Persistent hallucinations after laughing gas or a psychedelic trip? Vitamin B12 might help.

Some people notice that visual effects or hallucinations persist longer than the duration of a trip. This can happen, for example, after intensive use of psychedelics such as LSD or psilocybin, but also after recreational use of laughing gas (N₂O). In some of these cases, doctors refer to it as HPPD (Hallucinogen Persisting Perception Disorder), a condition in which visual disturbances such as flashes of light, afterimages, patterns, or moving structures continue to occur long after the substance has worn off.

What is less well known is that a vitamin B12 deficiency can cause a similar range of neurological and psychiatric symptoms, including hallucinations, psychosis, and cognitive disturbances. This is particularly relevant in the case of nitrous oxide use, as nitrous oxide can directly disrupt vitamin B12 metabolism.

In this article, we look at the possible role of vitamin B12 in persistent perceptual disturbances after drug use and why supplementation can help in some cases.

Why nitrous oxide can deplete B12

Nitrous oxide has a unique effect on the body. Specifically, it oxidizes the cobalt atom in vitamin B12 (cobalamin), thereby increasing the vitamin's effectiveness. becomes functionally inactive. As a result, important enzymes in the nervous system can no longer function properly.

This can lead to:

1. neurological symptoms (tingling, nerve damage, gait disturbances)

2. cognitive problems

3. depressive or psychotic symptoms

4. hallucinations or paranoid thoughts

Recent clinical studies and emergency department investigations show that psychotic symptoms and hallucinations occur regularly in people who use a lot of nitrous oxide. In a study from Australia, nearly half of the patients had psychotic symptoms and about a fifth had hallucinations.

The important point is that these complaints often improve after nitrous oxide use stops and vitamin B12 is supplemented.

B12 deficiency can itself cause hallucinations

Vitamin B12 is essential for the nervous system. It plays a role in:

1. myelin formation (insulation of nerves)

2. methylation processes in the brain

3. neurotransmitter balance

A deficiency can therefore lead to neuropsychiatric symptoms such as:

1. depression

2. cognitive decline

3. delirium

4. psychosis

5. hallucinations

In various medical case reports, hallucinations and delusions disappeared completely after patients were treated with B12 injections or high oral doses.

What does this mean for HPPD?

HPPD is usually associated with the use of LSD, psilocybin, or other psychedelics. This often involves visual effects such as:

1. afterimages

2. halos around light

3. geometric patterns

4. moving structures in the field of view

The precise cause is not yet fully clear, but changes in serotonin systems and the visual cortex are suspected to play a role.

However, there is an important point:

A B12 deficiency can cause similar visual and neurological symptoms.

This means that in people with persistent perceptual disturbances, especially if nitrous oxide has also been used, a B12 deficiency must be ruled out.

It is possible that:

1. nitrous oxide use causes a B12 deficiency

2. this deficiency exacerbates neurological symptoms and hallucinations

3. Supplementation helps the nervous system recover

For HPPD after psychedelics without nitrous oxide, there is no strong evidence yet that B12 directly cures it. However, it can provide support when there is a suboptimal B12 level or functional deficit. Supplementation with B12 can rule out the possibility that a low B12 level is having an influence. Having your B12 levels tested is also a good option!

When can B12 supplementation be beneficial?

Vitamin B12 supplementation can be particularly useful in these situations:

1. After heavy nitrous oxide use
Because nitrous oxide immediately inactivates B12.

2. In case of neurological symptoms
Such as tingling, numbness, or coordination problems.

3. In case of psychological symptoms after drug use
For example, hallucinations, confusion, or paranoia.

4. For vegetarians or vegans
Because food then often contains less B12.

5. In case of prolonged stress or poor nutrition
Which can delay recovery of the nervous system.

How B12 can support the recovery of the nervous system

Vitamin B12 contributes to various processes that are important for recovery after neurological stress:

1. repair of nerve tissue

2. regulation of methylation in the brain

3. support of neurotransmitters

4. reduction of homocysteine (neurotoxic amino acid)

Therefore, B12 is also often used for:

1. peripheral neuropathy

2. nerve damage

3. cognitive complaints

4. chronic fatigue

Practical tips

If you suffer from persistent visual disturbances after nitrous oxide or psychedelics:

1. Get your B12 level tested
You may also ask about methylmalonic acid (MMA) and homocysteine.

2. Consider B12 supplementation
Commonly used doses range between 1,000 and 2,000 µg per day.

3. Avoid nitrous oxide or psychedelics completely
This can continue to worsen the problem.

4. Ensure recovery of the nervous system
Getting good sleep, magnesium, omega-3, and stress reduction can help. A vitamin B complex (with B12) can also be considered.

Conclusion

Persistent hallucinations or visual disturbances after drug use are often directly linked to HPPD. However, another factor can sometimes play a role, namely vitamin B12 deficiency.

This is a major cause, especially with nitrous oxide use, because nitrous oxide directly inactivates the vitamin. In such cases, B12 supplementation plays an important role in recovery and symptoms can even disappear completely.

For HPPD after psychedelics such as LSD or psilocybin, the evidence for B12 as a treatment is still limited, but supporting healthy B12 levels may contribute to the recovery of the nervous system.