NAD+ — nicotinamide adenine dinucleotide — is a coenzyme present in every living cell and is central to some of the most fundamental processes in human biology: energy metabolism, DNA repair, mitochondrial function, and the regulation of proteins involved in cellular aging. Despite its critical role, NAD+ levels decline significantly with age, chronic stress, inflammatory conditions, and substance use — a depletion that is now recognized as a contributor to cognitive decline, fatigue, mood disruption, and impaired cellular repair. At Awakenings by Northwest Ohio Ketamine in Toledo, we offer NAD+ IV therapy as part of a holistic integrative wellness model designed to address these cellular-level deficits alongside our treatments for mental health and chronic pain.
The Science Behind NAD+ and Why It Matters
NAD+ is a molecule that exists in every cell and participates as a critical coenzyme in the metabolic conversion of food to cellular energy — particularly in the mitochondrial pathways of oxidative phosphorylation. It is also an essential substrate for sirtuins, a family of proteins involved in DNA repair, inflammation regulation, and cellular stress response, as well as for PARP enzymes that respond to DNA damage. These dual roles — energy metabolism and cellular maintenance — make NAD+ central to how cells function and how they age.
A landmark study published in Cell demonstrated that NAD+ repletion in aging mice restored mitochondrial homeostasis, reversed aspects of muscle degeneration, and produced measurable improvements in energy and physical function — findings that have accelerated interest in NAD+ as a therapeutic agent (Gomes et al., 2013). Human research is still developing, but clinical observations and early trials have generated significant interest in IV NAD+ for conditions including chronic fatigue, cognitive decline, substance withdrawal support, and mood disorders. The IV route bypasses the limited oral bioavailability of NAD+ precursors, delivering the molecule directly into the bloodstream for rapid cellular uptake.
In the context of mental health and the nervous system, NAD+ is relevant to neurotransmitter production, mitochondrial function in neurons (which are among the most energy-demanding cells in the body), and neuroprotective mechanisms involving sirtuin-1. For patients dealing with the neurological fatigue and cognitive symptoms that often accompany depression, PTSD, or chronic pain, optimizing NAD+ availability represents a cellular-level intervention that complements other treatments rather than competing with them. At Awakenings, we see NAD+ therapy as one meaningful tool within a holistic care model — not a cure-all, but a clinically rational approach to supporting the biological substrate that everything else depends on.
What NAD+ IV Therapy Involves at Awakenings
NAD+ is administered intravenously at our Toledo clinic in sessions that typically last several hours — longer than most IV vitamin infusions — because NAD+ infused too quickly can cause temporary discomfort including flushing, nausea, or chest tightness. Our clinical team, led by Dr. William James, MD, manages infusion rates carefully to minimize these transient effects and ensure the experience is as comfortable as possible. The duration and number of sessions vary depending on the clinical indication and individual patient factors, and we discuss this with every patient before beginning.
NAD+ therapy at Awakenings is often combined with IV vitamin and mineral therapy — including B vitamins, vitamin C, magnesium, and other micronutrients — as part of a comprehensive infusion protocol. The combination approach reflects the clinical reality that NAD+ metabolism is connected to B3 (niacin) metabolism and interacts with other cellular cofactors. Supporting the full nutritional ecosystem that NAD+ depends on is part of what makes a well-constructed IV protocol more effective than a single-ingredient infusion.
We also provide holistic wellness services and integration coaching for patients undergoing NAD+ therapy. For patients using NAD+ as part of a recovery or mental health support protocol, the days following an infusion series may be a period of increased clarity and openness to change. Integration coaching helps patients use that window deliberately — to establish new habits, process insights, and build the behavioral scaffolding that supports sustained wellbeing. Results vary by individual, and we are transparent with patients about what the current evidence supports and what remains under investigation.
Who May Benefit From NAD+ Therapy
Patients who may benefit from NAD+ IV therapy include those experiencing significant fatigue, cognitive fog, or low energy that has not responded adequately to standard interventions. Patients with a history of substance use disorder — including alcohol, opioids, or stimulants — represent another population for whom NAD+ therapy has been explored clinically, given its potential role in supporting mitochondrial repair and reducing some withdrawal-related symptoms, though this application should not be conflated with addiction treatment and requires coordination with appropriate addiction medicine support.
Patients at Awakenings dealing with chronic pain conditions — including fibromyalgia, chronic regional pain syndrome, and migraine — may also benefit from NAD+ therapy as part of a broader integrative pain management protocol. Mitochondrial dysfunction has been implicated as a contributing factor in several chronic pain conditions, and optimizing cellular energy metabolism through NAD+ represents a physiologically grounded approach to supporting the cellular environment in which pain signaling occurs. Dr. James’s background in pain management informs how we think about and deploy NAD+ in these contexts. You can learn more about how chronic pain and depression are connected and how integrated treatment approaches can address both simultaneously.
Patients with depression who are also undergoing IV ketamine infusion therapy at Awakenings may find that combining NAD+ therapy with their ketamine series provides additional cellular support during a period when neuroplasticity is elevated. While direct evidence for this combination remains limited, the complementary mechanisms — ketamine supporting synaptic renewal and NAD+ supporting mitochondrial and cellular repair — make the combination biologically coherent. We discuss with every patient whether NAD+ makes sense as part of their protocol at Awakenings. Discuss with your provider whether your clinical situation and goals support adding NAD+ therapy to your care plan.
