What psych ward docs may not know about nitrous

He had several psychotic breaks and was hospitalized a couple times without knowing precisely how the nitrous was causing them. It was clear that it was the drug, but the timing was peculiar because he wouldn't start getting strange ideas until a few days after he had last used the nitrous. During neither of the early hospital stays did any of his doctors, who knew of the nitrous use, suggest testing for or treating a vitamin deficiency -- they just fed him antipsychotics and waited for him to improve.

A few years passed and he had been off the nitrous for a while when he saw a relevant episode of the television show, House. Episode 3x14, "Insensitive," involves a patient who suffers from paranoid psychosis when a tape worm eats her B-12, and while watching it, a few things clicked for him. He told me about his new theory that a B-12 deficiency was responsible for his psychoses.

I did some digging on the web and found articles confirming his theory. It seems that nitrous oxide oxidizes a cobalamine precursor to B-12 (biochem geeks jump in here if I've got this jumbled), causing a B-12 deficiency in either people -- such as some vegetarians -- who may be prone to B-12 deficiency anyway, who then get nitrous during dental work, or in people who use nitrous both frequently and in quantity.

I can Google for "nitrous oxide cobalamine" and get lots of relevant hits, so this is not a secret, but the doctors missed it twice in two different hospitals in 2005, and they missed it again a couple weeks ago until I told them. My friend got reinvolved in nitrous and forgot to take enough of it sublingually, so he had another psychotic break and found himself in another psych ward. When I got to meet his doctor, I asked if he had been given any B-12 since he'd been admitted, and the doctor said that no, the psychosis was a result of anoxia, not B-12 depletion. I pressed, telling him I'd found confirmation on the web, and asked him to at least look into it and test my friend's B-12 levels.

Impressively, the doctor did as I asked, checked my theory in medical journals despite his skepticism, confirmed what I had told him, and ordered a blood test for my friend's B-12 levels and an injection of B-12. A little over a day later, my friend was mostly back to normal. The doctor asked me if he had ever been treated with B-12 previously and seemed tickled that he'd learned something from a patient's friends and family.

The doctor even spoke of writing a paper about the connection between B-12 deficiency and nitrous oxide, and I hope he does. A lot of people could be helped if more doctors knew to look at B-12 levels in people known to be using large quantities of nitrous oxide. My friend offered to help him with any details he might want to include. I hope they get this message out.