Psychiatric Anesthetic Treatments
Low-dose anesthetic approaches for treatment-resistant psychiatric disorders, as a complement or alternative to conventional treatments, in Lausanne, Switzerland.
What are these treatments?
Some recent therapeutic approaches use, within a strictly supervised setting, anaesthetic drugs administered at low doses to act on the symptoms of treatment-resistant psychiatric disorders. Unlike conventional anaesthesia, 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 anaesthesia.
In addition to ketamine, we offer two specific approaches: dexmedetomidine infusions and nitrous oxide inhalations. LCIP is one of the few centres in Switzerland to offer these protocols in an outpatient psychiatric setting. 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 tolerability compared to conventional treatments.
Dexmedetomidine
Dexmedetomidine is a medication originally developed for anaesthesia and intensive care, used for its sedative, anxiolytic and analgesic properties, without causing respiratory depression. When given at 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: this combination can enhance and prolong beneficial effects while modulating the intensity of the patient’s subjective experience.
Efficacy and benefits
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?
- Treatment-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).
Gold standard treatment
For the most severe forms of treatment-resistant depression, electroconvulsive therapy (ECT) remains the gold standard interventional treatment.
Treatment procedure
- Session scheduled after complete medical and anaesthetic assessment.
- Administered via IV infusion in a room equipped for continuous monitoring.
- Regular checks of blood pressure, heart rate, and oxygen saturation over approximately 60 minutes.
- Observation after infusion until fully stable (generally less than two hours on site).
The patient feels no pain; they may experience mild drowsiness or a sensation of 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: an ECG will be performed beforehand
- Severe uncontrolled hypotension
Ketadex combination
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.
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 anaesthesia. “Laughing gas”, as it is also known, is still commonly used in medicine — by dentists, in obstetrics, or in emergency medicine — at non-anaesthetising doses for its analgesic, sedative, and anxiolytic properties.
Nitrous oxide acts on targets similar to those of ketamine (NMDA receptor antagonist and partial opioid receptor agonist). Numerous studies are investigating its use at low doses for the treatment of depressive symptoms and other psychiatric indications (withdrawal from alcohol or other substances), as well as for certain forms of acute or chronic neuropathic pain, 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?
- Treatment-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.
Neuromodulation alternative
Patients with anxiety disorders may also consider transcranial magnetic stimulation (TMS), which has demonstrated efficacy for anxiety and OCD through non-invasive neuromodulation.
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, sensation of 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
Nitrous oxide may sometimes cause dizziness, nausea, vomiting, and headaches. If these occur during inhalation, treatment can be paused temporarily. Effects are transient and resolve quickly.
Anti-nausea medication and vitamin B12 supplementation are prescribed in advance.
Contraindications
- Nasal breathing limitation (rhinitis, sinusitis)
- Middle-ear occlusion or tympanic surgery
- Chronic obstructive pulmonary disease (COPD)
- Bowel obstruction
- Pneumothorax
- Certain ophthalmologic procedures (intraocular gas injection)
- Gas embolism
- Vitamin B12 or folate deficiency
- Pregnancy (first and second trimester)
Pre-session instructions
Before each inhalation, patients must fast for 4 hours for solids and 2 hours for liquids. Preventive anti-nausea medication should be taken one hour before the session, and vitamin supplementation will be prescribed.
Which treatment to choose?
Intravenous or intranasal ketamine remains one of the reference treatments in interventional psychiatry, owing to its demonstrated ability to act rapidly on treatment-resistant depressive symptoms.
While ketamine often remains the first choice within this therapeutic family, dexmedetomidine and nitrous oxide are relevant alternatives and complements, allowing the strategy to be tailored to each patient’s clinical profile, preferences and tolerability.
Dexmedetomidine vs ketamine
Traditionally used for its sedative and anxiolytic effect, dexmedetomidine is the subject of studies suggesting that it may also exert a direct antidepressant effect. In practice, it can be considered as a powerful potentiator of ketamine, attenuating dissociative effects, adjusting the intensity of the experience and adding its own antidepressant and anxiolytic effects to those of ketamine, or as an alternative when ketamine is contraindicated or poorly tolerated, or when dissociative effects are best avoided.
Nitrous oxide vs ketamine
Although less abundant than for ketamine, the available data suggest that the initial antidepressant effect of nitrous oxide may be of comparable magnitude, often with better tolerability. Nitrous oxide is thus a rapid and non-invasive option: no infusion or injection is required. Dissociative effects are minimal, and patients return to their usual state of consciousness very quickly after the inhalations.
| Technique | Administration | Onset of action | Duration of effect | Key strengths | Side effects |
|---|---|---|---|---|---|
| Ketamine | Slow intravenous infusion | Minutes to hours | Days to weeks | Intense, rapid effect on mood | Dissociation, transient increase in blood pressure |
| Dexmedetomidine (± ketamine) | Slow intravenous infusion | Minutes to hours | Days to weeks | Marked calming effect · Rapid effect on mood · Reduced anxiety · Very good tolerability · Can be combined with ketamine | Drop in blood pressure, bradycardia, fatigue |
| Nitrous oxide | Inhalation | Immediate effect | Days to weeks | Rapid action · Well tolerated · Short experience · Non-invasive | Dizziness, nausea |
Insurance coverage
Not reimbursed
Dexmedetomidine infusions and nitrous oxide inhalations are not reimbursed by basic health insurance or by supplementary insurance in Switzerland. The treatments, which include the interventions and monitoring of the specialists in psychiatry and anaesthesia, are therefore paid for by the patient.
Further information regarding fees and payment arrangements is available upon request.