At a Glance : Discover the potential of the stellate ganglion block (SGB) at Seaside Ketamine, a treatment for PTSD and anxiety often overlooked. This innovative procedure targets the sympathetic nervous system, offering rapid relief from symptoms that traditional therapies can miss. With a simple injection, you could experience significant improvements in your mental health. Don’t let anxiety hold you back—schedule your free consultation today and see how SGB can aid your healing journey!
There’s a procedure we offer at Seaside Ketamine that patients almost never know to ask about — not because it’s obscure or experimental in the fringe sense, but because most mental health clinics simply don’t know it exists or don’t know how to do it. That procedure is the stellate ganglion block, or SGB.
I first came across SGB research a few years ago while reading through some military medicine literature on PTSD. What stopped me wasn’t the procedure itself — nerve blocks are standard territory for anesthesiologists — it was the mechanism. Because the stellate ganglion block doesn’t work the way any other psychiatric treatment works. And for a specific subset of patients, that difference is everything.
The stellate ganglion is a cluster of sympathetic nerve tissue located in your neck, just in front of your cervical vertebrae on the right side. It’s part of the sympathetic nervous system — the branch of the autonomic nervous system that governs fight-or-flight responses. Heart rate, blood pressure, sweating, pupil dilation — the stellate ganglion has a hand in all of it.
In people with PTSD and certain anxiety conditions, this part of the nervous system is chronically overactivated. The body is running its threat-response programming at too high a baseline — not because there’s an active threat, but because the nervous system learned to anticipate one and never fully learned to stand down.
A stellate ganglion block involves injecting a local anesthetic — similar to what a dentist uses — directly around this nerve cluster under ultrasound guidance. The nerve is temporarily quieted. And for many patients, that quieting produces something remarkable: a rapid, significant reduction in hyperarousal symptoms that no medication had touched.
The research on SGB for PTSD has been building since a landmark randomized controlled trial published in JAMA Psychiatry in 2020, led by researchers at the Naval Medical Center in San Diego. That study found that a single right-sided stellate ganglion block produced significant and durable reductions in PTSD symptom severity compared to placebo — with effects measurable at three months.
The proposed mechanism involves nerve growth factor (NGF) and the pruning of abnormal sympathetic nerve sprouting into the amygdala and limbic system that appears to occur in chronic PTSD. The SGB may interrupt this abnormal signaling pathway and allow the brain’s threat-response circuitry to recalibrate toward a more normal baseline.
For depression, the research is earlier but intriguing. Some studies show SGB produces changes in central nervous system activity beyond the immediate site of injection — potentially through vagal pathways and downstream effects on the prefrontal cortex. The evidence here is not yet at the level of PTSD, but for patients with treatment-resistant presentations and prominent autonomic dysregulation, it’s worth considering.
At Seaside Ketamine, we see SGB as a particularly powerful option for:
Veterans and first responders with PTSD — especially those with prominent hyperarousal symptoms (hypervigilance, startle response, sleep disruption, inability to feel calm in objectively safe situations). This is where the most robust evidence sits.
Patients with autonomic dysregulation — those whose anxiety or PTSD has a strong physical component: racing heart, sweating, feeling perpetually “wired,” difficulty downregulating.
Long COVID patients with autonomic symptoms — there’s emerging clinical interest in SGB for post-viral dysautonomia, including some POTS-like presentations seen in Long COVID.
Patients who haven’t responded adequately to ketamine, medication, or therapy alone — SGB works through a completely different mechanism than any of these, which means prior non-response doesn’t predict SGB non-response.
I want to be direct about this because the word “injection” combined with “neck” reasonably makes people nervous.
The procedure takes about 20 minutes. You lie on your back. Using ultrasound guidance — meaning I can see exactly what I’m doing in real time — a small amount of local anesthetic is injected to numb the skin first. The stellate ganglion injection itself involves a fine needle. Most patients describe pressure rather than significant pain.
Within a few minutes of the injection, many patients notice a warming sensation on the right side of their face and neck — that’s a sign called Horner’s syndrome, and it tells us the block is in the right place. It’s temporary and resolves within a few hours as the anesthetic wears off.
Most patients go home within 30 minutes. There is no sedation required.
For a meaningful subset of our patients, we use SGB and ketamine together — not simultaneously, but in sequence. Ketamine addresses the central neuroplasticity piece: resetting depressive and anxious patterns in the brain’s synaptic architecture. SGB addresses the peripheral autonomic piece: quieting the sympathetic overdrive that keeps the body in a chronic state of alarm.
In patients with PTSD especially, these two dimensions — the central and the peripheral — often both need attention. Addressing only one can leave the other maintaining the illness. The combination can be more powerful than either alone.
Most patients are surprised by how manageable it is. The injection is guided by ultrasound imaging, which means we can see exactly what we’re doing — this isn’t a blind procedure. There’s some pressure and mild discomfort at the injection site, and a brief warming sensation in the face and neck that tells us we’ve landed in the right location. It takes about 20 minutes total. Most people sit up afterward, have some water, and are ready to drive themselves home within half an hour.
They’re working at different levels of the nervous system. Ketamine works centrally — resetting patterns in the brain by acting on the glutamate and NMDA receptor system, promoting rapid neuroplasticity. The SGB works peripherally — it targets the sympathetic nerve cluster that governs fight-or-flight signaling in the body. In PTSD, both the central fear-response circuits and the peripheral sympathetic system are dysregulated. The SGB quiets the peripheral activation directly and durably. For many patients, the combination addresses both dimensions in a way that neither does alone.
The strongest evidence is in patients with PTSD — particularly those with hyperarousal-dominant presentations. Think: hypervigilance, startle response, inability to feel calm even when safe, chronic sympathetic overdrive. There’s also growing interest in SGB for certain anxiety presentations, Long COVID autonomic symptoms, and treatment-resistant depression with autonomic dysregulation. It’s not the right tool for every patient, and we assess candidacy during your intake evaluation before recommending it. If you’re curious whether it applies to your situation, that’s exactly what the free consultation is for.
