Stellate Ganglion Block and Eating Disorder Therapy: No Evidence for Combined Use
There is no established role for stellate ganglion block (SGB) in the treatment of eating disorders, and it should not be performed either before or concurrently with eating disorder therapy. The available evidence does not support any connection between SGB and eating disorder treatment.
Why This Question Reflects a Misunderstanding
The stellate ganglion block is a sympathetic nerve block used for specific conditions related to sympathetic hyperactivity, including:
- Post-traumatic stress disorder (PTSD), where SGB reduced CAPS-5 symptom severity scores by 12.6 points compared to 6.1 points with sham treatment over 8 weeks 1
- Anxiety disorders, where SGB decreased GAD-7 scores by 9.0 points at 1 week and 8.3 points at 1 month, with approximately 75-80% of patients showing clinically meaningful improvement 2
- Chronic regional pain syndrome (CRPS) and other sympathetically-mediated pain conditions 3
The proposed mechanism involves reducing nerve growth factor (NGF) and subsequently lowering norepinephrine levels, which addresses sympathetic overdrive 3, 4. This mechanism has no relevance to the core pathophysiology of eating disorders.
Evidence-Based Treatment for Eating Disorders
The actual treatment approach for eating disorders is entirely different and well-established:
For Adolescents and Emerging Adults
- Family-based treatment (FBT) is the first-line psychotherapy for adolescents with anorexia nervosa and bulimia nervosa who have an involved caregiver 5, 6
- FBT achieves a remission rate of 48.6% at 6-12 months compared to 34.3% with individual treatment (OR 2.08; 95% CI 1.07-4.03) 6
For Adults with Bulimia Nervosa
- Eating disorder-focused cognitive-behavioral therapy (CBT) combined with fluoxetine 60 mg daily should be prescribed either initially or if minimal response to psychotherapy alone occurs by 6 weeks 5
For Adults with Anorexia Nervosa
- Eating disorder-focused psychotherapy that normalizes eating behaviors, restores weight, and addresses psychological aspects including fear of weight gain and body image disturbance 5
For Binge-Eating Disorder
- Eating disorder-focused CBT or interpersonal therapy, delivered in individual or group formats 5
The Multidisciplinary Approach Required
All patients with eating disorders require a coordinated treatment plan incorporating:
- Medical monitoring including vital signs, weight, BMI, and laboratory assessment (CBC, comprehensive metabolic panel, ECG for those with restrictive eating or severe purging) 5, 6
- Psychiatric evaluation for co-occurring conditions including depression, anxiety, and suicidality 5
- Nutritional rehabilitation with individualized weight gain goals and careful refeeding to prevent refeeding syndrome 5, 6
- Disorder-specific psychotherapy as the cornerstone of treatment 5
Important Clinical Caveat
If a patient with an eating disorder also has comorbid PTSD or severe anxiety disorder, these conditions should be assessed and treated as separate entities. In such cases, SGB might be considered as an adjunctive treatment specifically for the PTSD or anxiety symptoms 1, 2, but this would be entirely independent of and unrelated to the eating disorder treatment itself. The eating disorder would still require the standard evidence-based approaches outlined above 5.