PTSD affects millions of adults in the United States each year and can interfere with work, relationships, sleep, and everyday life. The Stellate Ganglion Block—a carefully placed nerve block in the neck—has moved from pain management into mental health research, drawing attention from military medicine and civilian clinics alike. At OC Ketamine Therapy in Newport Beach, we offer SGB as one of several interventional approaches for patients whose trauma symptoms have not responded to conventional care. (National Institute of Mental Health [NIMH], n.d.)
Understanding PTSD and the Stress Response
Post-traumatic stress disorder is not simply a psychological wound. PTSD can involve persistent changes in threat response, arousal, sleep, mood, and daily functioning after trauma. Everyday triggers—a sound, a smell, or an unexpected touch—can push the body into an alarm state that feels completely out of proportion to the present moment. Understanding why PTSD can be resistant to treatment requires recognizing that persistent symptoms may involve both psychological and physiological responses to threat. (NIMH, n.d.; U.S. Department of Veterans Affairs & Department of Defense [VA/DoD], 2023)
How Stellate Ganglion Block Works
The Stellate Ganglion Block targets the stellate ganglion, a bundle of sympathetic nerve fibers located in the lower neck. Using imaging guidance, our physician injects a local anesthetic near this ganglion to temporarily interrupt sympathetic nerve signaling.
For PTSD, SGB is thought to potentially reduce some of the chronic hyperarousal associated with symptoms such as hypervigilance, exaggerated startle response, poor sleep, and emotional reactivity. It is best understood as an emerging intervention rather than a proven reset for the nervous system. (Veterans Health Administration, n.d.)
What the Research Supports
We want to be transparent about where SGB stands scientifically. It is not an FDA-approved treatment for PTSD; its use for this indication is off-label and supported by emerging clinical evidence.
One of the most notable studies was a multisite, blinded, sham-controlled randomized clinical trial involving active-duty service members. Participants who received two SGB procedures two weeks apart had greater reductions in PTSD symptom severity over eight weeks than those who received sham procedures. The study’s authors emphasized that its short follow-up period and participant population limit how broadly the findings can be applied, and that further study is needed. (Rae Olmsted et al., 2020)
We find this evidence compelling enough to offer SGB as part of our integrative approach, while remaining clear that results vary by individual and that SGB is not established as a first-line PTSD treatment. It may be most appropriate as an adjunct to evidence-based PTSD care, including trauma-focused psychotherapy when appropriate. (Veterans Health Administration, n.d.; VA/DoD, 2023)
What to Expect During the Procedure
The procedure itself is relatively brief. We perform it with imaging guidance to support precise needle placement and protect surrounding structures in the neck. Most patients receive the injection and return home the same day.
Some patients notice changes within hours; for others, changes emerge over days or weeks. Temporary warmth, eyelid drooping, or nasal congestion on the treated side can occur and typically resolve as the local anesthetic wears off. Although serious complications are possible with SGB, careful screening and image-guided technique are important parts of procedural safety. (Veterans Health Administration, n.d.)
Who Might Be a Candidate for SGB?
At OC Ketamine Therapy, we consider this procedure for patients with PTSD who have not responded adequately to psychotherapy or medication, as well as patients who are already working with a therapist but remain so symptomatic that trauma-focused work feels inaccessible.
For some individuals, reducing the intensity of chronic hyperarousal may create more space to engage in therapy. However, SGB is not a replacement for trauma-focused treatment or other evidence-based PTSD care. We review your history, prior treatments, goals, and medical considerations during our consultation process before making any recommendation.
Safety, Cost, and Treatment Planning
Two barriers often arise when patients first learn about SGB. The first is uncertainty about safety. Because the injection is placed near important structures in the neck, patients understandably want to know the risks. We review the procedure, likely temporary effects, and relevant medical considerations carefully before proceeding.
The second barrier is cost. OC Ketamine Therapy is a self-pay practice and does not accept insurance. Our team can walk you through financing options, including CareCredit, before you commit to a treatment plan.
Combining SGB With Other Care
SGB may be sequenced with other treatments we offer, including ketamine infusions and ExoMind TMS sessions, when appropriate for an individual patient.
These interventions act through different mechanisms, but there is no universal combination protocol for PTSD. We are not a single-treatment clinic, and we determine whether any combination makes sense based on each person’s neurobiology, history, current symptoms, and treatment goals.
We understand that pursuing any new procedure requires courage, especially for patients whose trauma history makes vulnerability feel risky. Our process starts with a thorough consultation with Dr. Seif, during which she reviews your history, prior treatments, and goals. She will explain the current evidence base honestly, describe what the procedure involves in plain language, and make a recommendation based on your individual picture rather than a one-size-fits-all protocol.
