10 Hz repetitive transcranial magnetic stimulation for nitrous oxide dependence: a case report

Nitrous oxide (N 2 O) abuse has emerged as an increasingly serious public health concern, yet effective interventions for N 2 O dependence remain lacking. We report on a 21-year-old woman with N 2 O dependence who, after 6 months of repeated N 2 O inhalation, developed gait instability, limb numbness and tremors, accompanied by delusions and auditory hallucinations. During her first hospitalization, she was treated with antipsychotics and vitamin B12; however, she relapsed to N 2 O use shortly after discharge and was readmitted. Upon her second admission, she received 10 sessions of 10 Hz repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex. Her craving for N 2 O began to decline after the third session and continued to improve after the sixth, with dependence largely resolved by the end of the treatment course. No adverse events, such as headache or tinnitus, and no significant withdrawal symptoms were observed during treatment. The patient was followed up 3 times after discharge and had maintained abstinence from N 2 O for 3 months (12 weeks) since her last use, remaining emotionally stable and resuming normal daily life and work. To our knowledge, this is the first reported case of high-frequency rTMS for N 2 O dependence. Our findings suggest that rTMS may reduce craving in the short term in these patients, offering a promising therapeutic approach to this escalating public health problem.