ECTPhase 4KetofolNCT05655754
Comparison of Esketamine/Propofol and Methohexital Anesthesia for ECT
A Phase 4 study testing Methohexital and Ketofol in people with ECT and Depression, run by Medical University of Vienna at 1 site in Austria.
Trial summary
The current anesthetic drug used as standard for ECT procedure at the Department of Psychiatry and Psychotherapy, Medical University of Vienna, is the barbiturate methohexital (Brevital®). As far as we know, methohexital is the most common anesthetic in the procedure of ECT. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- ECT, Depression
- What is being tested?
- Methohexital and Ketofol
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 56 participants
- Where
- 1 siteAustria
- Study dates
- 1 Nov 2022to 31 Mar 2026
- Phase
- Phase 4
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- male or female inpatients
- age ≥ 18 years
- ICD-11 diagnosis of severe uni- or bipolar depression (F32.2, F32.2, F33.2, F33.3, F31.4, F31.5)
- Hamilton Depression Rating Scale HAMD17 ≥ 24
- ability to understand and willingness to sign written informed consent document
- negative urine pregnancy test in women
- anesthesiological approval for ECT (Classification of the American Society of Anesthesiologists ASA ≤ 3)
- antidepressant and antipsychotic medication in steady state for at least 7 days prior to first ECT treatment
Who cannot join
- severe somatic or neurological disease (esp. current or previous history of intracranial hypertension, uncontrolled severe hypertension, bleeds or aneurysm, recent myocardial infarction)
- current or past history of schizophrenia or schizoaffective disorder
- clinical relevant abnormalities on a general physical examination and routine laboratory screening
- pregnancy, breast feeding
- known allergy to the study drugs or compounds of the latter
Trial locations and contacts
1 site in 1 country.
About this study
Official title: A Prospective Randomized, Double Blind, Controlled, Safety and Non-inferiority Study of Esketamine Plus Propofol Compared to Methohexital Anesthesia for Electroconvulsive Therapy
The current anesthetic drug used as standard for ECT procedure at the Department of Psychiatry and Psychotherapy, Medical University of Vienna, is the barbiturate methohexital (Brevital®). As far as we know, methohexital is the most common anesthetic in the procedure of ECT. Only few heterogeneous randomized controlled trials to directly compare the use of (sole) ketamine and methohexital in ECT with relatively small sample sizes have been conducted so far, showing inconclusive findings: a retrospective comparison of methohexital and switch to ketamine anesthesia in 36 patients showed that ketamine prolonged seizure duration and accelerated posttreatment orientation. Others compared both drugs in terms of recovery and reorientation time showing that reorientation time was faster in the methohexital group (total N=9). Another study showed no difference in any outcome measure (depressive symptom improvement, cognition, adverse events) between both groups (total N=16, N=9 per group). Finally, a comparative investigation (total N=37, N=20 vs. N=17) detected no differences between both anesthetics but a higher systolic blood pressure posttreatment and longer motor seizure duration in the ketamine group. A favorable profile of ketamine in regards to seizure quality has been reported, however in terms of outcome measures methohexital and ketamine were similar (total N=50, N=23 vs. N=27).
The present study is designed as a prospective randomized non-inferiority trial comparing esketamine plus propofol (ratio 1:1, for better readability from now on referred to as "ketofol") to methohexital, the latter being the current standard anesthetic applied for ECT procedure at our department. Patients eligible for ECT will be randomly assigned to receive anesthesia with either ketofol or methohexital for the whole course of the individual ECT series. Group differences will be investigated both in regards to outcomes related to anesthesia, treatment-outcome and seizure quality.
Read more
Further, changes in cardiac enzyme levels before and after ECT-treatment and during the entire ECT series will be evaluated and possible group differences will be explored.
As stated above the sole/adjunct administration of ketamine as anesthetic agent for ECT has been associated with better seizure quality, similar antidepressant outcomes and anesthesia-associated events, while there is some evidence suggesting that the use of ketamine might present some advantages to other anesthetics in terms of cognitive side-effects accompanying ECT. Therefore, the aim of the present study will be to establish ketofol as a new standard for anesthesia at our Department.
- Conditions
- ECT, Depression
- Being tested
- Methohexital, Ketofol
- Keywords
- electroconvulsive therapy, depression, esketamine, anesthesia
- Medical subject headings
- Depression
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
MethohexitalDrug
anesthesia during ECT
KetofolDrug
anesthesia during ECT
| Study group | Role | What they receive |
|---|---|---|
| Methohexital | Active comparator | Initial dose: methohexital 1 mg/kg (≙ 80 mg methohexital in a subject with 80 kg). If sufficient hypnosis is not achieved with the initial dose further doses of 10 mg methohexital will be administered until sufficient depth of anesthesia according to defined criteria is achieved. Criteria for sufficient depth of anesthesia will be comprised by a) the abolition of the eye-lash reflex b) absence of motor reaction upon inflation of the tourniquet.
