Stellate Ganglion Block for the Treatment of Post-Traumatic Stress Disorder, Depression, and Anxiety [Internet]

Excerpt

Post-traumatic stress disorder (PTSD) can develop after exposure to a traumatic event related to combat or any life-threatening experience. Common symptoms of PTSD may include recurring nightmares, loss of interest in activities, inability to feel pleasure, difficulty concentrating, and insomnia. Subsequently, PTSD is a debilitating condition that is linked to reduced quality of life, depression, and anxiety. According to a CAMH paper published in 2018, the lifetime prevalence rate of PTSD for Canadians in general is approximately 9%, whereas 29% of police officers surveyed from 2 Canadian police departments were in the diagnostic range for PTSD. Furthermore, according to a Veteran Affairs Canada article published in 2019, up to about 10% of war zone Veterans will exhibit PTSD.

Treatments for PTSD typically involve psychotherapy and/or pharmacotherapy. Various forms of psychotherapy may be used such as exposure-based therapy, cognitive behavioural therapy, and stress inoculation training. Pharmacological treatment options may include antidepressants (e.g., selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors), antipsychotic drugs, mood stabilizers, and/or other agents. However, success rates of PTSD treatments are generally variable, with remission rates that range from 30% to 40%. Thus, alternative therapies such as stellate ganglion block (SGB) are being evaluated for the treatment of PTSD.

As part of the sympathetic nervous system, the stellate ganglion is collection of nerves located between the sixth (C6) and seventh (C7) cervical vertebrae. SGB is an outpatient procedure involving clinicians injecting a local anesthetic (e.g., ropivacaine 0.5%) to the stellate ganglion, which inhibits nerve impulses to the head, neck, and upper extremities. Since the stellate ganglion is connected to the amygdala — a brain region postulated to be abnormally activated in PTSD — SGB has been evaluated as a treatment modality for PTSD. However, its mechanism of action in ameliorating PTSD symptoms is not entirely elucidated. Furthermore, SGB has also been assessed for the treatment of anxiety and depression.^,

The aim of this report is to summarize and critically appraise the relevant evidence regarding the clinical effectiveness and evidence-based guidelines regarding the use of SGB for the treatment of PTSD, depression, or anxiety. Another CADTH report focused on the clinical evidence and guidelines for the use of SGB for the treatment of acute or chronic pain in the head, neck, or upper extremities.