Addressing Barriers to Accessing NAD+ Therapy
Cost is a real consideration with IV NAD+ therapy. NAD+ infusion series are typically not covered by commercial insurance, and the multi-hour duration of each session means cost per session is higher than many IV vitamin protocols. At Awakenings, we provide transparent pricing and are happy to discuss bundled options for patients who are interested in multiple treatments. We believe that patients deserve honest information about financial commitments before they make any decisions.
Time is another practical barrier — NAD+ sessions at full therapeutic doses require several hours in our clinic. Patients who work full-time may need to plan sessions around their schedule, and we work to accommodate a range of scheduling needs. Many patients find the infusion experience itself to be restful and even restorative; others bring reading material or use the time for reflection. Our clinical team is attentive throughout and will adjust the infusion pace if any discomfort arises.
Frequently Asked Questions
Is NAD+ therapy FDA-approved?
IV NAD+ infusions are administered as a medical infusion procedure under the supervision of our licensed clinical team. NAD+ itself is an endogenous molecule — present naturally in the body — and its IV administration falls under the scope of physician-supervised medical practice. It is not FDA-approved as a treatment for any specific disease, and we are transparent with patients about the current state of the evidence.
How many sessions are typically needed?
For general wellness and energy optimization, protocols typically involve three to five sessions in an initial series. For patients using NAD+ in the context of recovery support or significant fatigue-related conditions, longer protocols may be appropriate. We individualize the protocol based on your goals, your clinical situation, and your response to initial sessions.
Can I take oral NAD+ precursors like NMN or NR instead?
Oral NAD+ precursors — including nicotinamide mononucleotide (NMN) and nicotinamide riboside (NR) — are available as supplements and have their own evidence base for modestly increasing NAD+ levels over time. The IV route produces a more significant and immediate increase in NAD+ availability. Whether oral supplementation, IV therapy, or a combination is appropriate for your situation is something to discuss with your provider based on your goals and clinical context.
Are there side effects of NAD+ IV therapy?
The most common side effects are transient and infusion-rate-related — flushing, nausea, mild chest tightness, or headache that typically resolve within minutes of reducing the infusion rate. Our clinical team monitors every patient throughout the infusion and adjusts as needed. Serious adverse events are rare. Results vary by individual, and we discuss individual risk factors and contraindications before initiating treatment.
Can I combine NAD+ therapy with IV ketamine treatment at Awakenings?
Yes — many patients at Awakenings receive both IV ketamine and NAD+ therapy as part of a comprehensive integrative protocol. The combination is planned with Dr. James and our clinical team to ensure timing and sequencing are appropriate for your goals and clinical situation. All treatment plans at Awakenings are individualized.
Key Takeaways
- NAD+ is a coenzyme central to cellular energy metabolism, DNA repair, and aging that declines significantly with age, stress, and chronic illness.
- IV NAD+ therapy delivers the molecule directly into the bloodstream, bypassing the limited bioavailability of oral precursors and supporting cellular systems including mitochondrial function and sirtuin-mediated repair.
- At Awakenings in Toledo, NAD+ therapy is offered as part of a holistic integrative wellness protocol that may include IV vitamin infusions, ketamine therapy, and integration coaching.
- Patients who may benefit include those with significant fatigue, cognitive symptoms, chronic pain, mood disorders, or those in recovery from substance use.
- Results vary by individual; NAD+ therapy is not FDA-approved for specific disease treatment and is best approached as one component of a comprehensive, clinician-supervised wellness or treatment plan.
If you are dealing with persistent fatigue, cognitive fog, or the cellular wear of chronic illness or recovery and are looking for a holistic approach in the Toledo area, NAD+ therapy at Awakenings may be worth exploring. Schedule a consultation with Dr. James and our team to find out whether NAD+ therapy belongs in your care plan.
About Dr. William James, MD
Dr. William James, MD, leads Awakenings by Northwest Ohio Ketamine in Toledo, OH, bringing a clinical background spanning anesthesiology and pain management to the treatment of chronic pain and mood disorders. The clinical team also includes Dr. Nadeem Moghal, who completed a fellowship at the Cleveland Clinic Foundation Pain Management Center, and Ben Wagner, PMHNP-BC, a board-certified Psychiatric Mental Health Nurse Practitioner — a multidisciplinary composition specifically designed to hold the pain, mood, cognitive, and functional dimensions of each patient’s condition in view simultaneously. Together, they approach chronic pain as a whole-person condition, integrating anesthesiology expertise with behavioral health in a way that most single-specialty practices cannot.
References
Gomes, A. P., et al. (2013). Declining NAD+ induces a pseudohypoxic state disrupting nuclear-mitochondrial communication during aging. Cell. https://www.cell.com/cell/fulltext/S0092-8674(13)01521-3
Conze, D., et al. (2019). Safety and metabolism of long-term administration of NIAGEN (nicotinamide riboside chloride) in a randomized, double-blind, placebo-controlled clinical trial of healthy overweight adults. Scientific Reports. https://www.nature.com/articles/s41598-019-46120-z
National Institutes of Health, National Institute on Aging. NAD+ and the Biology of Aging. https://www.nia.nih.gov/
Medical Disclaimer
The information in this blog post is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. IV NAD+ therapy is not FDA-approved for the treatment of any specific disease. NAD+ infusions should only be administered under the supervision of a licensed and qualified medical provider. Individual results vary. Please discuss your clinical situation, goals, and all potential risks with your provider before initiating any infusion therapy. If you are experiencing a medical emergency, please call 911 or go to your nearest emergency room.