DSR SGB and Ketamine Infusions on The Dr. Gabrielle Lyon Show
In a recent episode of The Dr. Gabrielle Lyon Show, Dr. John How discusses the changing landscape of mental healthcare, focusing on how Stella's Dual Sympathetic Reset (DSR), an advanced Stellate Ganglion Block (SGB), is helping people find relief from PTSD, anxiety, depression, and more.
Dr. Lyon asks Dr. How to dig into the specifics of this cutting-edge treatment and explain how it can fit into someone's healing journey. The pair also talks about how Ketamine Infusion Therapy can help people break through depression and when to consider using these modalities together.
Burnout led Dr. John How to DSR SGB
Dr. How is a board-certified emergency medicine physician. After a decade in emergency medicine, he could feel his job wearing on his body and mind. Interested in making a change, he started to look for other things to do. Dr. How regularly used the ultrasound machine to diagnose and guide treatment for various conditions in the emergency department. As he pursued his interest in ultrasound, he ultimately discovered his passion for regenerative medicine.
Dr. How describes broadly regenerative medicine as an ultrasound-guided procedure where you inject a product – from the body or elsewhere – into a joint, tendon, or ligament that's inflamed, irritated, or torn to trigger the body's response to fix it.
In his regenerative medicine training on the neck, Dr. How learned about the Stellate Ganglion Block (SGB) for PTSD. He says he felt "super skeptical that a shot in the neck could help PTSD significantly."
Around the same time, he realized that his burnout symptoms were closely aligned with the hyperarousal state associated with PTSD. Dr. How remembers feeling irritable, not sleeping well, having trouble focusing, and not being able to switch between tasks as quickly as he previously could – an essential skill in the emergency department. Dr. How figured he should try SGB for himself.
"I had [SGB] and holy smokes, it's the coolest trick in medicine. I knew I needed to be doing it on a regular basis." -Dr. John How
Dr. How opened his regenerative medicine clinic in 2020 and started to offer SGB. To learn more about how to help his patients achieve the best possible outcome, he reached out to Dr. Gene Lipov, the pioneer of the Dual Sympathetic Reset (DSR) protocol and Chief Medical Officer at Stella. Eventually, Dr. How joined Stella as a treating provider at Stella's Irvine and San Diego clinics.
The need for effective mental healthcare
According to the World Health Organization's 2023 report, approximately 280 million people in the world suffer from depression – that's almost 4% of the population. 30% of people experiencing depression have treatment-resistant depression, meaning they've failed multiple treatment modalities.
PTSD is also a pervasive mental health challenge. Half of all adults in the US will experience at least one trauma in their life. While most will not develop PTSD, 10% will. These rates are much higher among individuals with military experience and first responders.
Medication and talk therapy can be tremendously helpful for some. But these modalities often require some trial and error – like interviewing several therapists before finding "the one" or working with a provider to choose the right medication(s) and dose. Dr. Lyon and Dr. How agree that these treatment modalities need time to really take effect. Enter Stella's biological interventions, which can actually help people get more out of talk therapy and medication.
What is the Stellate Ganglion Block (SGB)?
The nervous system controls functions like circulation, digestion, heart rate, and more. The sympathetic nervous system activates the fight-or-flight response during a threat or perceived danger. Certain diseases and traumatic or highly stressful experiences can disrupt or dysregulate the sympathetic nervous system. For example, PTSD is the result of a fight-or-flight response that says "on" even after the traumatic or stressful experience is over.
There are bundles of sympathetic nerves throughout the body. SGB targets the stellate ganglion in the neck. Most SGB protocols involve one injection of local anesthetic but Stella's Dual Sympathetic Reset (DSR) involves injections at two levels of the neck, C6 and C4. Our providers use ultrasound to find the safest path from the skin to the nerves and ensure that the procedure is done correctly.
Dr. How explains that the term "nerve block" sometimes confuses people. He clarifies that "DSR SGB doesn't blunt your reflexes." Instead, he tells patients to think of it as a sympathetic nervous system "reset" that will help their brain work normally again. He adds that the anesthetic wears off after 6-8 hours.
"After SGB, you can act instead of react which can be life-changing." -Dr. John How
Who can DSR SGB help?
People with PTSD, anxiety, or depression diagnosis may be a good fit for treatment. However, a formal diagnosis is not required. Before any type of procedure, Stella requires patients to meet with a mental health expert for an intake assessment. During this 50-minute telehealth appointment, providers work one-on-one with patients to learn about their challenges and goals. Our providers consider their patient's unique medical, biological, psychological, and social factors to make a personalized recommendation.
In Dr. How's experience, many of his patients who have a positive outcome have invested time in talk therapy or other treatment modalities like EMDR and medication. Dr. How notes that DSR SGB can help people who are feeling "good cognitively but are still experiencing physiological symptoms" find relief.
One of the patients Dr. How treated described DSR SGB as a "vacation in a syringe."
How Ketamine Therapy works
Ketamine, though traditionally used as an anesthetic, has been found to have rapid-acting antidepressant properties. In the right setting, Ketamine Infusion Therapy and Spravato® (esketamine) can provide significant relief from depression and PTSD symptoms, particularly in people who haven't responded to other treatments.
Dr. How expanded on the therapeutic benefits of Ketamine Infusions, "The euphoric and dissociative effects of ketamine only last one to two hours but the neuroplasticity and nerve regrowth can last 48 hours or longer." He suggests that patients schedule Integration Therapy with one of Stella's providers or talk therapy sessions with their existing provider so they can unpack their experiences and draw insights that will help them move forward.
Like DSR SGB, Stella's ketamine protocols are designed to keep patients safe and support the best possible treatment outcome. Stella strictly administers ketamine in a clinical office under the direction of a board-certified physician. Dr. How strongly advocates for in-office ketamine because the drug's dissociative properties can put people who use it at home in a "compromised position." Stella's clinics are safe, trauma-informed spaces where patients can use ketamine in a controlled environment to break through depression.
The power of combining DSR SGB and Ketamine Infusions
In May 2024, Dr. Lipov and two co-authors published a study finding that the combination of DSR SGB and ketamine infusions seems to be significantly more effective in reducing symptoms of PTSD and depression than DSR SGB alone.
Dr. How uses a gardening analogy to explain how these treatments work together. DSR SGB stops the nerve growth that is occurring as a result of an overactive sympathetic nervous system and "prunes" the extra nerve fibers that were created around the amygdala, thereby resetting the amygdala to its pre-trauma state. Ketamine Infusion Therapy "fertilizes" the brain, strengthening neural communication and repairing the damage caused by cortisol and other stress hormones.
The dual approach addresses both the physiological and psychological aspects of depression and PTSD, offering a more comprehensive treatment option.
Additionally, patients who experienced non-combat related traumas reported greater relief compared to those who had combat and/or warfare-related traumas.
Collaboration is the key to better outcomes
Dr. Lyon asked Dr. How what he hopes the future of mental healthcare will be. He answered that because "medicine is traditionally very siloed we need more collaboration between providers." Dr. How noted that mental health providers typically aren't proceduralists who offer interventions like DSR SGB or Ketamine Infusion Therapy. The more connections providers from different specialties can make with each other, the more their patients stand to gain.
The more tools a provider has in their toolbox, the better. -Dr. John How
Dr. How, and the entire Stella team, encourages anyone searching for relief from mental health challenges like PTSD, anxiety, and depression not to give up on finding the right treatment. There are highly effective, evidence-based mental health care solutions available. Our team of Care Advocates is ready to connect when you are.