Nitrous Oxide for Depression

Recruiting in Palo Alto (17 mi)

+1 other location

Overseen by Paul Myles, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: University of Chicago

Must not be taking: NMDA-antagonists

Disqualifiers: Bipolar, Schizophrenia, Substance use, others

Prior Safety Data

Trial Summary

What is the purpose of this trial?

To evaluate the acute and sustained antidepressant effects of nitrous oxide in people with major depressive disorder; and further evaluate these effects by identifying the optimal dose and regimen to guide current practice, and to plan a future large pragmatic trial.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you've used NMDA-antagonists like ketamine in the past 3 months or are undergoing ECT treatment.

What data supports the effectiveness of the drug nitrous oxide for depression?

Research indicates that nitrous oxide, which is commonly used for pain relief, has shown significant antidepressant effects in adults with severe treatment-resistant depression, with maximum effects observed 24 hours after administration. Additionally, nitrous oxide is a NMDAR antagonist, similar to ketamine, which is known for its antidepressant properties. ^{1 2 3 4 5}

How is nitrous oxide different from other drugs for depression?

Nitrous oxide is unique because it works as an NMDAR antagonist, similar to ketamine, which can help with depression by affecting brain chemicals differently than traditional antidepressants. It is inhaled as a gas, offering a novel administration route compared to pills or injections. ^{2 5 6 7 8}

Research Team

Peter Nagele, MD, MSc

Principal Investigator

University of Chicago, Department of Anesthesia and Critical Care

Paul Myles, MD

Principal Investigator

The Alfred Hospital, Department of Anesthesiology and Perioperative Medicine

Eligibility Criteria

This trial is for adults with major depressive disorder (MDD), confirmed by specific criteria and a score >16 on the HDRS-21 scale. Participants must not have psychosis, recent substance abuse (except nicotine), ongoing ECT treatment, significant medical issues, or be pregnant/breastfeeding. Those with suicidal intentions, bipolar disorder, schizophrenia, panic disorder or certain other mental health conditions are excluded.

Inclusion Criteria

I have been diagnosed with major depression without psychosis.

I am 18 years old or older.

Exclusion Criteria

Active suicidal intention, as determined by clinical interview assessment tool (Sheehan-STS) and clinical examination

A current or past history of bipolar disorder, schizophrenia, or schizoaffective disorder

Pregnancy or breastfeeding

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive weekly 1-hour inhalational sessions of either nitrous oxide or placebo for 4 weeks

4 weeks

4 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 weeks

Treatment Details

Interventions

• Nitrous Oxide (Other)
• Placebo (Other)

Trial Overview The study tests the antidepressant effects of nitrous oxide gas compared to a placebo in people with MDD. It aims to find the best dose and usage pattern for nitrous oxide to improve depression symptoms quickly and sustainably as preparation for a larger future trial.

Participant Groups

Group I: Treatment; Nitrous Oxide 50% or 25%, group Active Control 1 Intervention

Four-weekly, 60-minute inhalation sessions of 25% or 50% nitrous oxide, randomly assigned.

Group II: Control; Oxygen-air mixture, group Placebo Group 1 Intervention

Four-weekly, 60-minute inhalation sessions of an oxygen and air mixture.

Nitrous Oxide is already approved in Canada for the following indications:

Approved in Canada as Nitrous oxide for:

• Anesthesia
• Pain relief
• Hypoxic respiratory failure in neonates

Who Is Running the Clinical Trial?

University of Chicago

Lead Sponsor

Trials

1,086

Recruited

844,000+

Pete Salzmann

University of Chicago

Chief Executive Officer since 2018

MD from University of Chicago’s Pritzker School of Medicine, MBA from Stanford University’s Graduate School of Business

Anh Nguyen

University of Chicago

Chief Medical Officer

MD from Rutgers New Jersey Medical School, MBA from University of Chicago

The Alfred

Collaborator

Trials

110

Recruited

10,030,000+

Dr. Alfred Merz

The Alfred

Chief Executive Officer

Doctor of Science in Pharmacy from the Swiss Federal Institute of Technology (ETH), Zurich

Dr. Patrizia Cavazzoni

The Alfred

Chief Medical Officer

MD from Harvard Medical School

Findings from Research

This study aims to investigate whether a single inhaled dose of nitrous oxide (N2O) can provide rapid antidepressant effects in adolescents with major depressive disorder, with assessments at 2 and 24 hours post-administration.

