Nitrous Oxide for Depression and Other Hazards of Modern Psychiatry

Sandra Steingard, MD
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This week, MIA featured a news item regarding a recent “proof of concept” study conducted at Washington University of St. Louis that investigated whether nitrous oxide, commonly known as laughing gas, was effective in reducing symptoms of depression. In a press release, one of the investigators, notably the anesthesiologist on the team, was quoted as saying,“It’s kind of surprising that no one ever thought about using a drug that makes people laugh as a treatment for patients whose main symptom is that they’re so very sad.”

Surprising indeed. I think one needs to be in the rabbit hole of modern psychiatry to understand why a drug like this would be overlooked as a treatment for depression. I would argue that it is a reflection of what Joanna Moncrieff has called the disease-centered approach to understanding these drugs. We have the conceit that the drugs we prescribe rather than being generic euphoriants or tranquilizers  target specific disease states. The narrative of modern psychiatry includes the notion that these states – or disorders – are ones that psychiatrists are adept at identifying. It would have been damaging to the basic premise of modern psychiatry – bolstered by the neo-Kreplinians at Washington University – to admit we were just giving out psychoactive drugs, i.e., substances that would impact most everyone in similar ways. If I were to inhale nitrous oxide, my mood would undoubtedly be elevated. I never tried it during its heyday when I was in college, but I knew many others who did and I did not need a rating scale to know they were – at least for a time – a pretty happy bunch.

There has recently been an interest in the use of ketamine, known as special K, to treat depression. This is another drug that has a dramatic effect on most everyone who uses it. It is used by anesthesiologists and not just for those who are depressed. If you scan the ads in publications aimed towards psychiatry, you will find many ads for stimulants. These drugs, along with the benzodiazepines (Ativan, Valium, etc.), are not disease specific drugs. They may be particularly helpful for those who struggle in certain ways, but they effect us all in similar ways. I do not need to be suffering from any kind of disorder to be sedated by a benzodiazepine.

I remember wondering why we did not give stimulants to depressed patients. As a resident, I was told they were ineffective. It was suggested that they might be helpful for older patients who had low energy but I would have been criticized as a psychiatrist if, thirty years ago, I had prescribed them to a depressed patient. But then the notion was heavily promulgated that children with Attention Deficit Hyperactivity Disorder (ADHD) did not grow out of their problems. We were told that in fact many adults missed out on getting properly diagnosed and were in need of treatment. And the flood gates of stimulant prescribing opened. I see people who have many reasons to be inattentive – on multiple drugs for their other diagnosed conditions, using substances, living in highly stressful environments.  I know that it is considered legitimate practice – if they provide the correct history –  to diagnoses them with ADHD.  As psychiatrists we do not tell patients that there are drugs that – at least in the short run – can increase focus. We say that we have determined that they have an illness  and we can give them a drug to treat this. Since ADHD is accepted as a life long problem, when we follow this particular narrative, we create a life long customer for the stimulant industry. I do not think it is a coincidence that this interest in adult ADHD began to arise as most antidepressants were going off patent and their efficacy was being questioned. Although the stimulants have been around for a long time and are available in inexpensive generic forms, what is being promoted now are drugs that resist tampering. These drugs are addictive and often abused. So the market now is for drugs that doctors can prescribe but will be resistant to a problem we know is endemic – misuse, diversion, and abuse. It is interesting that stimulants are now coming back into fashion for the treatment of depression.

While it is not controversial to talk about the general effects of benzodiazepines and stimulants, the group of drugs classified as anti-depressants are thought to be specifically effective for those who are depressed. This idea is worth examining further. Before fluoxetine (Prozac) was marketed, the research focus in psychopharmacology was on determining which individuals would respond to anti-depressants. I was taught in the 1980’s that those individuals who had neuro-vegetative symptoms such as poor sleep with early morning awakening, thoughts of guilt, motoric slowing or agitation, were the ones who should be prescribed anti-depressant drugs. The older antidepressants had many noxious side effects. People – doctors and patients – avoided them. Fluoxetine was considered much safer and better tolerated. So physicians started to prescribe it more broadly, encouraged by the enormous hype surrounding this drug. And what did we find? Many people, not just those who fit the more narrowly defined “melancholic depression” reported improvement. Books were written about their broad effects. But never was the notion widely entertained that these drugs had general effects that most people would experience, the idea was that the drugs worked on people with an ever proliferating set of diagnoses: social phobia, dysthymic disorder, personality disorders, etc.

