Stellate Ganglion Block Case Studies
Case Study: Dysautonomia, Panic Attacks, and Ketamine Therapy
Profile: Male, Mid-20s, Scottsdale
Treating Physician: Dr. James Leathem, DO
The Challenge
In 2022, he had COVID-like symptoms along with high stress at work and was in a difficult romantic relationship. He started experiencing severe panic attacks, where he felt so short of breath that he thought he couldn’t breathe. For about 6 months, these panic attacks were debilitating. Every evening he’d feel severe shortness of breath. His Whoop showed increased resting heart rate, decreased HRV, poor sleep with 10 or more wake events. He also had brain fog with some loss of sense of smell, and GI issues including IBS and bloating. He continued to experience bodily symptoms of anxiety but not the severe shortness of breath by the time he came to us. He had tried psilocybin and LSD before, mostly good psychedelic experiences, but had one bad psychedelic experience that made him nervous to try psychedelics again.
Initial Emotional State
He presented in an obvious autonomic dysregulated state. His anxiety was palpable, his mental health survey scores were very high, he fidgeted during the initial consultation and had poor eye contact. He was anxious and most worried about the ketamine infusion therapy since he had a prior bad trip with LSD and experienced demonic activity in that experience, which made him fearful to go into the psychedelic headspace again. He was optimistic about the SGB because the AI had suggested it and it was not going to involve a psychedelic medicine experience. The SGB was somewhat passive compared to the ketamine infusions being a more active participation process.
What He Had Tried Before
He had been trialing medications such as SSRIs and talk therapy on and off with a psychiatrist. He had tried a variety of methods including IFS, EMDR, and somatic experiencing. Nothing he had tried thus far led to any sustained healing. The SSRIs caused side effects like sexual dysfunction, a flattened affect, and sleep issues. Talk therapy only helped partially but it did help give him some further insight into himself. He had reached a wall. He went to AI and put his list of symptoms into ChatGPT, and the AI suggested stellate ganglion blocks as well as ketamine therapy as alternative approaches. He hadn’t thought of these as options until then, so he looked into what clinics were near him and our clinic came up.
Clinical Assessment
We administered mental health surveys including the GAD-7, PCL-5, PHQ-9, ACE, SSRS, and Pain, as well as conducted a medical history and psychiatric evaluation. His scores were:
- GAD-7: 21
- PCL-5: 57
- PHQ-9: 22
When he presented to our clinic he had diagnoses of anxiety, migraines, insomnia, irritable bowel syndrome, stomach ulcer, allergic rhinitis, chronic fatigue syndrome, and sexual dysfunction. We added the diagnosis of dysautonomia after his initial consultation. His prior bad trip was a relative risk factor when considering ketamine infusion therapy. However, given the medical nature versus recreational nature and titrateability of the ketamine, it was safe to proceed and did not affect treatment planning.
Why Ketamine Was Considered
Ketamine infusion therapy was appropriate to help with his depression and PTSD. However, it was more appropriate to start with bilateral SGBs to help calm his autonomic nervous system and decrease some of his anxiety symptoms so that he would do better in the ketamine infusion therapy. Success looked like this: GAD-7 from 21 down to 4, PCL-5 from 57 down to 19, PHQ-9 from 22 down to 8, along with subjective improvement and better HRV, resting heart rate, and sleep metrics on his Whoop.
Treatment Plan
The entire treatment course was just under 3 weeks. Started with two SGBs, the Dual Sympathetic Reset, right side on a Monday, then left side on Wednesday. Then started ketamine on Friday of that week, and the following week Monday, Wednesday, Friday, and the following week Monday and Wednesday. He also did 5 sessions of psychedelic integration coaching, 3 hours total, on the days after infusions 1, 2, 4, and 6. He also had an outside therapist that he still worked with on a biweekly basis. He still lived with his parents and they were very supportive during this time.
