Nitrous Oxide Inhalation Treatments

An Alternate Therapy for Depression

What are Nitrous Oxide Inhalation Treatments?

Nitrous Oxide works on some of the same pathways as Ketamine and may be used for the treatment of depression. The procedure involves breathing a controlled mixture of nitrous oxide and oxygen while resting in a comfortable chair for the duration of the procedure. Nitrous Oxide has long been recognized for its anxiolytic and analgesic effects and safe profile. There is a small but growing body of research supporting its use for depression. For some patients nitrous oxide treatments may be a good option.

The Procedure

  • The procedure begins with check-in and a discussion with your provider.
  • When you ready to begin and are resting comfortably in a reclining chair, the provider will adjust the gas mixture and provide you with a soft mask to place over your mouth and nose.
  • While wearing the mask, you’ll breathe normally for the duration of the hour-long procedure. Key vitals are monitored throughout.
  • After the procedure has completed and you have had time to sufficiently recover you may leave on your own. You may drive following a nitrous oxide inhalation procedure.

Why Choose Nitrous Oxide Treatments?

Nitrous oxide may offer rapid relief from symptoms of depression. Nitrous oxide inhalation therapy offers advantages for some patients: It does not require the placement of an IV, it allows for patients to resume normal activities immediately following the procedure including driving.

Why Choose Wells Medicine?

We are experts in the use of anesthetics, focused in-office procedures, and the treatment of depression. Our concern for the best in evidence-based medicine and comprehensive approach to care and treatment options for our patients led us to nitrous oxide inhalation treatments. We have experience administering these treatments in a comfortable, safe and compassionate setting. 

Next Steps

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More on Nitrous Oxide Inhalation Treatments:

What is Nitrous Oxide? 
 
Nitrous oxide is also known Nitrous, laughing gas, or NOS. It is the chemical compound N2O. At room temperature it is a colorless gas with a slightly sweet smell and taste. In medicine it is recognized for its anxiolytic (anxiety-reducing) and analgesic (pain-reducing) properties.

Nitrous oxide has been used since the 1800s for medical procedures. It is considered a safe anesthetic agent and has been used widely in dentistry and surgery and in emergency medicine and for procedures such as childbirth. It remains in wide use today. In dentistry, it is often used by itself with oxygen. In surgery, it is often combined with other anesthetic agents. It is generally considered very safe for use in limited and controlled environments when administered by properly-trained professionals.

Similar to ketamine, nitrous oxide, is an NMDA-receptor antagonist. While the exact mechanisms of action of nitrous oxide and ketamine are not fully known (like many drugs), this NMDA receptor antagonist characteristic is widely theorized to likely play a key role. Research on nitrous oxide inhalation treatments show promising results in the ability to reduce the symptoms of mood disorders.
 
How Does It Work?
 
As with many drugs – especially anesthetic agents – the pharmacological mechanisms of action are not fully understood. Nitrous oxide affects many receptors in the nervous system including dopamine receptors, benzodiazepine receptors, alpha-2 adreno-receptors, and NMDA (N-Methyl, D-Aspartate) receptors. This NMDA receptor antagonism is also a mechanism of action for ketamine, and is widely studied as one of the most likely mechanisms by which ketamine is so effective in treating depression – which is may be the basis for nitrous oxide’s potent anti-depressant promise.
 
Benefits of Nitrous Oxide

* Quick Symptom Relief: Patients can experience improvements in their mood shortly after treatment. Often reporting feeling a lift in spirits and a decrease in depressive symptoms, often noting an improvement in their overall outlook on life.
* Innovative Treatment: Nitrous Oxide represents a breakthrough in depression care, offering new hope where other treatments may not have been effective.
* Minimal Downtime: The treatment sessions are quick, allowing patients to continue with their daily activities with little to no interruption. They can even drive home!
* A Gentle Option: For those sensitive to traditional antidepressants, Nitrous Oxide provides a less invasive alternative.
 
Risks and Side Effects

While nitrous oxide inhalation therapy is generally safe, it is a medical procedure and carries potential risks and side effects.
 
Common, and Temporary Side Effects: Dizziness and nausea are common side effects during the active procedure. Mild disorientation may also occur during the procedure. These side effects generally dissipate rapidly following the active procedure.
            
Possible but Rare Side Effects: Vitamin B12 deficiency may occur from prolonged exposure to nitrous oxide and can lead to anemia or nerve damage, however this is mitigated by limited and controlled exposure duration and frequency in the clinical setting, and may be further mitigated by taking B12 supplements. Hypoxia can result from low oxygen levels in some cases and is more likely to be seen when the drug is used recreationally, however it is mitigated by the use of oxygen in combination with the nitrous oxide and continuous monitoring of patients in the clinical setting.

Alternatives

Alternatives include, but are not limited to, ketamine infusions, ECT, TMS, psychotherapy, and conventional antidepressant medications. When considering the best course of treatments or therapies you should review the details of your medical conditions with your doctors.
 
Research

Recent studies support nitrous oxide’s potential as a promissing treatment option for depression:
 
“Laughing Gas as a Treatment for Depression?” Eugene Rubin, Psychology Today, 2015

“Laughing gas studied as depression treatment” Jim Dryden, the SOURCE, Washington University in St Louis, December 9, 2014

Nagele et al “Nitrous Oxide for Treatment-Resistant Major Depression: A Proof-of-Concept Trial” Biological Psychiatry July 1,2015

Zarate and Machado-Vieira “Potential Pathways Involved in the Rapid Antidepressant Effects of Nitrous Oxide” Biol Psychiatry. 2015 Jul 1

Kohtala et al “Putative rapid-acting antidepressant nitrous oxide (“laughing gas”) evokes rebound emergence of slow EEG oscillations during which TrkB signaling is induced” March 2018

Nagele, Zorumski, Conway “Exploring Nitrous Oxide as Treatment for Mood Disorders: Basic Concepts” J Clin Psychopharmacol. 2018 Apr