Madrona Clinics believes Stellate Ganglion Blocks (SGB) as a promising, evidence-based treatment for anxiety, depression, PTSD, and related mood disorders. Bolstered by new clinical and preclinical findings, SGB has demonstrated significant symptom improvements, particularly in patients whose conditions are refractory to conventional approaches. Explore this off-label treatments and evidence supporting SGB. We plan on making this treatment available in the near future.
What is a SGB?
SGB involves injecting a local anesthetic around the stellate ganglion (a cervical sympathetic nerve cluster). This temporarily disrupts excessive sympathetic signaling the body’s fight-or-flight response, potentially “resetting” autonomic overactivity seen in anxiety and trauma-related disorders.
General Overview
Evidence Across Populations: Both civilian and military cohorts—spanning PTSD, anxiety, and chronic stress—have shown clinically significant improvements post-SGB.
Safety and Tolerability: SGB is generally well tolerated, with rare complications largely minimized by modern ultrasound guidance.
Rapid Acting: Many patients report improvement in anxiety, stress, or PTSD symptoms within days or weeks.
Sustained Effects: Clinical and case-series data indicate beneficial effects can persist for weeks to several months, offering a crucial therapeutic window.
Stand-Alone Treatment?
While SGB can yield rapid and measurable symptom relief, it is best viewed as one component of a multimodal plan. Augmenting SGB with psychotherapy, medication management, and lifestyle interventions can help ensure comprehensive, lasting improvements in overall mental well-being.
Dose & Frequency?
There’s no single, universal schedule for repeat Stellate Ganglion Block (SGB) injections; how frequently they’re done depends on factors such as symptom severity, how long each treatment’s benefits last, and whether the patient’s condition is improving under a broader treatment plan.
How does it work?
Sympathetic Reset
SGB involves injecting a local anesthetic around the stellate ganglion (a cervical sympathetic nerve cluster). This temporarily disrupts excessive sympathetic signaling the body’s fight-or-flight response, potentially “resetting” autonomic overactivity seen in anxiety and trauma-related disorders.
Neurochemical Modulation
- Reduced Norepinephrine (NE): Chronic stress elevates nerve growth factor (NGF), which fosters sympathetic sprouting and high NE levels. By blocking the stellate ganglion, SGB can decrease NGF and NE, reducing hyperarousal and anxiety (Kirkpatrick et al. 2023).
- HPA Axis Regulation: Chronic stress and depression are linked with overactivity of the HPA axis (increased CRF, ACTH, and cortisol). SGB may dampen this stress cascade, enabling the body to rebalance its stress response.
Neuroprotective/Anti-Apoptotic Effects
Rodent models show that SGB raises anti-apoptotic proteins (e.g., Bcl-2) and lowers pro-apoptotic proteins (e.g., Bax) in key brain regions, suggesting improved neuronal survival and potential resilience to stress-induced structural damage.
Facilitation of Psychotherapy
In many patients, the calming window after SGB can enhance engagement in psychotherapy, potentially accelerating progress in cognitive-behavioral therapy or exposure-based treatments for PTSD.