Why is this a problem? Isn’t it a good thing that these drugs have broader uses? Isn’t it a good thing to reduce suffering among a larger group of people?

Here is the rub. This is what we still do not know about drugs: What are the long term side effects? How hard is it to stop them?  How do we deal with the corrupting influence of the profit driven forces so powerful in medicine?  Most of these drugs are still studied over weeks and then prescribed for years. With drugs like stimulants, ketamine and nitrous oxide, I have a particular worry because these drugs are known to cause psychosis. Colleagues of mine have told me that they do not see people who become psychotic on stimulants. If they don’t, they are not looking. I am not comfortable assuming when an 18 year old develops psychotic symptoms after several years of treatment with an antidepressant that these two things are not related or that the psychosis was inevitable because the person had a diathesis to Bipolar Disorder. Stimulants are used to create animal models of psychosis because we have known for decades that stimulants can cause a person to become psychotic.

I think these newer drugs have a huge potential for harm. This is due in the short run to the potential for abuse and diversion. But I remain equally worried about long-term consequences. Psychiatry has not begun to reckon with the unanswered questions concerning drugs we have been prescribing for decades.  It is reckless to promulgate use of what appear to be even more dangerous drugs before we address these critical questions.

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79 COMMENTS

  1. Hi Sandy-thanks for the post. I share with you concerns about long term effects. Moreover, in the literature on fast spiking GABA interneurons-ketamine (which blocks NMDA receptors) will cause these fast spiking inter-neurons to die.

    If we must do drugs, I wonder why we don’t use buprenorphine for depression. Jaak Panksepp, a good neuroscientist, argued in a recent issue of an Association for Psychological Science journal, that buprenorphine should be tired. I guess it is in clinical trials in Israel. Heroin addicts did not have negative long term outcomes, although ODs were/are a problem. To my knowledge, heroin does not cause violence and if not used in high quantity, does not impair function.

    For ADHD, there are studies using nicotine patches. They are just as efficacious as Ritalin on increasing attention. On a psychological basis, people smoked for years throughout several centuries without devastating psychological effects. Presumably, the nicotine patches don’t cause cancer, although they will raise blood pressure. If I were a parent, I would prefer the nicotine patch to some version of speed.

    My preference is no drugs. But, if we’ve got to do drugs, shouldn’t we be weighing the pros and cons of everything.

    • I’m fine with people using performance enhancing drugs under some circumstances. But calling that medicine and drugs targetted at specific disorders has opened the gates of hell. Not mentioning that these drugs are all addictive and do have side effects, some more, some less serious, especially over the long-term.
      If you want to use drugs, that should be your choice but please don’t tell me it’s because of your mental illness.

  2. I hate to over-use quotation marks, but it’s important to me that I make it clear that I don’t consider extreme states “illnesses” or “disorders.” Also, based on almost 30 years of reading the literature on the effecicacy (or lack thereof) and “side-effects”of a range of psychiatric drugs, I don’t advocate their use – or at least, I advocate that people who consider taking them fully inform thmeselves of the potenital risks and benefits.

    But based on personal experience, I feel very differently about the voluntary use of psychoactive substances for the expansion of counsciousness and personal growth. I’ve experienced what others might call “depression” most of my life – although I call it alienation and despair. One of the things that has made a difference in my understanding of myself and my relationship to the universe is nitrous oxide (not done recreationally, but in the dentist’schair). On one such occaission, I experienced the purest joy, the deepest calm, a sense that everything was completely and impeccably understood and that all was perfect as it was. I merged seamlessly with all matter and energy – I WAS all matter and all energy – and no longer a separate entity.

