Effect of methohexital, propofol, and etomidate on electroconvulsive therapy outcomes in patients with severe depression

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What is this study about?

The study involves adults who have Severe unipolar depression and are receiving electroconvulsive therapy. During each treatment session an intravenous dose of one of three short‑acting sleep‑inducing medicines—methohexital, propofol or etomidate—will be given to keep the patient comfortable while the electric stimulus is applied. The purpose of the study is to find out whether the choice of anaesthetic agent influences the clinical response to the therapy.

Participants will attend a series of treatment visits during which the assigned anaesthetic is given, the electric current is delivered to produce a brief seizure, and a small recording device placed on the scalp measures brain activity using EEG. EEG, or electroencephalogram, simply tracks the brain’s electrical signals with painless sensors. After each session, mood will be checked with a short questionnaire and a standard depression rating scale, and any side effects such as changes in blood pressure, heart rate, or memory will be recorded. The study follows individuals from the first treatment until they show a noticeable improvement in mood, as defined by the rating tools.

1 enrollment and baseline assessments

after joining the study, you will complete the Montgomery–Åsberg Depression Rating Scale (MADRS) to measure the severity of depression and the Patient Health Questionnaire-9 (PHQ-9) to record your symptoms.

a baseline electroencephalogram (EEG) may be recorded to document brain activity before any treatment.

2 randomization to an anaesthetic agent

you will be assigned to receive one of three intravenous anaesthetic drugs: methohexital, propofol, or etomidate. the assignment is made by the study team and you will not choose the medication.

3 pre‑session preparation for each ECT session

before each electroconvulsive therapy (ECT) session, a nurse will check your vital signs (blood pressure, heart rate, and oxygen level) and confirm that you have an intravenous (IV) line in place.

you will be asked about any new symptoms or side effects since the previous session.

4 administration of anaesthetic and muscle relaxant

once the IV line is ready, the assigned anaesthetic (methohexital, propofol or etomidate) will be given as a single 500 mg intravenous bolus.

immediately after the anaesthetic, 500 mg of suxamethonium will be administered intravenously to relax your muscles during the seizure.

5 delivery of electroconvulsive therapy

while you are under the effect of the anaesthetic, the ECT device will deliver a brief electrical stimulus to your brain.

the EEG will record the seizure activity, including its duration and intensity, which helps the clinical team evaluate the treatment.

6 post‑session monitoring and recording

after the electrical stimulus, you will be observed in a recovery area until the anaesthetic wears off and you are fully awake.

the staff will monitor vital signs, note any adverse events, and document seizure characteristics from the EEG.

7 depression questionnaire after the first session

following the first ECT session, you will complete the Patient Health Questionnaire-9 (PHQ-9) again to track changes in your depressive symptoms.

8 depression questionnaire after the sixth session

after the sixth ECT session, you will repeat the Patient Health Questionnaire-9 (PHQ-9) to further assess symptom improvement.

9 final assessments and study completion

when the treating physician decides that the course of ECT is finished, you will undergo a final Montgomery–Åsberg Depression Rating Scale (MADRS) assessment and a final Patient Health Questionnaire-9 (PHQ-9).

the number of ECT sessions needed to reach a 50 % reduction in the MADRS score, and the number needed to achieve a total MADRS score below 12, will be recorded as the primary and key secondary outcomes of the study.

Who Can Join the Study?

Give written informed consent, which means you sign a form showing you understand the study and agree to join before any procedures begin.
Be between 18 and 75 years old.
Have a diagnosis of severe unipolar depression that requires electroconvulsive therapy (ECT); this is a serious form of depression treated with a controlled electric current to the brain.
Be judged by your psychiatrist as suitable for ECT, meaning the doctor believes the treatment is appropriate for you.
Be starting your first acute course of ECT, which means this is the initial series of ECT sessions you will receive.
Be able to follow the study steps and attend all scheduled ECT sessions as planned.
Have an ASA Physical status I-III, a classification of overall health before anesthesia where I‑III indicates you are generally healthy to having mild to moderate health conditions.

Who Cannot Join the Study?

You cannot join the study if you are left‑handed (meaning you usually write and do tasks with your left hand).
You cannot join the study if you have a personality disorder (a long‑lasting pattern of thoughts and behaviors that causes problems) or an active substance use disorder (ongoing misuse of alcohol or drugs).
You cannot join the study if you are pregnant or breastfeeding (carrying a baby or feeding a baby with your milk).
You cannot join the study if you are unable to give legal consent (you cannot legally agree to take part in the study).
You cannot join the study if you are receiving involuntary psychiatric treatment (treatment you are forced to have because of mental‑health laws).
You cannot join the study if you have any contraindications (medical reasons that make a drug unsafe) to the study’s anaesthetic medicines or to neuromuscular blockers (drugs that relax muscles).
You cannot join the study if you have severe obesity with a Body Mass Index (BMI) greater than 45 (a measure of body weight relative to height that is very high).
You cannot join the study if you have epilepsy (a condition that causes seizures) or if you take any antiseizure medication (drugs used to prevent seizures, even for other reasons like nerve pain).
You cannot join the study if you have bipolar disorder (a mood condition that causes extreme highs and lows).
You cannot join the study if you have non‑affective psychotic disorders (serious mental illnesses such as schizophrenia that involve loss of contact with reality).
You cannot join the study if you have a significant neurological disorder that could affect the brain’s electrical activity (EEG), seizure patterns, or the reliability of the study results.

Where you can join this trial?

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Other Sites

Site Name	City	Country	Status
Vumxuqxruozxbusk heemzmvnkgpauej	Turku	Finland

Trial status

Country	Status	Recruitment Start
Finland	Not yet recruiting	01.09.2026

Trial locations

Investigated Drugs:

Propofol

Methohexital is a short‑acting anesthetic that is given through a vein. In this study it is one of the test drugs used to put patients to sleep before they receive electroconvulsive therapy (ECT). Researchers want to see if using methohexital changes how well the depression improves after ECT.

Propofol is another intravenous anesthetic that works quickly and wears off fast. It is also tested in the trial as a possible agent to sedate patients before ECT. The study compares propofol with the other anesthetics to find out whether it affects the success of the depression treatment.

Etomidate is an IV anesthetic that is often used when a stable blood pressure is important. In this trial it is tested as a third option for putting patients to sleep before ECT, and the researchers will examine whether etomidate influences the improvement in depressive symptoms.

Suxamethonium is a medication that relaxes muscles very quickly when given by IV. It is used in the trial as a background drug to prevent strong muscle movements during the electric shock of ECT, making the procedure safer for the patient.

Severe unipolar depression – Severe unipolar depression is a mood disorder characterized by persistent low mood, loss of interest, and reduced energy that lasts for at least two weeks. The symptoms often worsen over time if not managed, leading to increased difficulty in daily functioning. Individuals may experience changes in sleep, appetite, and concentration. Feelings of hopelessness and worthlessness can become more intense. The condition can fluctuate, with periods of relative stability followed by further decline.

Trial ID:

2025-524829-40-00

Protocol code:

ANECTEEG

Trial Phase:

Therapeutic confirmatory (Phase III)

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Effect of methohexital, propofol, and etomidate on electroconvulsive therapy outcomes in patients with severe depression

What is this study about?

Who Can Join the Study?

Who Cannot Join the Study?