Maintenance dose: none (The drug combination is injected in order to initiate anesthesia) Route of administration: intravenous Duration: few seconds to initiate anesthesia. The procedure will be repeated for each ECT session. Receives: Drug: Methohexital |
| Ketofol | Active comparator | Esketamine and propofol will be prepared shortly before injection by the nurse anesthetist as follows: 4 ml esketamine 25mg/ml, 6ml NaCl (0,9%), 10ml propofol (10mg/ml). The stability of ketamine-propofol mixtures (undiluted, 50:50 ratio) in one syringe has been documented for up to 3 hours.
Initial dose: esketamine 0,5 mg/kg + propofol 0,5 mg/kg (≙ 40 mg esketamine + 40 mg propofol in a subject with 80 kg). If sufficient hypnosis is not achieved with the initial dose further doses of 5mg esketamine and 5 mg propofol will be administered until a sufficient depth of anesthesia is achieved.
Maintenance dose: none (The drug combination is injected in order to initiate anesthesia) Route of administration: intravenous Duration: few seconds to initiate anesthesia. The procedure will be repeated for each ECT session Receives: Drug: Ketofol |
What is being measured
The primary outcome is the main question the study is designed to answer.
antidepressant effect
- HAMD17 change between baseline and post-ECT in both treatment arms over a series of 8 ECT sessions
Measured: 4 weeks
recovery time
Mean recovery time over 8 ECT sessions in both treatment arms
Measured: 4 weeks
Secondary outcomes (5)
adverse events
AEs during anesthesia/ECT
Measured: 4 weeks
concomitant medication
use of concom. medication during intervention to treat AEs
Measured: 4 weeks
cognition
MMSE, Beck's Depression Inventory (BDI), multiple-choice word test (MWT-B), trail making test (TMT), reaction test (RT), cognitrone (COG), non-verbal learning test (NVLT), verbal learning test (VLT) (Vienna testing system, https://vts.schuhfried.com), compare cognitive outcomes before and after ECT in both treatment arms
Measured: 4 weeks
time to reorientation
compare time to reorientation in both treatment arms
Measured: 4 weeks
seizure quality
compare a function of seizure duration, concordance (seizure duration in the electromyogram/seizure duration in the electroencephalogram), midictal amplitude, peak heart rates and interhemispheric coherence in both treatment arms
Measured: 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Dec 2022
- Study start1 Nov 2022
- Primary completion31 Mar 2026
- Study completion31 Mar 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for ECTStudies of the same condition, open and under way.
- More trials run by Medical University of ViennaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Depressive patients, that are eligible for ECT, will be randomized to receiving either ECT with esketamine plus propofol or methohexital anesthesia for the whole series (min. 8 treatments). Participants and treating psychiatrists will be unaware or the anesthetic used; anesthetists will know the substance that it aministered during ECT. Both drugs will be compared in terms of safety, recovery time and clinical outcome.
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 56 participants (actual)
Sponsor and investigators
- Lead sponsor
- Medical University of Vienna
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Pia Baldinger-Melich, Medical University of Vienna
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05655754
- Sponsor's protocol ID
- BMF22114
- Acronym
- Ketofol
- Status last verified
- May 2025
- First submitted
- 6 Dec 2022
- Last updated
- 7 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 7 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Prospective Randomized, Double Blind, Controlled, Safety and Non-inferiority Study of Esketamine Plus Propofol Compared to Methohexital Anesthesia for Electroconvulsive Therapy
- ClinicalTrials.gov ID
- NCT05655754
- Acronym / sponsor ID
- Ketofol / BMF22114
- Conditions
- ECT, Depression
- Keywords
- electroconvulsive therapy, depression, esketamine, anesthesia
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 56 participants (actual)
- Lead sponsor
- Medical University of ViennaUniversity, hospital or other
- Study start
- 1 Nov 2022 (actual)
- Primary completion
- 31 Mar 2026 (actual)
- Study completion
- 31 Mar 2026 (actual)
- First posted
- 19 Dec 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The current anesthetic drug used as standard for ECT procedure at the Department of Psychiatry and Psychotherapy, Medical University of Vienna, is the barbiturate methohexital (Brevital®). As far as we know, methohexital is the most common anesthetic in the procedure of ECT. Only few heterogeneous randomized controlled trials to directly compare the use of (sole) ketamine and methohexital in ECT with relatively small sample sizes have been conducted so far, showing inconclusive findings: a retrospective comparison of methohexital and switch to ketamine anesthesia in 36 patients showed that ketamine prolonged seizure duration and accelerated posttreatment orientation. Others compared both drugs in terms of recovery and reorientation time showing that reorientation time was faster in the methohexital group (total N=9). Another study showed no difference in any outcome measure (depressive symptom improvement, cognition, adverse events) between both groups (total N=16, N=9 per group). Finally, a comparative investigation (total N=37, N=20 vs. N=17) detected no differences between both anesthetics but a higher systolic blood pressure posttreatment and longer motor seizure duration in the ketamine group. A favorable profile of ketamine in regards to seizure quality has been reported, however in terms of outcome measures methohexital and ketamine were similar (total N=50, N=23 vs. N=27).