    More than any psychiatric treatment or therapy I experienced before then -or in the 40 years since then- this experience with nitrous oxide had a more profound amelioration of my sense of alienation and despair. Theimperfectly recollected feeling of that moment is often the only thing that keeps me in this body. So it’s hard for me to understand why this might be a problem.

    • Darby, Thanks for continuing to share your perspective on the meaningful connections for this range of issues. I also wondered if you had ever enjoyed controlled substances where it was as legal as the ground you walk on? We plainly know that expectations and environment can matter as much or more than the intended chemistry. So I doubt that our country has many useful studies of drugs that rankle today’s Carrie Nation’s.

      Similarly, I wonder why behavioral healthcare professionals think they can get accurate reports of experiences when the patient’s aren’t enjoying their liberties equally. Then it is back to the random trial data with dubious absence of context all over again.

  3. Sandra

    You make several references to ADHD without using quotation marks or questioning the legitimacy of the diagnosis. I believe there is a great deal of evidence that this has been another manufactured diagnosis created by Big Pharma colluding with the APA for self serving and other nefarious purposes.

    I know you are trying to approach these questions from a critical perspective. Where do you stand on this question; are you ready to let go of the ADHD diagnosis?

    My experience from critical sources starting with Dr. Peter Breggin many years ago and numerous others in the years since, combined with my own work as a counselor in community mental health tells me the following:

    1) that some of the “ADHD” behaviors that lead to labeling By biological Psychiatry certainly do exist, but more fundamentally arise out of a prolonged state of excessive or heightened anxiety.
    2) that there are multiple factors in one’s environment that better explain the behaviors (or so-called symptoms) such as a trauma history (either witnessed or directly experienced), oppressive and/or inconsistent confusing, or constantly changing boundaries (for children) maintained by dysfunctional parents, and/or allergic reactions to certain substances or toxins in the environment.

    Many drugs (both legal and illegal) have different reactions for different people who have had the above noted experiences. Over the years I have talked with people who are calmed by cocaine and energized by heroin, and some with exactly the opposite reactions. All categories of legal and illegal substances have BOTH short term and long term consequences and the SHORT TERM consequences are NOT always falling on the positive side of the scale.

    When you make reference to antidepressants you tend to emphasize or only mention potential dangers of long term consequences (and we are learning more everyday about the long term dangers of perturbing the serotonergic system).

    For the short term, what about suicidality, akathisia (extreme anxiety and discomfort), and emotional numbing or a state of “selfish indifference.” The latter description is one that I have noticed in working (for 21 years) with many people on these drugs. I have also seen many people who have been on multiple SSRI’s and never “get better” and seem to get worse or go from one crisis period to another with only short periods of relative stability in between. Sandra, have you not observed the same phenomena among your patients?

    We all know (here at MIA) about the past hype of Prozac and other SSRI’s (Prozac Nation etc.). We also know about the significance scientific evidence of the Placebo Effect which clearly explains the explanation of short term positive effects reported by people. A good question to investigate regarding SSRI’s: are there really any significant numbers of people out there who actually claim that SSRI’s work great over a period of many years? Can Biological Psychiatry really prove that there is even a small subset of people who actually benefit from these drugs over the long term? I question if they can do this.

    As to more short term negative effects, emotional numbing or “selfish indifference” might have an initial subjective experience that could be described by an individual as “positive.” But even in the short term this effect could be seriously undermining their ability to understand or solve the very problems in their life that are giving rise to the experience of depression.

    These drugs can lead people away from seeking out the means and resources to solve their problems, but instead lead them into a state of passive acceptance of the status quo that actually prolongs their experience of depression. This state of passive acceptance can often prevent the development of necessary coping mechanisms and new insights that are essentially to making progress in their life.

    So Sandra, my point is that short term effects can also be proven to be quite harmful (in different ways) even prior to the growing evidence of iatrogenic damage done by neurochemical dis-regulation in the long term. I hope you will speak to this as well.

