Can Hyperbaric Oxygen Treat Psychiatric Disorders? |
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In PTSD trials, benefits were found in combat, sexual trauma, and civilian populations.
A 2025 study found HBOT improved memory, attention, and executive function after brain injury.
Post-COVID patients showed psychiatric and cognitive improvement from HBOT that persisted for one year.
For decades, hyperbaric oxygen therapy (HBOT) has been used in emergency medicine to treat carbon monoxide poisoning, “the bends,” and wounds that won’t heal. But new evidence suggests breathing pure oxygen at higher than normal pressure may help people with posttraumatic stress disorder (PTSD), depression, anxiety, and cognitive impairment. Here's how.
What Is Hyperbaric Oxygen Therapy?
HBOT involves breathing 100-percent-pure oxygen inside a chamber that is pressurized to 1.5 to 3 times normal atmospheric pressure. Under these conditions, oxygen dissolves directly into the plasma (i.e., the liquid part of blood) in addition to binding to red blood cells. This floods our tissues with much higher oxygen concentrations than we can achieve through normal breathing
The benefits of HBOT involve much more than just oxygenation. Research shows that HBOT can reshape our brain. For example, it restores energy production in cells whose mitochondria aren’t functioning well. Mitochondria are known as the “powerhouses” of our cells, because they generate energy in the form of ATP. They also produce molecules known as “reactive oxygen species” or ROS that help the immune system fight off infections and cancer. HBOT also stimulates the growth of new neurons and blood vessels, reduces neuroinflammation, and triggers the formation of new synapses, which are connections between neurons.
Researchers have described a process known as the hyperoxic-hypoxic paradox that happens when our oxygen level cycles between high and normal levels. Such fluctuations trick the body into experiencing a false sense of oxygen deficiency (hypoxia). This activates the brain's repair mechanisms and triggers neuroplastic changes that reshape the brain's structure and function.
Posttraumatic Stress Disorder
Some of the strongest evidence for HBOT as a treatment for psychiatric disorders comes from research on PTSD, and from patients who didn’t respond to conventional treatments. Veterans who failed antidepressants, antianxiety medications, exposure therapy, and EMDR were enrolled in a trial using HBOT. Not only did their PTSD symptoms improve, but their brain scans also showed measurable changes that were associated with improved functioning.
This was not an isolated result. A review published in 2024 found that PTSD symptoms consistently improved across multiple studies involving military and civilian populations alike, in men and women, and whether PTSD originated from combat, sexual trauma, or other sources. The benefits didn't depend on the type of trauma. They depended on the biology causing the disorder. This review also found a correlation between dose and outcome, meaning that more treatments produced better results.
Depression and Anxiety
The evidence for HBOT in depression and anxiety is encouraging. In stroke patients with depression, HBOT improves mood by repairing the damaged blood vessels and reducing brain inflammation that caused the depression in the first place. When researchers tested HBOT against psychotherapy in patients with depression and anxiety following a spinal cord injury, the HBOT group's mood and anxiety improved as much as those in the psychotherapy group.
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Long COVID has caused a wide range of neuropsychiatric symptoms, including anxiety, depression, cognitive impairment, sleep disruption, and PTSD-like symptoms. These are similar to the neuroinflammatory and vascular problems that HBOT is known to treat. Results of treatment with HBOT in post-COVID patients have been encouraging. In a double-blind randomized trial, patients with post-COVID symptoms who received HBOT showed significant improvements in their psychiatric symptoms, cognitive functioning, energy levels, sleep quality, and pain. All were measured against a placebo control. What makes this particularly interesting is that a follow-up study found that these benefits persisted after one year. For chronically ill patients who are looking for more than just short-term benefits, these findings provide hope.
HBOT can also improve cognition. PTSD, depression, and anxiety impair cognitive functioning in some individuals by disrupting memory, attention, executive function, and processing speed in ways that interfere with our daily functioning. HBOT addresses all of these problems, as a 2025 study demonstrated. This study found improvements in neurobehavioral symptoms in patients with post-brain-injury symptoms treated with HBOT, compared to controls.
Although early studies exploring HBOT as a treatment for psychiatric conditions provide hope, it should be noted that the evidence is preliminary and larger studies are needed. For individuals suffering from depression and anxiety in which there is no underlying neurological cause (e.g., no TBI or stroke), the benefits of HBOT are still largely theoretical. Although the field is advancing, more studies are needed to confirm the results from early studies.
Also, HBOT is not without risks. Rarely, this treatment can injure the middle ear (although such injury is generally mild) or cause oxygen toxicity (rare), and claustrophobia may occur. Also, HBOT requires a significant amount of time and money. A course of treatment typically requires 20-40 sessions, and the U.S. Food and Drug Administration has not yet approved HBOT as a treatment for any psychiatric indication. This means your insurance is unlikely to cover your treatment, and the cost can range from $150 to $650 per session, resulting in a total cost of $3,000 to $26,000 for a course of treatment.
What is exciting about HBOT from a psychiatric standpoint is that the findings extend to so many different populations and conditions. HBOT appears to be treating something that multiple psychiatric disorders share in common. Possibilities include neuroinflammation, disrupted perfusion, and mitochondrial dysfunction.
As neuroimaging tools become more sophisticated and larger trials get underway, clearer answers will emerge about who will benefit the most, what protocols are optimal, and how HBOT might be utilized more broadly in psychiatric care. For now, the evidence is strong enough to take it seriously, and the results, particularly for people who have run out of other options, are hard to ignore.
Doenyas-Barak K, et al. (2022). Hyperbaric oxygen therapy improves symptoms, brain's microstructure and functionality in veterans with treatment resistant post-traumatic stress disorder: A prospective, randomized, controlled trial. PLOS ONE. https://doi.org/10.1371/journal.pone.0264161
Zilberman-Itskovich S, et al. (2022). Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial. Scientific Reports. https://doi.org/10.1038/s41598-022-15565-0
Liu F, et al. (2017). Effects of hyperbaric oxygen therapy on depression and anxiety in patients with incomplete spinal cord injury. Medicine. https://doi.org/10.1097/MD.0000000000007497
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