Response to Treatment
He responded exceptionally well and rapidly. We saw meaningful change after the two SGBs. Since he saw his resting heart rate improve as well as his sleep, he was more engaged and motivated by the process. By the end of the ketamine infusion series his survey scores had a drastic improvement and he felt like he had conquered and reprocessed the bad trip that he had been living with after his last psychedelic experience.
Side Effects, Setbacks, and Plan Adjustments
His first ketamine session was challenging. In a rare instance, he actually did not feel relaxed from the small amount of propofol given to anxious patients. Instead it made him feel out of control, so we did not use propofol on all other infusions and he did great. He also had an overactive bladder, and once we were able to get that under control with a larger dose of desmopressin, he had no other issues in the treatment program.
Outcome
His Whoop was showing improvements in several metrics including HRV, resting heart rate, REM, deep sleep, and sleep latency. His score changes were:
- GAD-7: 21 down to 4
- PCL-5: 57 down to 19
- PHQ-9: 22 down to 8
In his own words: “Words cannot describe what this has done for me, a tremendous transformation in my life. The blocks and the ketamine are only a fraction of the experience, but the friendships, the care, and the support I received from everyone there was absolutely phenomenal. I would recommend this place to anyone looking to reclaim the joy in their life.”
Closing Note
His history of a bad trip with demonic activity made him apprehensive at first, but in time we gained his trust and helped him shift into a much more regulated state, with a renewed perspective on psychedelic medicines when administered in a comprehensive program in a therapeutic way versus a recreational way. After the SGBs there was one positive fork in the road, and after the 6th ketamine infusion there was another. The combination of both really helped him.
Case Study: Complex PTSD, Anxiety, and Ketamine Therapy
Profile: Female, 49, Anthem, AZ
Treating Physician: Dr. Gregory Wong, MD
The Challenge
She was dealing with symptoms of insomnia, migraines, digestive issues, and a general inability to focus. She felt edgy, had trouble relaxing, was irritable, and afraid. She was carrying lots of negative beliefs about self and people in general. She felt distant from people and had lost interest in life in general. She was diagnosed with complex PTSD, depression, and anxiety. She has significant childhood trauma including verbal, physical, and sexual abuse. She did not grow up feeling loved, and her parents were divorced. Two months prior to starting care, she had experienced the loss of a daughter.
Initial Emotional State
The patient was very anxious and hypervigilant. She was mildly flat in affect and solemn. She did engage in conversation but seemed appreciative of the care plan. She had no prior experience with ketamine or any other psychedelic substance.
What She Had Tried Before
She had been struggling for many years. She started CBT in adolescence from 13 to 18 years old. She had tried EMDR in 2011, when she was 35 years old. She restarted CBT 5 months prior to our first appointment. She had failed all regular care including EMDR, CBT, and medication including Wellbutrin and Hydroxyzine.
Clinical Assessment
The evaluation started with an in-person consultation and evaluation. She answered patient surveys including the GAD-7, PCL-5, PHQ-9, and ACE. Her scores were:
- GAD-7: 21
- PCL-5: 57
- PHQ-9: 22
With consultation, discovery, and evaluation of her surveys, it was determined that she had severe cPTSD, severe anxiety, and severe depression. It was also discovered that her nervous system was dysregulated and causing increased sympathetic responses.
Why Ketamine Was Considered
All three of her diagnoses led to the recommendation of ketamine with integration support care. The first goal was to calm her system down to get out of fight or flight mode, and then layer in ketamine to help with deeper emotional processing.
Treatment Plan
The treatment plan was to combine both ketamine and stellate ganglion block together to help initially calm her nervous system down and reset it. Ketamine was then initiated after we could help her control her physical stress response.
Response to Treatment
During the first week of treatment, she received two SGBs and a single ketamine treatment session. She was already feeling quite calm, with a significantly decreased sense of stress and anxiety. She had never felt this calm before as an adult. She was able to fully engage in the remainder of the care and coaching provided.
