatment outcomes, and seizure quality. Participants will be randomly assigned to receive either methohexital or ketofol anesthesia for their entire ECT treatment series. Methohexital is given intravenously at an initial dose of 1 mg/kg with additional doses if needed to achieve adequate anesthesia. Ketofol is prepared by mixing esketamine and propofol and administered intravenously at 0.5 mg/kg each, with extra doses as required. Each anesthesia dose is given shortly before each ECT session. During the 4-week treatment period, participants will undergo assessments including antidepressant effects, recovery and reorientation times, adverse events, cognition, seizure quality, and medication use. Cardiac enzyme levels will be monitored before and after ECT sessions throughout the series. This comprehensive monitoring aims to compare safety and effectiveness profiles of the two anesthetics while ensuring participant well-being throughout the study duration.

Comparison of Esketamine/Propofol and Methohexital Anesthesia for ECT