The research will also explore if combining N2O with the SSRI fluoxetine leads to greater mood improvements over 12 weeks compared to fluoxetine alone, addressing the common delay in symptom relief associated with SSRIs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide (N2O) and subsequent open-label SSRI treatment of adolescents with depression (NOTAD): study protocol for a randomised controlled trial. Stewart, RM., Wong, JWY., Runions, KC., et al.[2022]

Nitrous oxide (N2O) demonstrated a significant reduction in depression severity scores in patients with major depressive disorder (MDD) at 2 hours, 24 hours, and after 2 weeks, indicating both rapid and sustained antidepressant effects based on a meta-analysis of 4 studies involving 133 patients.

While N2O showed promising efficacy in improving depression symptoms, it was associated with a higher risk of nausea and vomiting, suggesting that safety considerations are important when using this treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy and tolerability of inhaled nitrous oxide in major depressive disorder: a systematic review and meta-analysis. Qiu, Y., Li, L., Duan, A., et al.[2023]

A systematic review identified 59 cases of nitrous oxide (N2O) use disorder and 17 cases of EMONO use disorder, highlighting the potential for addiction, especially when used in larger quantities and for longer durations than intended.

The study suggests that N2O use disorder can develop not only from recreational use but also from medical exposure, indicating a need for careful monitoring of its use in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide: What do we know about its use disorder potential? Results of the French Monitoring Centre for Addiction network survey and literature review. Fidalgo, M., Prud'homme, T., Allio, A., et al.[2020]

Chronic abuse of nitrous oxide (N2O) in pediatric patients can lead to serious neurological issues, including symptoms like limb numbness and weakness, as seen in a study of 9 patients diagnosed with N2O-induced spinal cord degeneration.

Vitamin B12 deficiency was common among these patients, and while all received B12 supplementation and recovered muscle power within 2 months, some experienced lasting sensory deficits, highlighting the importance of prompt treatment to prevent permanent damage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Recreational nitrous oxide abuse related subacute combined degeneration of the spinal cord in adolescents - A case series and literature review. Lan, SY., Kuo, CY., Chou, CC., et al.[2022]

In a pilot study involving 23 participants with major depressive disorder, augmenting standard antidepressant treatment with nitrous oxide (N2O) significantly improved depressive symptoms, with a reduction in Hamilton Depression Rating Scale scores from 22.58 to 5.92 compared to a placebo group.

The study found that 91.7% of participants receiving N2O experienced a significant response (≥ 50% reduction in symptoms), and 75% achieved remission, although common side effects included nausea, vomiting, and headache.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide as an adjunctive therapy in major depressive disorder: a randomized controlled double-blind pilot trial. Guimarães, MC., Guimarães, TM., Hallak, JE., et al.[2021]

A 22-year-old woman developed severe health issues, including polyneuropathy and pancytopenia, due to recreational nitrous oxide use, which caused a functional vitamin B12 deficiency and increased homocysteine levels.

After receiving vitamin B12 supplementation and rehabilitation, the patient showed significant recovery, highlighting the importance of recognizing and treating the serious complications associated with nitrous oxide abuse.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide-induced polyneuropathy, pancytopenia and pulmonary embolism: a case report. Parein, G., Bollens, B.[2023]

Two patients developed serious neurological issues, including limb weakness and numbness, after long-term recreational use of nitrous oxide (N2O), leading to a diagnosis of subacute combined degeneration (SCD).

Treatment involved stopping N2O use and administering vitamin B supplements, which significantly improved their symptoms, highlighting the need for awareness of N2O's neurotoxic effects and the importance of early diagnosis to prevent irreversible damage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Subacute combined degeneration induced by nitrous oxide inhalation: Two case reports. Zhao, B., Zhao, L., Li, Z., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Nitrous oxide (N2O) and subsequent open-label SSRI treatment of adolescents with depression (NOTAD): study protocol for a randomised controlled trial. [2022]

2. Germany pubmed.ncbi.nlm.nih.gov

The efficacy and tolerability of inhaled nitrous oxide in major depressive disorder: a systematic review and meta-analysis. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Nitrous oxide: What do we know about its use disorder potential? Results of the French Monitoring Centre for Addiction network survey and literature review. [2020]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Recreational nitrous oxide abuse related subacute combined degeneration of the spinal cord in adolescents - A case series and literature review. [2022]

5. Brazil pubmed.ncbi.nlm.nih.gov

Nitrous oxide as an adjunctive therapy in major depressive disorder: a randomized controlled double-blind pilot trial. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Nitrous oxide-induced polyneuropathy, pancytopenia and pulmonary embolism: a case report. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Subacute combined degeneration induced by nitrous oxide inhalation: Two case reports. [2022]

8. New Zealand pubmed.ncbi.nlm.nih.gov

Hyperbaric oxygen therapy to improve cognitive dysfunction and encephalatrophy induced by N2O for recreational use: a case report. [2020]