    Richard

    • “”that some of the “ADHD” behaviors that lead to labeling By biological Psychiatry certainly do exist, but more fundamentally arise out of a prolonged state of excessive or heightened anxiety.
      2) that there are multiple factors in one’s environment that better explain the behaviors (or so-called symptoms) such as a trauma history (either witnessed or directly experienced), oppressive and/or inconsistent confusing, or constantly changing boundaries (for children) maintained by dysfunctional parents, and/or allergic reactions to certain substances or toxins in the environment””

      I apologize for temporarily digressing but Richard, as a mental health professional, I strongly urge you to keep sleep apnea in mind when dealing with the possibility of clients being misdiagnosed with ADHD.

      http://www.huffingtonpost.com/dr-michael-j-breus/adhd-sleep-disorders_b_3193570.html

      Additionally, many people with learning disabilities and central auditory processing disorder are misdiagnosed with ADHD. One thing to watch out for though in getting diagnosed with LD by a psychologist/neuropsychologist is that many of the LDs are in the DSM so of course, they will think that taking a psych med will be very helpful when actually, it would greatly worsen the LDs. Probably better to self diagnose and research compensatory mechanisms if one strongly suspects having LD and doesn’t need an official diagnosis for other reasons.

      Speaking of sleep apnea, it has been shown that when the apnea is treated, the depression greatly improves. What a surprise says AA sarcastically.

      http://wkzo.com/news/articles/2014/dec/22/treating-sleep-apnea-may-lessen-depression-too/

    • “For the short term, what about suicidality, akathisia (extreme anxiety and discomfort), and emotional numbing or a state of “selfish indifference.””

      Great points. First, I think it is outrageous that people are prescribed drugs which are known to cause violence and suicides and when these occur they are always blamed on the person not on the drug and the person and not his/her doctor has to face legal consequences. Secondly, the effects of these drugs are highly dependent not only on an individual person but also on momentary circumstances (e.g. alcohol will make a happy person even more joyous but drunk while sad will make one teary or even suicidal – I have both witnessed and experienced it – psych drugs are no different). Also the effects on the person can change in time due to dependence, tolerance etc.

      “These drugs can lead people away from seeking out the means and resources to solve their problems, but instead lead them into a state of passive acceptance of the status quo that actually prolongs their experience of depression. ”
      I totally agree.

  4. Dr. Steinberg, I want to mention how readable and fair to drug users you are and point to how much that suggests your attitude toward getting questioned or pressed for further moral explanations tends to be an open one. In fact, almost every psychiatrist I have had to meet has not so much as liked getting consulted, their conceit about knowing their patients’ best interests having drifted all the way over to insisting on docile acceptance.

    In other words, my best interest had to be understanding diseases and how dangerous it was to reduce medications, and I saw a lot of this, and almost nothing else. Not just for myself alone, but nearly 100% of requests to continue struggling with personal issues in freedom met with, and I’m sure, still meet with this hypocrisy, no matter that there is no such reason as the doctor will claim to prove dangerous and covert agitation, and that the person has no plan to carry out, no contemplation whatsoever, and no history of actual violence. No, he or she can’t leave because of danger to self or others, since they want to decide for themselves about any little thing.

    This is the most outrageous direction for the conceit about drugs-for-diseases to go in. I’m sure that those who get around to planning violence or self-destruction rely on the conceit exactly at the turning point in their careers when they get to live out the reversal of power. I’m also certain that the corresponding effort to sell diseases for the insanity defense hurts the chances for escaping abusive and inappropriate clinical treatments, or just ineffective and misconceived ones, and stands in our way for escaping stigma as much as the glacial pace of reforms in prescribing practices itself.

  5. Dr Steingard,

    as always you have got me thinking deeply about some important issues.

    I would just like to say to all mental health professionals that if they ever manage to paint the Mona Lisa on a grain of rice with their rubber ruler (diagnosis of mental illness) and a 4 inch paint brush (drugs) whilst riding on a roller coaster, to give me a call. I don’t mean to discourage them, but after so long one would think they might have examined the task they are trying to achieve and the ineffective tools being employed to achieve it.

