Stellate Ganglion Block for Treatment-Resistant Posttraumatic Stress Disorder

By: Derek Welch

Posttraumatic stress disorder (PTSD) is a complex mental health condition that can arise after experiencing or witnessing a life-threatening event such as a natural disaster, military combat, or violent assault. Epidemiological studies reveal that PTSD affects about 3.5% of adults in the U.S. annually, with women twice as likely to be affected as men¹. The lifetime prevalence varies from 1.3% to 12.2% worldwide². Factors contributing to PTSD include exposure to trauma, lack of social and familial support, individual susceptibility including genetic predisposition, prior history of mental health conditions, and the severity and duration of the traumatic event³.

Traditional treatments for PTSD typically include psychotherapy, cognitive-behavioral therapy (CBT), and medications like Selective Serotonin Reuptake Inhibitors (SSRIs). These approaches aim to reduce symptoms by helping the individual process the trauma, develop coping strategies, and restore a sense of control⁴. Eye Movement Desensitization and Reprocessing (EMDR) is a specialized form of therapy that utilizes bilateral stimulation to help process distressing memories⁵. Recently, ketamine, an NMDA receptor antagonist, has emerged as a potential therapy for PTSD, with early research showing promising results in rapidly reducing symptoms, though further studies are required to establish long-term efficacy⁶.

Stellate ganglion block (SGB) is a procedure where a local anesthetic is injected into a cluster of nerves located between the C6 and C7 vertebrae. This technique has been used for pain management for nearly a century and has recently been employed to treat posttraumatic stress disorder (PTSD). A significant reduction in Generalized Anxiety Disorder questionnaire (GAD-7) scores has been observed following SGB treatment, with 79.6% of patients demonstrating clinically meaningful improvement within a week⁷. SGB has been shown to reduce Clinician-Administered PTSD Scale for DSM-5 total symptom severity scores over 8 weeks compared with sham treatment⁸.

Moreover, SGB is recognized as a fast-acting treatment. The rapid effect of SGB, with symptomatic improvements observed within minutes to days post-procedure, is an attribute that distinguishes it from other treatments⁹. By presenting a biological approach to mental health, SGB may also contribute to destigmatizing mental health treatments⁹. Its nature, not requiring continuous daily or weekly administration, could further enhance patient adherence to the treatment protocol¹⁰.

However, there are risks and considerations that must be addressed. The exact means by which SGB alleviates PTSD symptoms is not fully understood¹¹. While promising, the information underscores the necessity for more substantial, well-powered, randomized, sham-controlled trials to fully understand the short-term efficacy, durability of effects, and safety of the treatment. SGB is also generally promoted as an adjunct therapy for those unresponsive to conventional treatments, emphasizing the necessity of patient-specific assessment and an individualized approach¹¹.

In conclusion, stellate ganglion block appears to be an encouraging approach for the treatment of PTSD, showing substantial benefits in reducing anxiety and PTSD symptoms. However, further research is required to elucidate the mechanism, evaluate the long-term efficacy, and fully understand potential risks. This promising treatment must be approached with careful consideration and individualized assessment.

References

1. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (2017). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.

2. Atwoli, L., Stein, D. J., Koenen, K. C., & McLaughlin, K. A. (2015). Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences. Current Opinion in Psychiatry, 28(4), 307-311.

3. Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748.

4. Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (Eds.). (2009). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies.

5. Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71.

6. Feder, A., Parides, M. K., Murrough, J. W., et al. (2014). Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry, 71(6), 681-688.

7. Lynch JH, Mulvaney SW, Bryan CJ, Hernandez D. Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients. J Pers Med. 2023;13(6):958. Published 2023 Jun 6. doi:10.3390/jpm13060958.

8. Rae Olmsted KL, Bartoszek M, Mulvaney S, et al. Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Psychiatry. 2020;77(2):130–138. doi:10.1001/jamapsychiatry.2019.3474.

9. Navaie M, Keefe MS, Hickey AH, McLay RN, Ritchie EC, Abdi S. Use of stellate ganglion block for refractory post-traumatic stress disorder: a review of published cases. Journal of Anesthesia & Clinical Research. 2014;2014.

10. Lipov E, Ritchie EC. A review of the use of stellate ganglion block in the treatment of PTSD. Current Psychiatry Reports. Aug 2015;17(8):599.

11. Lipov EG, Joshi JR, Sanders S, Slavin KV. A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Medical Hypotheses. Jun 2009;72(6):657-661.