Side Effects, Setbacks, and Plan Adjustments
She had no difficulty, setbacks, or side effects which altered or extended her care.
Outcome
In three weeks, from July 30 through August 21, 2025, she had the following improvements:
- GAD-7: 21 down to 2
- PCL-5: 57 down to 8
- PHQ-9: 22 down to 4
She was able to restore to a highly functional life and return to work. She was able to maintain significant improvements but began to recede back into her prior patterns over the next six months. She is still not able to come for routine maintenance care at this time. The truth is that behavioral health requires maintenance care, and she needs long term care from a lifetime of trauma exposure.
Closing Note
This case was memorable because it was the first time we were able to treat anxiety before initiating ketamine treatments. We saw a profound decrease in her physical fight or flight response at the early stages of the ketamine protocol. In her own words: “I have not felt this calm in decades, or ever. This is life changing.”
Case Study: Childhood Trauma, Chronic Anxiety, and Ketamine Therapy
Profile: Male, 50, Scottsdale
Treating Physician: Dr. Deepak Sharma, MD
The Challenge
He described feeling chronically on edge, emotionally burdened, persistent anxiety, difficulty relaxing, poor sleep, unresolved childhood trauma. His mother died when he was a child and he didn’t know his father. He was raised by an aunt. He used to cope with alcohol and opioids when he was in his 20s but has overcome addiction. He still struggles with anxiety and depression. His symptoms also impacted sleep, emotional regulation, and relationships, particularly strain between him and his wife. Improving his mood, overall health, and reconnecting with his wife were important personal goals.
Initial Emotional State
Initially, he was very anxious and reported poor sleep the night before because he was thinking about the treatment. He was also excited and hopeful about starting, but his system appeared overwhelmed and hyperactivated. His biggest concern seemed to be whether he would finally be able to experience improvement and calm in a way that had felt unavailable to him for much trauma of his adult life.
What He Had Tried Before
Wellbutrin didn’t help so he stopped. Talk therapy helped partially. Group therapy through a recovery group helped partially. His friend from his recovery group had success with our program, and he saw a huge change in his friend, so he wanted that for himself.
Clinical Assessment
The patient was evaluated through clinical interview, review of psychosocial and medical history, symptom tracking across visits, and ongoing assessment of subjective and functional response during the treatment series. Screening surveys used: C-SSRS, GAD-7, PCL-5, PHQ-9, and ACE. All of them were clinically significant. Initial scores were:
- C-SSRS: 6
- GAD-7: 18
- PCL-5: 45
- PHQ-9: 18
- ACE: 4
Particular attention was paid to trauma history, anxiety severity, sleep disruption, chronic pain, autonomic symptoms, medication goals, and prior substance use history. A major clinical finding was that the patient repeatedly described experiencing a level of calm and peace he had rarely or never felt before, which appeared therapeutically meaningful given his lifelong trauma history.
Why Ketamine Was Considered
Ketamine was considered appropriate because the patient had chronic, entrenched symptoms related to trauma, depression, anxiety, and pain that had not been adequately resolved through prior treatment efforts. The goals were to reduce anxiety, improve nervous system regulation, support trauma processing, and help move him toward reducing medication burden.
Treatment Plan
We recommended six ketamine infusions and two SGB procedures. The treatment course was individualized as we went, with supportive coaching and integration emphasized throughout. Dosing was adjusted based on tolerance and therapeutic response, including bolus modifications and eventual dose reduction. After the initial series, he enrolled in a monthly membership plan for ongoing maintenance.
Response to Treatment
The patient responded well early, reporting after the first infusion that he already felt less anxious and lighter overall. As treatment progressed, he became more hopeful, less irritable, and increasingly able to describe profound calmness and relaxation, at times stating that he could not remember the last time he had felt that calm or content.