    Regards
    Boans

  6. “This is what we still do not know about drugs: What are the long term side effects? ”

    Uhh… yes, we do. While we may not know every single “side effect” that there may be, we also don’t know every single thing about the universe but yet you don’t hear astronomers and physicists telling the public “but we still don’t know why we’re here or how things work the way they do!”

    We know more about psychiatric drugs than ever needed to be known to conclude that they are harmful far beyond any relative degree of “help” they may bring to some. Which reminds me of Phillip Hickeys blog post here about children being afflicted with tardive dyskinesia: what possible benefit could a child possibly receive from a drug that would be worth life-long involuntary movement disorders? A dose of a drug taken years ago, still hurting them today and that will still be hurting them 60 years from now… I think it’s safe to say, we know so much about these drugs, future generations will look back on statements like “we still don’t know how these drugs work in children” and “we still don’t know the long term side effects” as being a shame in the history of medicine. What we do know is far more important than whatever there might be that we don’t know. We know the drugs are just psycoptropic drugs. We know that they don’t really work for any therapeutic purposes and when they’re not being used simply as chemical straight jackets, most people who report improvement would go on to improve with just about any intervention. I think that’s more than enough to conclude that this is a disaster and psych drugs ought to be banned, at least in children.

    • Perhaps ethanol’s “sedating” GABA actions prevent it leading to more “spiritual” heights, despite the NMDA antagonism? Whatever. Many you affect your NMDA and GABA receptors when enjoying a glass of wine, in a similar manner to laughing gas or ketamine + benzo.

      • Hermes, Alcohol is probably the best drug going for anxiety and social phobia. It works better than psychiatric drugs and a controlled drinker can function and live a reasonable lifespan.

        A problem drinker or someone who wants to stop drinking can find hundreds of people in the rooms of 12 Step fellowship that can help them live life sucessfully without the drug, and without psychiatry.

        • Fiachra, Another of Dr. Moncrieff’so points has been that the myth of the chemical cure gets sustained along with an equally doctrinaire mindset of prohibitionism. Here for sure we see the likeness between genuinely medical and psychiatric approaches. As well it shows psychologists sitting on their hands rather than bolstering the message when particular individuals advocate for the health benefits of alcohol, or insist on attention to helping chronic pain sufferers get all the relief they need by forcing physicians to make careful discrimination between dependence and risk of dependence versus addiction on the other.

          Usually the maverick’s get nowhere with their message and the most protected survivor is the status quo.

          So the game of labels and forced treatment for psychiatric survivors themselves, as far as myths and prohibitions and coercion, gets very deadly and cases off-track dangerously, so that errors in favor of the “conceits” assure the anti-self-medication and over-diagnosis outcomes we know are so pervasive and disempowering. Except to the professionals and the apparatchiks of the justice system and media goon squads who like medical model politics just fine for us.

          “Conceit” is an especially smart word for pointing out the way to reinforce better attitudes in caregivers one by one, a good little tweak to their mantra that “we must follow the treatment plan.” But from the survivor perspective the main issue with disease talk is getting taken out of the loop in your own right for how your future turns out, and the silliness of getting made to say you understand your illness so that your jailers will turn into doctors again(or what it makes you do). To me, it’s as sanctimonious as it is authoritarian, and the most stupid of things about forced treatment for psychologists to leave unchallenged about their city cousins, the doctors.

  7. Concerning use of drugs as medicine, I read an interesting book by Ylikangas about the history of drug use in Finland (the book is only available in Finnish). As many know, drugs such as opium, heroin and cocaine were commonly prescribed by doctors and quacks in 19th century and early 20th century in many parts of world. Ylikangas points out that a recurring theme with each new drug was that at first it was promoted as having no side effects or issues at all. It would take longer time to see the actual issues. For instance, heroin was first promoted as similar to opium but without addiction potential.