Results vary by individual, and SGB does not work for everyone. Some patients experience substantial relief; others notice modest improvements; and some find minimal benefit. We believe it is our responsibility to present the evidence clearly and support you regardless of your response. Discuss with your provider whether this treatment is appropriate for you, particularly if you have neck conditions, bleeding disorders, or take blood thinners.
Frequently Asked Questions
What is a Stellate Ganglion Block, and how is it different from a typical nerve block?
A Stellate Ganglion Block targets a specific cluster of sympathetic nerve fibers in the neck called the stellate ganglion. SGB has long been used in pain medicine. In PTSD care, it is being studied as a possible way to reduce persistent sympathetic nervous system activation rather than as a treatment that blocks sensation. (Veterans Health Administration, n.d.)
Is SGB FDA-approved for PTSD?
No. SGB is not an FDA-approved treatment for PTSD. It is performed off-label for this indication and has been studied in military and civilian populations. We discuss the current evidence and its limitations during consultation. (Rae Olmsted et al., 2020; Veterans Health Administration, n.d.)
How many SGB injections are needed to see results for PTSD?
Protocols vary by provider and individual response. The major randomized trial used two procedures two weeks apart, while some patients may receive one procedure or a series depending on their history and response. We tailor the approach during your consultation. (Rae Olmsted et al., 2020)
Can I combine SGB with ketamine therapy or TMS?
Potentially. We may consider sequencing SGB with ketamine or ExoMind TMS as part of an individualized plan. Each recommendation depends on your history, current symptoms, goals, and medical considerations.
How long do the effects of SGB last for PTSD?
The key randomized study assessed symptoms through eight weeks. Some patients report earlier or more gradual changes, but duration varies by individual and longer-term research is still needed. (Rae Olmsted et al., 2020; Veterans Health Administration, n.d.)
Key Takeaways
- SGB is a procedure that targets sympathetic nerve fibers in the neck and may reduce persistent hyperarousal associated with PTSD.
- SGB is not FDA-approved for PTSD and is performed off-label for this indication.
- A randomized clinical trial in active-duty service members found greater PTSD symptom reduction with two SGB procedures than with sham procedures over eight weeks. (Rae Olmsted et al., 2020)
- At OC Ketamine Therapy in Newport Beach, SGB is performed with imaging guidance and considered only after a thorough consultation.
- SGB may be included in a broader treatment plan, but it does not replace trauma-focused psychotherapy or other evidence-based PTSD care.
- Results vary by individual, and additional research is needed to clarify long-term outcomes.
Conclusion
PTSD is one of the most complex and misunderstood conditions we treat, and we recognize that patients considering SGB have often already endured years of treatments that did not provide adequate relief. The evidence supporting this procedure is still emerging, and we are committed to offering it in a setting that prioritizes safety, honest communication, and individualized care.
If you are ready to learn more, we invite you to schedule a consultation. Dr. Seif and our team are here to walk through the science, answer your questions, and help you decide whether SGB belongs in your treatment plan.
About Dr. Dina Seif
Dina Seif, MD, believes that with the right mindset and support, every one of us has the potential to transform and heal our minds. She specializes in creating a personalized plan for each patient and is committed to providing a supportive healing environment for your journey. Dr. Seif is a member of the American Society of Ketamine Physicians and was recognized as a Physician of Excellence by the Orange County Medical Association. Dr. Seif has 15+ years of experience with ketamine in the emergency setting and founded one of the first ketamine practices in Orange County in 2019. She has administered thousands of infusions and cared for hundreds of patients from around the world. Dr. Seif is board-certified in Emergency Medicine and is a graduate of the University of California, Irvine, where she attended college, medical school, and business school. After an internship in Internal Medicine at St. Vincent’s Medical Center in New York, she returned to California for Emergency Medicine residency at LAC+USC Medical Center where she also completed a fellowship in Emergency Ultrasound and was a Professor of Clinical Emergency Medicine at Keck School of Medicine of USC for 5 years.
References
National Institute of Mental Health. (n.d.). Post-traumatic stress disorder. National Institutes of Health.
Rae Olmsted, K. L., Bartoszek, M., Mulvaney, S., et al. (2020). Effect of stellate ganglion block treatment on posttraumatic stress disorder symptoms: A randomized clinical trial. JAMA Psychiatry, 77(2), 130–138. DOI: 10.1001/jamapsychiatry.2019.3474
U.S. Department of Veterans Affairs & Department of Defense. (2023). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder.
Veterans Health Administration. (n.d.). Stellate ganglion block treatment for PTSD at VA.
Medical Disclaimer
The information provided in this blog is for educational purposes only and does not constitute medical advice. Treatment outcomes vary by individual. Results may vary. Please consult with a qualified healthcare provider before beginning any new treatment. Discuss with your provider whether this treatment is appropriate for you.