Stellate Ganglion Block (SGB) for PTSD, Anxiety & Depression
An ultrasound-guided procedure offered as an adjunct to your existing mental health care — never as a replacement for it. Riverside & Menifee, CA.
Serving Riverside, Moreno Valley, Corona, Jurupa Valley, Grand Terrace, Colton, Redlands, Loma Linda, Rialto & Eastvale across the Inland Empire.
Begin With a Referral & Consultation
We offer SGB for PTSD, anxiety, or depression only as an adjunct to care you're already receiving from a mental health professional — we are never your primary mental health treatment provider. The $95 consultation fee is credited toward treatment if you proceed.
Book Your $95 Consultation
No separate referral form or fax needed — just book and pay for your consultation. We'll confirm your current or referring mental health provider as part of your assessment.
Records & History Review
We review your relevant medical and psychiatric history ahead of your visit.
Candidacy & Safety Screening
Screening for contraindications, current stability, and coordination with your mental health provider.
Informed Consent & Scheduling
Full discussion of the investigational, off-label nature of this procedure before anything is scheduled.
Most consultations take 45–60 minutes. Your $95 fee is credited toward your treatment cost if you proceed — it is never lost. We give you an honest assessment, including telling you clearly if SGB is not right for your situation.
How SGB May Help
SGB targets the sympathetic ("fight-or-flight") nervous system. Researchers are still working out exactly why it appears to ease certain PTSD and anxiety symptoms — we think that honesty matters more than a tidy explanation.
Sympathetic "Fight-or-Flight" Reset
Temporarily quiets the stellate ganglion's sympathetic signaling, which may be chronically overactive in PTSD and anxiety.
Amygdala Connection (Theorized)
The stellate ganglion has neural links theorized to influence the amygdala and other fear/threat-processing structures.
Hyperarousal & Reactivity Relief
Research suggests the biggest benefit is in hypervigilance, startle response, sleep disruption, and physical trauma-cue reactivity. (2)
Vagus Nerve Pathway (Alternate Hypothesis)
Some researchers propose an indirect effect mediated through the vagus nerve rather than the amygdala directly. (3)
Mechanism Not Fully Elucidated
Researchers are candid that the exact mechanism is still under investigation — this is an active area of study, not settled science.
Adjunct to Trauma-Focused Therapy
A combination trial found SGB before cognitive processing therapy accelerated improvement, and helped patients with an incomplete CPT response. (7)
What the Research Shows
We believe patients and referring providers deserve a transparent look at the evidence — including where it's strong, where it's mixed, and where it's still preliminary. Numbers refer to the source list at the bottom of this page.
A 2020 sham-controlled RCT in JAMA Psychiatry (113 active-duty service members) found significantly greater CAPS-5 improvement with SGB than sham at 8 weeks (−12.6 vs. −6.1 points, p=.01). (1) An earlier, smaller 2016 trial did not find a significant benefit. (4,5) National evidence reviews (VA/DoD, AHRQ, DoD PHCoE) currently call the evidence insufficient for a formal recommendation and note this is an off-label use. (4,5)
A 285-patient case series found meaningful GAD-7 improvement in 79.6% of patients at 1 week and 75.5% at 1 month. (8) A separate 114-patient retrospective review found 86.8% improved at 3 months (~52% average reduction). (9) Both are uncontrolled, open-label studies — a lower tier of evidence than a blinded RCT.
Evidence specific to depression is limited to secondary outcomes within PTSD trials. (1) We're not aware of a dedicated randomized trial with depression as the primary target — we consider this the most investigational of the three indications.
The Bottom Line
The research on SGB for PTSD, anxiety, and depression is encouraging but still developing. The largest, most rigorous trial to date showed a statistically significant PTSD benefit; an earlier, smaller trial did not. National evidence bodies currently describe the evidence as insufficient for a formal treatment recommendation and classify this use as investigational and off-label. We share this in full so you and your mental health provider can make a fully informed decision together — SGB is not an established, first-line, or guaranteed treatment for any mental health condition.
We offer SGB for PTSD, anxiety, and depression only as an adjunct to care directed by your own mental health specialist — you must be referred by your psychiatrist, therapist, or other mental health provider, or already established in ongoing mental health treatment. We are not your primary mental health treatment provider; we administer the procedure and coordinate with your existing specialist so SGB complements the care you're already receiving. There's no separate referral paperwork to submit — simply book your $95 consultation, and we'll confirm this as part of your assessment.
If you are experiencing a mental health emergency or thoughts of self-harm, call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room. This clinic does not provide emergency or crisis services.
Safety Profile & Side Effects
Serious complications are uncommon when SGB is performed under ultrasound guidance by an experienced provider, but they cannot be completely eliminated.
Common & Usually Self-Limited
Temporary drooping eyelid & facial flushing (Horner's syndrome), voice hoarseness, injection-site soreness or bruising, warmth/tingling in the arm, transient heart-rate or blood-pressure changes.
Uncommon but Serious
Intravascular injection (seizure risk), pneumothorax, hematoma, recurrent laryngeal nerve injury, phrenic nerve involvement, esophageal/tracheal puncture, infection, epidural spread, allergic reaction. (10)
Why Ultrasound Guidance & Our Experience Matter
Real-time ultrasound lets us directly visualize the carotid artery, jugular vein, vertebral artery, thyroid, esophagus, and longus colli muscle before and during the injection — helping reduce (though not eliminate) the risk of inadvertent vascular puncture or injection into a nearby structure. We've performed ultrasound-guided cervical sympathetic blocks for pain management for many years; that procedural experience is what we bring to this adjunct service.