The present study is designed as a prospective randomized non-inferiority trial comparing esketamine plus propofol (ratio 1:1, for better readability from now on referred to as "ketofol") to methohexital, the latter being the current standard anesthetic applied for ECT procedure at our department. Patients eligible for ECT will be randomly assigned to receive anesthesia with either ketofol or methohexital for the whole course of the individual ECT series. Group differences will be investigated both in regards to outcomes related to anesthesia, treatment-outcome and seizure quality.
Further, changes in cardiac enzyme levels before and after ECT-treatment and during the entire ECT series will be evaluated and possible group differences will be explored.
As stated above the sole/adjunct administration of ketamine as anesthetic agent for ECT has been associated with better seizure quality, similar antidepressant outcomes and anesthesia-associated events, while there is some evidence suggesting that the use of ketamine might present some advantages to other anesthetics in terms of cognitive side-effects accompanying ECT. Therefore, the aim of the present study will be to establish ketofol as a new standard for anesthesia at our Department.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
- Model description
- Depressive patients, that are eligible for ECT, will be randomized to receiving either ECT with esketamine plus propofol or methohexital anesthesia for the whole series (min. 8 treatments). Participants and treating psychiatrists will be unaware or the anesthetic used; anesthetists will know the substance that it aministered during ECT. Both drugs will be compared in terms of safety, recovery time and clinical outcome.
| Arm | Type | Receives |
|---|---|---|
| Methohexital | Active comparator | Drug: MethohexitalInitial dose: methohexital 1 mg/kg (≙ 80 mg methohexital in a subject with 80 kg). If sufficient hypnosis is not achieved with the initial dose further doses of 10 mg methohexital will be administered until sufficient depth of anesthesia according to defined criteria is achieved. Criteria for sufficient depth of anesthesia will be comprised by a) the abolition of the eye-lash reflex b) absence of motor reaction upon inflation of the tourniquet. Maintenance dose: none (The drug combination is injected in order to initiate anesthesia) Route of administration: intravenous Duration: few seconds to initiate anesthesia. The procedure will be repeated for each ECT session. |
| Ketofol | Active comparator | Drug: KetofolEsketamine and propofol will be prepared shortly before injection by the nurse anesthetist as follows: 4 ml esketamine 25mg/ml, 6ml NaCl (0,9%), 10ml propofol (10mg/ml). The stability of ketamine-propofol mixtures (undiluted, 50:50 ratio) in one syringe has been documented for up to 3 hours. Initial dose: esketamine 0,5 mg/kg + propofol 0,5 mg/kg (≙ 40 mg esketamine + 40 mg propofol in a subject with 80 kg). If sufficient hypnosis is not achieved with the initial dose further doses of 5mg esketamine and 5 mg propofol will be administered until a sufficient depth of anesthesia is achieved. Maintenance dose: none (The drug combination is injected in order to initiate anesthesia) Route of administration: intravenous Duration: few seconds to initiate anesthesia. The procedure will be repeated for each ECT session |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- male or female inpatients
- age ≥ 18 years
- ICD-11 diagnosis of severe uni- or bipolar depression (F32.2, F32.2, F33.2, F33.3, F31.4, F31.5)
- Hamilton Depression Rating Scale HAMD17 ≥ 24
- ability to understand and willingness to sign written informed consent document
Key exclusion criteria (5 listed)
- severe somatic or neurological disease (esp. current or previous history of intracranial hypertension, uncontrolled severe hypertension, bleeds or aneurysm, recent myocardial infarction)
- current or past history of schizophrenia or schizoaffective disorder
- clinical relevant abnormalities on a general physical examination and routine laboratory screening
- pregnancy, breast feeding
- known allergy to the study drugs or compounds of the latter
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Methohexitalanesthesia during ECT | Drug | Methohexital |
| Ketofolanesthesia during ECT | Drug | Ketofol |
Primary outcome
antidepressant effect
Time frame: 4 weeks
• HAMD17 change between baseline and post-ECT in both treatment arms over a series of 8 ECT sessions
recovery time
Time frame: 4 weeks
Mean recovery time over 8 ECT sessions in both treatment arms
5 secondary outcomes
adverse events
Time frame: 4 weeks
concomitant medication
Time frame: 4 weeks
cognition
Time frame: 4 weeks
time to reorientation
Time frame: 4 weeks
seizure quality
Time frame: 4 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Oct 2026.
- Individual participant dataSharing planned: No
Related trials for ECT
Active, not recruiting
CET- REM (Correlating ECT Response to EEG Markers)
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Low Amplitude Pulse Seizure Therapy Versus Standard Ultra-Brief Right Unilateral Electroconvulsive Therapy
Suicidal Ideation, Major Depressive Disorder
Recruiting
Magnetic Seizure Therapy for Schizophrenia - Trial
Treatment Resistant Schizophrenia, Schizophrenia
Not yet recruiting
Peri-procedural Weighted Blanket Use for ECT
Post-ect Agitation, Post-ictal Agitation
Not yet recruitingObservational study
Longitudinal Effects of Brain Stimulation on Decision-Making and Reward Learning
Depression / Major Depressive Disorder
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Methohexital and Ketofol in people with ECT and Depression, run by Medical University of Vienna at 1 site in Austria.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 7 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Austria. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
antidepressant effect (time frame: 4 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Oct 2026.