Empirical evidence for the neurocognitive effect of nitrous oxide as an adjunctive therapy in patients with treatment resistant depression: A randomized controlled study.

A double-blinded, placebo-controlled randomized trial tested whether nitrous oxide (N2O) improves cognitive function in 44 patients with treatment-resistant depression. Thirty-four patients completed cognitive tests before treatment and at 1 and 2 weeks after a one-hour inhalation of 50% N2O/50% oxygen or placebo (50% air/50% oxygen). Although N2O did not produce a significant antidepressant effect at 1 week, patients who received N2O showed better executive function at 1 week compared with placebo, and this improvement remained after controlling for changes in depressive symptoms. No significant differences were found in subjective cognitive function, processing speed, or attention over the 2-week follow-up. The results suggest N2O may have a pro-cognitive effect on executive function independent of mood improvement.

Study at a glance

Abstract

Nitrous oxide (N2O) has demonstrated an antidepressant effect for treatment-resistant depression (TRD), but no studies investigated the effects of N2O on different cognition domains. This study aimed to test whether N2O would display pro-cognitive effects. We conducted a double-blinded, placebo-controlled, randomized controlled trial, 44 patients with TRD were randomized to N2O group (one-hour inhalation of 50% N2O/50% oxygen) or placebo group (50% air/50% oxygen). Thirty-four patients completed cognitive tests at the pre-treatment phase, 1-week, and 2 weeks post-treatment including subjective cognitive function, processing speed, attention, and executive function. Although the antidepressant effect of N2O was not significant at 1 week, patients still showed better performance of executive function at 1 week after receiving N2O compared with the placebo. Moreover, this significant improvement still existed at 1 week after controlling for the change in depressive symptoms over-time. Additionally, no significant difference was observed in subjective cognitive function, processing speed, and attention between these two groups across the 2-week follow-up period. As the first study investigating the treatment effects of N2O on improving cognitive function in TRD patients, the current study indicated that N2O has a potential pro-cognitive effect on executive function and this effect might be independent from improvements in depressive symptoms.