Patient Safety: Contraindications
SGB is not appropriate for everyone. "Absolute" means we do not offer the procedure; "Relative" means it may be possible with appropriate clearance and coordination.
| Condition | Classification | Clinical Rationale |
|---|---|---|
| Allergy to amide local anesthetics | Absolute | Ropivacaine, bupivacaine, and lidocaine are amide anesthetics. |
| Recent myocardial infarction / cardiac conduction abnormality | Absolute | Unacceptable cardiovascular risk. |
| Glaucoma | Absolute | Risk of intraocular pressure changes. |
| Pregnancy | Absolute | Insufficient safety data. |
| Local or systemic infection near injection site | Absolute | Risk of introducing infection. |
| Active or unstable psychiatric crisis (active suicidal ideation with plan, acute psychosis, acute mania) | Absolute | Must be stabilized by your mental health team before an elective adjunct procedure. |
| Not currently referred by / established with a mental health professional | Absolute | We require active mental health treatment coordination. |
| Anticoagulant / antiplatelet therapy or bleeding disorder | Relative | Individualized risk assessment, often with prescribing physician. |
| Severe COPD/emphysema or contralateral phrenic nerve palsy | Relative | Risk of compromising breathing on both sides. |
| Contralateral vocal cord paralysis / recurrent laryngeal nerve palsy | Relative | Risk of compromising the airway on both sides. |
Some criteria reflect our own practice's safety policy for this elective adjunct use rather than a published guideline. Your candidacy is always individually assessed.
What to Expect
We work to make every step safe, transparent, and coordinated with your mental health provider.
Before Your Procedure
Consultation to confirm candidacy, review history, discuss the investigational/off-label status, and obtain informed consent.
During the Procedure
Ultrasound identifies the C6 level; local anesthetic (commonly ropivacaine 0.5%) is injected under direct visualization. About 15–20 minutes. (8,10)
Immediately Afterward
Monitored recovery. A drooping eyelid, facial warmth, or mild hoarseness are expected signs the block reached the area — usually resolve within hours.
Follow-Up & Series
Published protocols commonly use two injections about two weeks apart. (1) Your plan is individualized with you and your provider.
When Will I Notice Effects?
Varies by individual. Some research shows benefit sustained 1–3 months; long-term durability is still being studied.
Coordination With Your Provider
You continue your psychotherapy and/or psychiatric care throughout — SGB complements, never replaces, that care.
Transparent Pricing
SGB for PTSD, anxiety, or depression is considered investigational and off-label, so it is not covered by insurance, Medicare, or Medicaid — self-pay only.
Single Injection
- Physician-administered, ultrasound-guided
- Continuous monitoring
- Recovery period included
- Post-procedure physician check
Two-Injection Series
- All single-injection inclusions ×2
- Consultation to plan your series
- Mid-series check-in
- Coordination with your mental health provider
A $95 consultation is required before treatment and is credited toward your cost if you proceed. This procedure is an off-label, investigational use of an FDA-approved local anesthetic — it is not billed to insurance and no reimbursement is sought for this indication.
Our Locations
Two Inland Empire locations serving Riverside, Menifee, and the surrounding communities.
Riverside
Riverside, CA 92506
Frequently Asked Questions
Common questions about SGB for mental health at our practice.
Is SGB a cure for PTSD, anxiety, or depression?
Will this replace my therapy or medication?
Is SGB FDA-approved for mental health conditions?
Does insurance cover this procedure?
How many injections will I need?
Do I need a referral?
Related Care at UPC
SGB is one option among several physician-administered, adjunct treatments we offer alongside your existing mental health care team.
IV Ketamine Infusion Therapy
Physician-administered ketamine infusions for treatment-resistant depression and chronic pain, offered at our Riverside & Menifee locations.
Questions Before You Book?
Contact our office directly, or explore our full range of regenerative medicine and pain management treatments.
Ready to Talk to Your Care Team About SGB?
Schedule a $95 consultation (credited toward treatment), or ask your mental health provider to reach out to coordinate care. We'll walk you through candidacy, risks, benefits, and the investigational nature of this procedure together.
- Rae Olmsted KL, et al. Effect of Stellate Ganglion Block Treatment on PTSD Symptoms: A Randomized Clinical Trial. JAMA Psychiatry. 2020;77(2):130–138. PMID 31693083.
- Differential PTSD symptom cluster response to stellate ganglion block: secondary analysis of a randomized controlled trial. Translational Psychiatry. 2024.
- Central effects of stellate ganglion block mediated by the vagus nerve? An alternate hypothesis for treating PTSD; see also CADTH, Stellate Ganglion Block for PTSD, Depression, and Anxiety: A Review of Clinical Effectiveness (2019).
- Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of PTSD. Evidence Synthesis Program, Dept. of Veterans Affairs.
- Evidence Brief: Stellate Ganglion Block for PTSD. Psychological Health Center of Excellence, U.S. Dept. of Defense, 2021.
- Stellate ganglion blockade for the treatment of PTSD: A systematic review and meta-analysis. Autonomic Neuroscience: Basic and Clinical. 2025. PMID 41151498.
- Effectiveness of Combined Cognitive Processing Therapy with Stellate Ganglion Block: An Open-Label Randomized Wait-List Clinical Trial. Psychotherapy and Psychosomatics.
- Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients. Journal of Personalized Medicine. 2023;13(6):958.
- Three-Month Durability of Bilateral Two-Level Stellate Ganglion Blocks in Patients with Generalized Anxiety Disorder: A Retrospective Analysis. Brain Sciences. 2025;15(2):188.
- Stellate Ganglion Blocks. StatPearls [Internet], NCBI Bookshelf.
6900 Brockton Avenue, Suite 203
Riverside, CA 92506
951-900-3253
Mon–Fri, 8:30 AM – 4:00 PM