Side Effects, Setbacks, and Plan Adjustments
The main documented side effect was headache, which prompted the addition of Toradol. Infusion speed and bolus timing were modified when sessions felt too light. He also had emotional material emerge during sessions, including experiences related to his deceased mother, and later during booster work he was dealing with marital stress.
Outcome
He described feeling more relaxed after the stellate ganglion blocks, less burdened by the past, and waking up feeling better than he had in years. He was off all prescription medications for the first time in a long time and was planning meaningful travel with his wife to reconnect and restore their relationship.
Closing Note
“For most of my life I lived in anxiety and survival mode. Now I know what calm feels like, and I finally feel like I’m getting my life back.”
Case Study: Anxiety, Depression, and Ketamine Therapy
Profile: Male, 40s, Gilbert
Treating Physician: Dr. Deepak Sharma, MD
The Challenge
He presented with anxiety, depression, and cyclothymia. His wife had just recently told him she was filing for divorce. She had one foot out the door for the last 10 years and he tried his best to save the marriage. They have two boys age 10 and 12. His mom was verbally and physically abusive. It was mostly him and his older brother that got the brunt of the abuse. His younger siblings didn’t. Dad was always working so was never around much. He was in a bad car accident in August that required 4 plates to be placed at his eye socket. He has had numerous concussions as a kid. He served 4 years as a veteran, which was stressful at times.
Initial Emotional State
He was anxious and hopeless. He was more worried about the results of the divorce than the treatment. He was also worried that the treatment wouldn’t help, but he was desperate to try something as he was running out of options.
What He Had Tried Before
He had been seeing a therapist at the VA and was prescribed 4 different medications for mental health and 2 for chronic migraines: Lamotrigine, escitalopram, hydroxyzine, buspirone, nortriptyline, and Aimovig. The divorce was what prompted him to seek further help.
Clinical Assessment
The patient was evaluated through a comprehensive clinical interview, with attention to mood symptoms, trauma history, neurologic injury, chronic pain burden, psychosocial stressors, and functional impairment. Screening surveys used and scores:
- C-SSRS: 1
- GAD-7: 19
- PCL-5: 44
- PHQ-9: 19
- ACE: 3
Key findings included a long history of unresolved childhood trauma, physical and verbal abuse from his mother, absent father, significant current life stress related to divorce and family disruption, persistent anxiety and depressive symptoms, trauma-related distress, chronic pain, migraines, and a history of TBI and concussions that appeared to compound emotional dysregulation and nervous system overactivation.
Treatment Plan
A structured ketamine infusion series combined with stellate ganglion block treatment was recommended. He completed six infusions along with right and left SGB treatments over 3 weeks. He was encouraged to engage in integration work, review discharge materials, and build a home meditation practice. Dosing was modified because he was taking Lamotrigine. Toradol was added for headache management and NAD+ was trialed for fatigue.
Response to Treatment
The patient showed gradual but meaningful improvement, even though his sessions were not marked by dramatic psychological insights. Early on, he began describing moments of relaxation and calmness during infusions, and after his stellate ganglion blocks, he reported feeling more relaxed in his body. He also began describing more inner peace, quietness of mind, and a greater sense of calm.
Outcome
After treatment, he repeatedly described feeling more relaxed, calmer in his body, and quieter in his mind. His scores were noted to be much improved, though some PTSD-related symptoms still appeared to persist. Around the third week after his sixth infusion, he noticed a growing difficulty being away from his children. Booster treatment was used as a reset, and ongoing maintenance every 1 to 2 months was recommended.
Closing Note
This case was meaningful because the patient was carrying an unusually heavy emotional load all at once: longstanding trauma, depression, anxiety, chronic pain, poor sleep, a recent serious car accident, and the acute heartbreak of a divorce with painful custody concerns. One turning point was when he began to notice that the blocks and infusions were creating real physical relaxation and quietness in his mind. Before treatment, he felt trapped in anxiety, emotional spirals, and constant stress. After treatment, he began to feel more relaxed in his body, quieter in his mind, and better able to face what was happening.