The Weekly Mind Reader: Laughing Gas for Suicide Prevention

by Staff Writer
August 18, 2023 at 10:05 AM UTC

This week we report on a bevy of clozapine research, a promising Esmethadone case study, and let our readers take it from there.

A new The Journal of Clinical Psychiatry study puts forth an intriguing theory about the use of “laughing gas” to treat people with severe, treatment-resistant depression who experience suicidal thoughts. 

Safety and Efficacy of Laughing Gas for Suicide Prevention

In an exploratory analysis, researchers found that inhaling nitrous oxide (commonly known as laughing gas, “whippits,” or N2O) significantly reduced suicidal thinking within 24 hours among these patients. Though the study was small, with only two dozen participants, over half who inhaled a 50 percent nitrous oxide/oxygen mixture experienced a meaningful drop in suicidal ideation the next day based on a standard psychiatric questionnaire. In contrast, only 12 percent who inhaled a placebo gas mixture experienced this rapid anti-suicidal effect.

Importantly, the researchers didn’t observe any negative side effects from the treatment. However, the gas does carry some known risks like vitamin B12 depletion and neurotoxicity with improper, long-term use. Larger scale, longer-term studies would help evolve a complete safety profile.

The authors noted that their results are strikingly similar to what has been observed with the anesthetic ketamine, which has shown promise as a fast-acting anti-suicidal agent. This suggests nitrous oxide may have comparable benefits in curbing suicidal thoughts in people struggling with severe depression.

But the experts cautioned they’d like more investigation before the compound is considered for use as an antidepressant. The study was a pooled analysis of past clinical trials, not a dedicated investigation of suicidal ideation. Additionally, the anti-suicidal benefits were not persistent. They dissipated by two hours after inhalation. Existing N2O studies suggest that antidepressant effects may persist for at least two weeks, so there could be possible carryover effects the study didn’t pick up on.

Another cautionary note: these results aren’t generalizable to someone without clinical depression. Certainly, no one should start abusing the compound, as in whippits, to treat any form of mental illness. 

But for the estimated 100 million people worldwide grappling with severe depression, laughing gas could be an inexpensive, fast-acting treatment option somewhere down the line. The authors also posit that the mixture might provide temporary respite for patients in the midst of an acute suicidal crises. 

In Other Psychiatry News

  • A study assessed the efficacy of adjunctive use of cariprazine, an atypical antipsychotic, in patients with major depressive disorder who showed an inadequate response to other antidepressants.
  • Olanzapine should be included in the differential diagnosis of substance use, including opioid intoxication, especially in the emergency department setting.
  • With no major psychopathologic differences from other forms of psychosis, experts aren’t clear on the incidence and prevalence of postictal psychosis in patients with epilepsy. This case report reviews the importance of making an accurate diagnosis.
  • A new clinical vignette examines chronic hypercalcemia as a possible organic cause of mania with psychotic features.
  • Not all patients of bipolar personality disorder are “high splash,” a clinical psychologist argues in an opinion piece. It depends on how well they can manage “whole object relations.”
  • Psychiatrist.com is now on YouTube. Follow us there. Here’s an informative video on the history of clozapine use in schizophrenia that was posted to our channel this week. 

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Original Research

The Relationship of Anxious Arousal With Treatment of Dysphoria Using Virtual Reality Mindfulness and 2 Accelerated Transcranial Magnetic Stimulation Protocols

Baseline levels of anxious arousal were not predictive of outcomes of treatment with VR or accelerated TMS.

Austin M. Spitz and others

Case Report

The Psychiatric Presentation of Creutzfeldt-Jakob Disease

This case highlights the difficulty in controlling symptoms such as agitation and visual hallucinations in patients with Creutzfeldt-Jakob Disease.

Beatrice M. Thungu and others