    Heroin, cocaine and opium were widely available. Heroin was used in cough medicine. Finland was actually the biggest consumer of legal heroin during 1930s. After the Second World War, Finland was dealing with poverty and other issues. UN or other such international body demanded an explanation from Finland for the huge use or import of legal heroin. The Finnish president at the time answered that we need lots of heroin because of our climate. It was not commonly said that there’s any problem in public talk. However, restrictions of heroin and other drugs were quite rapidly mandated after some international orders, and the public image of these drugs likewise changed quickly among doctors and general public.

    • I found a short English description of this book I referred to: Mikko Ylikangas: Unileipää, kuolonvettä, spiidiä. Huumeet Suomessa 1800–1950 [Opium, death’s tincture, speed. Drugs in Finland 1800–1950]

      “This book presents an account of the history of drugs in Finland, as well as changes in legal and illegal drug use. Even in the early 19th century, the authorities were concerned about opium abuse. Medical doctor Elias Lönnrot – best known for collecting the folk poems that make up the Kalevala, the Finnish national epic – coined the name ‘unileipä’, ‘the staff of dreams’, for opium. A period of prohibition of alcohol in the 1920s spurred a huge increase in the sale of cocaine; in the 1930s Finland led the Western world in consumption of heroin as a cough suppressant. In the late 1940s, the United Nations investigated why Finland, with a population of four million, consumed as much heroin in a year as other countries did over an average of 25 years. This was explained by the severity of wartime conditions: drugs were used to maintain battle readiness and to combat anxiety, sleeplessness and tuberculosis. Social problems caused by misuse did not, however, get out of control. This book was awarded a prize for the best science book of the year in Finland in 2009.”

      There were issues with addiction and so on, but perhaps even the use of heroin was not entirely bad, at least in those conditions. There were people getting addicted, but there are perhaps many untold stories of people who got through from day to day life with drugs such as heroin, went to work and otherwise led a relatively normal life. The society did not get out of control, even in those severe conditions after the war, even though legal heroin was widely available.

  8. I needn’t remind anyone that depression hurts. That the long term effects of nitrous oxide [and ketamine] are unknown doesn’t mean that informed individuals should not be given access. After all, many of us have taken and continue to take SSRIs for depression under long standing representation that each new anti-depressant was more effective. (For readers of MIA, it is no secret that this claim has not survived critical scrutiny where treatment predicated on these medications was supposed to be “evidence based” and representing “best practices.”) Like I said, depression hurts, and given this I trust many individuals will do anything if only to make the pain subside briefly where for so many one, two or three anti-depressants and an antipsychotic adjunctively continues to be treatment in its entirety.

  9. My first time visiting this site. Great discussion.
    Isn’t it interesting how ketamine and laughing gas seem to always need further evaluation before they can be prescribed, yet, doctors are very quick to prescribe very dangerous antipsychotic meds that have only gone through a few 6 week clinical trials?
    The recent results for laughing gas showed positive results after only a day of use. Why do you need a study to continue using them? The medicine is cheap. These patients have likely have miserable lives and have been on all kinds of serious psychotic meds for years that have offered little to no relief. Hear they got some relief, and doctors are refusing to continue to prescribe the medicine until further testing is performed.
    Both ketamine and N2O have been used for years. The medicines are reported to have well known effects that self regulate on withdrawal of the medicine.

    • I personally wish there were more liberations for people who suffer from more severe forms of mental distress and at the same time know what is going on. Ketamine and N2O may be useful for some individuals, used in some proper way. Using them may be better for some individuals compared to what is going on otherwise in psychiatry, with promoting of neuroleptics and SSRIs.

  10. There are drugs and there are drugs. Some drugs calm the person down, some do not. Some drugs, such as NMDA antagonists and benzos, are usually pleasant and conforming to the person. He’ll like to take them. Other drugs, such as dopamine antagonists, often make the patient feel like shit. That’s one reason why psychiatrists have invented concepts such as “patient does not have adherence”, “he does not have insight”, etc. Neuroleptics make you feel like shit. That’s a major reason patients don’t like to eat them. I think there’s some actual reason to look again into laughing gas and ketamine.

