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Kronenberg G, Schoretsanitis G, Seifritz E, Olbrich S. The boon and bane of nitrous oxide. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01801-3. [PMID: 38613686 DOI: 10.1007/s00406-024-01801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
Nitrous oxide (N2O) has been known since the end of the eighteenth century. Today, N2O plays a huge role as a greenhouse gas and an ozone-depleting stratospheric molecule. The main sources of anthropogenic N2O emissions are agriculture, fuel combustion, wastewater treatment, and various industrial processes. By contrast, the contribution of medical N2O to the greenhouse effect appears to be small. The recreational and medical uses of N2O gradually diverged over time. N2O has analgesic and anesthetic effects, making it widely used in modern dentistry and surgery. New research has also begun studying N2O's antidepressant actions. N-methyl-D-aspartate (NMDA) antagonism and opioid effects are believed to be the main underlying biochemical mechanisms. At this point, numerous questions remain open and, in particular, the conduct of larger clinical trials will be essential to confirm N2O's use as a rapid-acting antidepressant. The N2O concentration delivered, the duration of a single inhalation, as well as the number of inhalations ultimately required, deserve to be better understood. Finally, the non-medical use of N2O has gained significant attention in recent years. Sudden deaths directly attributed to N2O are primarily due to asphyxia. Heavy, chronic N2O use may result in vitamin B12 deficiency, which, among other things, may cause megaloblastic anemia, venous thrombosis, myeloneuropathy, and skin pigmentation. Helpful biochemical tests include homocysteine and methylmalonic acid. The centerpiece of treatment is complete cessation of N2O use together with parenteral administration of vitamin B12.
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Affiliation(s)
- Golo Kronenberg
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zürich, Lenggstrasse 31, P.O. Box 363, 8032, Zurich, Switzerland.
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zürich, Lenggstrasse 31, P.O. Box 363, 8032, Zurich, Switzerland
- Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Northwell/Hofstra University, Hempstead, New York, USA
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zürich, Lenggstrasse 31, P.O. Box 363, 8032, Zurich, Switzerland
| | - Sebastian Olbrich
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zürich, Lenggstrasse 31, P.O. Box 363, 8032, Zurich, Switzerland
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Brunt TM. Nitrous oxide: A difficult case for classification as an addictive substance. Addiction 2024; 119:621-622. [PMID: 38123187 DOI: 10.1111/add.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Tibor Markus Brunt
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Victorri-Vigneau C, Grall Bronnec M. Yes, nitrous oxide addiction undeniably exists! Addiction 2024; 119:625-626. [PMID: 38196069 DOI: 10.1111/add.16430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes - Service de pharmacologie clinique - Centre d'Evaluation et d'Information sur la Pharmacodependence - Addictovigilance (CEIP-A), Nantes, France
- INSERM UMR1246, SPHERE methodS in Patients-centered outcomes and Health REsearch, Université de Nantes et de Tours, Nantes, France
| | - Marie Grall Bronnec
- INSERM UMR1246, SPHERE methodS in Patients-centered outcomes and Health REsearch, Université de Nantes et de Tours, Nantes, France
- Nantes université, CHU Nantes, Service d'Addictologie et de Psychiatrie de liaison, Nantes, France
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Back S, Kroon E, Colyer-Patel K, Cousijn J. Nitrous oxide addiction or not, action is needed. A response to commentaries. Addiction 2024; 119:627-628. [PMID: 38404020 DOI: 10.1111/add.16457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Sammie Back
- Department of Psychology Education and Child Studies, Neuroscience of Addiction (NofA) Laboratory, Center for Substance Use and Addiction Research (CESAR), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Emese Kroon
- Department of Psychology Education and Child Studies, Neuroscience of Addiction (NofA) Laboratory, Center for Substance Use and Addiction Research (CESAR), Erasmus University Rotterdam, Rotterdam, the Netherlands
- Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Karis Colyer-Patel
- Department of Psychology Education and Child Studies, Neuroscience of Addiction (NofA) Laboratory, Center for Substance Use and Addiction Research (CESAR), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Janna Cousijn
- Department of Psychology Education and Child Studies, Neuroscience of Addiction (NofA) Laboratory, Center for Substance Use and Addiction Research (CESAR), Erasmus University Rotterdam, Rotterdam, the Netherlands
- Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Winstock AR. Nitrous oxide: The label 'potentially addictive' may do more harm than good. Addiction 2024; 119:623-624. [PMID: 38183384 DOI: 10.1111/add.16426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Adam Rohan Winstock
- University College London, Institute of Epidemiology and Health Care, London, UK
- Global Drug Survey, London, UK
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Allan J, Cameron J, Simpson H, Kor K. It is time to take nitrous oxide seriously without waiting for more evidence of harms. Addiction 2024; 119:619-620. [PMID: 38092561 DOI: 10.1111/add.16410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 03/05/2024]
Affiliation(s)
- Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, Australia
| | - Jacqui Cameron
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Helen Simpson
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Kenny Kor
- School of Health and Society, University of Wollongong, Wollongong, Australia
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Gernez E, Lee GR, Niguet JP, Zerimech F, Bennis A, Grzych G. Nitrous Oxide Abuse: Clinical Outcomes, Pharmacology, Pharmacokinetics, Toxicity and Impact on Metabolism. TOXICS 2023; 11:962. [PMID: 38133363 PMCID: PMC10747624 DOI: 10.3390/toxics11120962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
The recreational use of nitrous oxide (N2O), also called laughing gas, has increased significantly in recent years. In 2022, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) recognized it as one of the most prevalent psychoactive substances used in Europe. Chronic nitrous oxide (N2O) exposure can lead to various clinical manifestations. The most frequent symptoms are neurological (sensitive or motor disorders), but there are also other manifestations like psychiatric manifestations or cardiovascular disorders (thrombosis events). N2O also affects various neurotransmitter systems, leading to its anesthetic, analgesic, anxiolytic and antidepressant properties. N2O is very challenging to measure in biological matrices. Thus, in cases of N2O intoxication, indirect biomarkers such as vitamin B12, plasma homocysteine and plasma MMA should be explored for diagnosis and assessment. Others markers, like oxidative stress markers, could be promising but need to be further investigated.
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Affiliation(s)
- Emeline Gernez
- CHU de Lille, Centre de Biologie Pathologie Génétique, 59000 Lille, France; (E.G.); (F.Z.)
| | | | - Jean-Paul Niguet
- Service de Neurologie, Hôpital Saint Vincent de Paul–GHICL, 59000 Lille, France;
| | - Farid Zerimech
- CHU de Lille, Centre de Biologie Pathologie Génétique, 59000 Lille, France; (E.G.); (F.Z.)
| | - Anas Bennis
- Assistance Publique—Hôpitaux de Paris, Service de Neurologie, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France;
| | - Guillaume Grzych
- CHU de Lille, Centre de Biologie Pathologie Génétique, 59000 Lille, France; (E.G.); (F.Z.)
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