What is it about?
Some recent therapeutic approaches use, within a strictly supervised setting, anesthetic drugs administered at low doses to act on the symptoms of treatment-resistant psychiatric disorders.
Unlike conventional anesthesia, the aim is not to put the patient to sleep for surgery, but to harness specific effects on brain activity and neurochemistry.
These techniques can bring rapid mood improvement, sometimes within hours, whereas antidepressants often take several weeks to work.
They are offered only after a complete evaluation, as a complement or alternative to treatments already tried, and are always carried out on an outpatient basis under the supervision of a team trained in interventional psychiatry and anesthesia.
In addition to ketamine, we offer two specific approaches: dexmedetomidine infusions and nitrous oxide inhalations.
They are not suitable for all situations and are never a “miracle” solution. Their value lies in their rapid onset of action and, in some cases, better tolerance compared to conventional treatments.
Dexmedetomidine (alone or in combination with ketamine)
Dexmedetomidine was originally used in anesthesia and intensive care for its sedative, anxiolytic, and analgesic properties, without causing respiratory arrest.
When given at very low doses under close monitoring, it acts on specific brain receptors (alpha-2 adrenergic receptors), thereby modulating pathways involved in anxiety and mood regulation.
In interventional psychiatry, it may be used alone or combined with ketamine (Ketadex): this combination can enhance and prolong beneficial effects while modulating the intensity of the patient’s subjective experience.
Dexmedetomidine may exert a direct antidepressant effect in addition to its sedative and anxiolytic properties. This potential is thought to rely on the modulation of central noradrenergic activity and indirect interactions with glutamatergic NMDA pathways.
Effects are noticeable during the session and in the following hours: calmness, reduced rumination, renewed energy or motivation to engage in activities.
A series of several sessions, spaced over days or weeks, helps to consolidate improvement.
Who is it intended for?
Resistant depression: particularly when several antidepressants have proven ineffective or poorly tolerated.
- Severe anxiety disorders: frequent panic attacks, generalized anxiety requiring rapid relief.
- Situations where immediate calming is desired (acute psychological distress, severe insomnia).
- Session scheduled after complete medical and anesthetic assessment.
- Administered via 60-minute IV infusion, in a room equipped for continuous monitoring.
- Regular checks of blood pressure, heart rate, and oxygen saturation.
- Observation after infusion until fully stable (generally less than two hours on site).
The patient feels no pain; they may experience mild drowsiness or deep calm during infusion.
Side Effects and Precautions
- Most frequent: temporary drop in blood pressure, slowed heart rate, lightheadedness.
- Possible transient fatigue in the hours following.
Contraindications:
Certain heart conditions
- Severe uncontrolled hypotension
The dexmedetomidine–ketamine combination (Ketadex) can reduce the intensity of ketamine-induced dissociative symptoms, making treatment more comfortable for those who fear or cannot tolerate these effects, while enhancing antidepressant and anxiolytic action.
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Nitrous Oxide Inhalations
The English chemist, Joseph Priestley, discovered nitrous oxide in the 18th century and since the 19th century, it has been used in anesthesia. “Laughing gas”, as it is also known, is still commonly used by dentists, in obstetrics or in emergency medicine, in non anesthising doses, for its analgesic, sedative and anxiolytic properties.
Outside the medical field, nitrous oxide has also attracted media attention due to the risk of abuse and intoxication when inhaled for its euphoric effects.
Numerous studies are investigating its use at low doses in the treatment of depressive symptoms and other psychiatric indications (withdrawal from alcohol or other substances), but also in the treatment of certain acute or chronic neuropathic pains, with particularly promising results.
As with ketamine, the antidepressant action is much faster than that of conventional antidepressants, with effects observed within a few hours. Likewise, this treatment does not “cure” depression, but complements other treatments whose efficacy is insufficient.
Who is it intended for?
- Resistant depression when standard options are insufficient.
- Patients seeking a long-term drug-free approach (no daily medication to take).
- Need for rapid relief, e.g., during a period of significant emotional distress.
Efficacy and Benefits
Though data are less abundant than for ketamine, evidence suggests the initial antidepressant effect of nitrous oxide can be comparable in magnitude, with better tolerance and fewer dissociative effects.
Relief is often felt quickly: improved mood, reduced anxiety, lightness.
Generally well tolerated; some patients report mild sensory changes or temporary detachment during inhalation.
Treatment Procedure
- Gas inhalation for 60 minutes under supervision, using a nose-and-mouth mask.
- Rapid return to normal state after inhalation: no significant residual effects beyond a few minutes.
- Patients can usually leave unaccompanied unless otherwise advised.
Side Effects and Precautions
Possible: dizziness, nausea, vomiting, headaches. If these occur during inhalation, treatment can be paused temporarily. Effects are transient. Anti-nausea medication and vitamin B12 supplementation are prescribed in advance.
Contraindications include:
- Nasal breathing limitation (rhinitis, sinusitis)
- Middle ear blockage or recent ear surgery
- COPD
- Bowel obstruction
- Pneumothorax
- Certain ophthalmologic procedures (intraocular gas injection)
- Gas embolism
- Vitamin B12 or folate deficiency
- Pregnancy (first and second trimester)
Which Treatment Should You Choose?
IV or intranasal ketamine remains one of the reference treatments in interventional psychiatry for its proven ability to act rapidly on resistant depressive symptoms.
While ketamine is often the first choice in this therapeutic family, dexmedetomidine and nitrous oxide are valuable alternatives or complements, allowing adaptation to each patient’s clinical profile, preferences, and tolerance.
Dexmedetomidine vs Ketamine
Traditionally used for sedation and anxiety relief, dexmedetomidine may also have direct antidepressant effects. In practice, it can be used to strongly enhance ketamine (reducing dissociation, modulating experience intensity, adding its own antidepressant and anxiolytic effects) or as an alternative if ketamine is contraindicated, poorly tolerated, or dissociative effects are to be avoided.
Nitrous Oxide vs Ketamine
Though less documented than ketamine, nitrous oxide may produce a comparable initial antidepressant effect with better tolerance. It offers a rapid, non-invasive option — no infusion or injection — with minimal dissociation and extremely fast recovery.
| Technique | Administration | Onset of action | Duration of effect | Advantages | Side effects |
|---|---|---|---|---|---|
| Ketamine | Slow IV infusion | Minutes to hours | Days to weeks | Intense, rapid mood improvement | Dissociation Increased blood pressure |
| Dexmedetomidine (± ketamine) | Slow IV infusion | Minutes to hours | Days to weeks |
Marked calming Rapid mood improvement Reduced anxiety High tolerance Can combine with ketamine |
Low blood pressure Bradycardia Fatigue |
| Nitrous oxide | Inhalation | Immediate | Days to weeks |
Rapid, well-tolerated Short session Non-invasive |
Dizziness Nausea |
Are These Treatments Covered by Insurance?
Dexmedetomidine infusions and nitrous oxide inhalations are not reimbursed by either basic or complementary insurance schemes in Switzerland.
The patient has to meet the entire cost of treatment as well as of the monitoring by specialists in psychiatry and anaesthesia.
More information on costs and payment terms is available upon request.
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