  11. Many doctors seem to have an aversion to prescribing meds that have the potential to make a patient feel good. I expect they have concern that a patient will take the med for the purpose of getting high even when it is not effective at treating the disease. This is a reasonable concern with meds that cause physical addiction or have serious side effect risks. Years of using ketamine and N2O in other applications show them to be non-addictive and to have low risk profiles. So what is the concern with giving them a try? Isn’t there some benefit to providing a few minutes or symptom relief to a person that is suffering with major depression?

    Research indicates that 30% of patients with major depressive disorder will not get any benefit from the standard SSRI/antipsychotic med regiment. The standard meds have many risks and side effects.

    After years of taking standard medicine and getting no apparant relief of symptoms, doctors told me it is very important that my family member keep taking the medicine. They have warned me that young adults with major depression have a high risk of suicide when they are not taking their meds. Non-compliance seems to be real problem. To me, it does not seem logical to ask a patient to keep taking a med that is not providing benefits especially when the med has high risk of serious, possibly permanent, side effects.

    When reporting a lack of response to the medicine, doctors have recommended increasing the dose beyond the FDA approved prescribing guidelines. When asked about possibly prescribing ketamine and N2O, the doctors have refused siting the need for more research and the meds not having FDA approval for that use. To the patient, it appears to be hypocritical to site FDA guidelines as a reason for not using a med and at the same time prescribing another med in a way that exceeds FDA guidelines.

    Psychiatrists routinely prescribe meds off-label…when they want to. Now we have Ketamine and N2O that seem to show some promise in treating treatment resistant depression. From the research, patients will know within a matter of days if the meds are working. Therefore, exposure would be limited to a short term if the med is not working. With the SSRIs, you will have the meds in your system for months before you know if they are not working.

    Yet, doctors are not willing to prescribe ketamine and N2O for treatment resistant depression that has failed to respond to the current meds.

    Suicide is a real risk without EFFECTIVE treatment
    I suspect Compliance may be less of an issue with Ket and N2O due to low side effects and they may even like the buzz
    Short duration/quick response if it works.

    • Ketamine is not a safe drug, by no measure it is.
      “Isn’t there some benefit to providing a few minutes or symptom relief to a person that is suffering with major depression? ”
      So the answer to “depression” is getting high? Because that is what you’re advocating for essentially. What about heroin then? I bet it can also bring at least temporary relief. I don’t doubt that this is going to make one feel better temporarily but it’s unlikely to help anyone long term unless you want someone to keep getting high in order not to kill oneself. It’s a dead end. These drugs are just as risky as other psychoactive drugs – short term risk include sudden death among others, long-term use is largely a question-mark with some data showing it’s far from innocuous.
      If one needs to stay high in order to live what is this life worth anyway?

  12. “If one needs to stay high in order to live what is this life worth anyway?”

    I agree…but my relatives may feel differently.

    Though, I’m currently on Suboxone, which doesn’t get me “high,” when I was getting high (or whatever), the reason was so I wouldn’t suicide and ruin my parents’ lives.

  13. Dear Sandra, I read all these comments with mixed interest. However, I myself took one 60 minute PAN- treatment (Psyhotropic analgesic nitrous oxide) session 21 years ago, and I have not had a single drink since, because of the sustained anti-graving state of mind. The treatment transformed my physical and mental life totally in a new balanced direction without side effects.
    All in all, PAN treatment has been a part of the South African national healthcare since early 1980’s, and well over 27,000 people have received PAN in Europe with a proven success rate of 98%.
    Nitrous oxide treatment for mothers in child labor, in stead of epidural injection has been in use in Europe and Canada since 1947, and from 2011 in the United States. Is it probably because of the known resistance of the pharmaceutical industry toward nitrous oxide that it so unbelievable difficult to admit that the aforesaid treatment could have a significant socioeconomic impact. The U.S. substance withdrawal industry marketplace is saturated with shady treatment spas and crossly negligent 28 day compulsory get sober programs which have nothing to do with scientifically proven methods. AA ‘s 12 step is good, but it is based on faith and the potential will power nothing else.