Interventional Treatment of Post-Traumatic Stress Disorder (PTSD)


Post-Traumatic Stress Disorder (PTSD) is a chronic anxiety disorder caused by experiencing life-threatening trauma. It leads to symptoms such as heightened arousal, increased vigilance, re-experiencing, and avoidance of memories related to the traumatic event.
PTSD symptoms may include:
- Anxious thoughts, feelings, or dreams related to traumatic events;
- Psychological or physical distress;
- Attempts to avoid trauma-related memories;
- Changes in thinking and emotions;
- An increased “fight or flight” response.
PTSD can cause clinically significant distress, functional disorders, and even lead to suicide.
Prevalence of PTSD Among Military Personnel
This disorder is very common among military personnel returning from combat. Studies on service members who returned from Iraq and Afghanistan estimated PTSD prevalence at up to 21.8%. Among those who participated in the Vietnam War, this figure reached 17%.
Given the ongoing combat in Ukraine, bombings by Russian aggressors targeting civilian cities, and mass migration due to life-threatening circumstances, PTSD could become a reality for hundreds of thousands, or even millions, of Ukrainians.
Treatment Methods for PTSD
The modern standards for PTSD treatment include pharmacological therapy, psychotherapy, or a combination of both. While many pharmacological methods are considered evidence-based, their effectiveness remains inconsistent. Antidepressants, such as monoamine oxidase inhibitors and selective serotonin reuptake inhibitors, may have undesirable side effects.
Although psychotherapy is effective, it requires a long-term commitment, and the stigma surrounding psychiatric care complicates seeking treatment, especially among military personnel.
One of the minimally invasive methods that has shown promising results in alleviating PTSD symptoms is the stellate ganglion block (SGB).
This procedure involves injecting a local anesthetic under fluoroscopic or ultrasound guidance into the stellate ganglion, a part of the autonomic nervous system located between the C6 and C7 vertebrae. The procedure is usually performed twice, with an interval of several weeks, predominantly on the right side.
There is a significant amount of scientific literature confirming the effectiveness of this procedure. A major contribution to the research on this method has been made at Johns Hopkins Hospital (Baltimore, USA). A specialist from this institution, Oleg Turkot, shared his experience with SGB and other interventions during a visit to the SPRAVNO Pain Medicine Center.
Mechanism of Action of Stellate Ganglion Block
The effect of SGB in PTSD is explained by modulation of sympathetic nervous system activity. There are three main scientific explanations:
- Connections with the Amygdala
The stellate ganglion has extensive connections with the amygdala, a brain region whose activation is associated with PTSD. - Regulation of Nerve Growth Factor (NGF)
Through the stellate ganglion, nerve growth factor (NGF) reaches the brain, stimulating neuronal connections. This increases norepinephrine levels, detected in the urine and cerebrospinal fluid of PTSD patients. SGB helps reduce NGF production, which suppresses norepinephrine activity and disrupts pathological molecular cascades. - Reduction of Brain Electrical Activity
SGB reduces brain electrical activity (as seen in electroencephalography, EEG), which is also linked to decreased norepinephrine levels.
Source: Facebook Vadym Biloshytsky