Exploring How IV Ketamine and Stellate Ganglion Block Decrease Cortisol Levels

In recent years, innovative treatments like ketamine and stellate ganglion block (SGB) have gained attention for their potential to treat a variety of conditions, including chronic pain, PTSD, and depression. One of the mechanisms through which these treatments exert their beneficial effects is by modulating cortisol levels. This blog explores how ketamine and SGB work to decrease cortisol, a stress hormone, and discusses the implications of this reduction for mental health and overall well-being.

Understanding Cortisol and Its Impact

Cortisol, often referred to as the "stress hormone," is produced by the adrenal glands and plays a crucial role in the body's response to stress. It helps regulate various bodily functions, including metabolism, immune response, and inflammation. While cortisol is essential for survival, chronic elevation of cortisol levels due to prolonged stress can lead to numerous health issues, including anxiety, depression, hypertension, and impaired cognitive function.

Ketamine: Mechanism and Effects on Cortisol

Ketamine is a dissociative anesthetic that has been used in medical settings since the 1970’s. More recently, it has been repurposed for its rapid-acting antidepressant and anti-anxiety effects. Here’s how ketamine interacts with cortisol:

1. NMDA Receptor Blockade: Ketamine works primarily by blocking N-methyl-D-aspartate (NMDA) receptors in the brain. This blockade leads to a cascade of neurochemical events that promote neuroplasticity and mood stabilization. By enhancing the brain's ability to adapt and form new connections, ketamine helps reduce the overall stress response, indirectly lowering cortisol levels.

2. HPA Axis Modulation: The hypothalamic-pituitary-adrenal (HPA) axis is the central stress response system. Ketamine has been shown to modulate the HPA axis, leading to a decrease in the secretion of cortisol. Studies have demonstrated that ketamine administration results in a rapid reduction in cortisol levels, which contributes to its therapeutic effects in treating depression and anxiety.

3. Reduction in Inflammatory Markers: Chronic stress and elevated cortisol levels are associated with increased inflammation in the body. Ketamine has anti-inflammatory properties that help reduce levels of pro-inflammatory cytokines. By decreasing inflammation, ketamine further supports the reduction of cortisol and the overall stress response.

Stellate Ganglion Block (SGB): Mechanism and Effects on Cortisol

SGB is a procedure that involves injecting a local anesthetic into the stellate ganglion, a collection of nerves in the neck that are part of the sympathetic nervous system. This block can have profound effects on the body's stress response, including the modulation of cortisol levels:

1. Sympathetic Nervous System Modulation: The stellate ganglion is part of the sympathetic nervous system, which regulates the fight-or-flight response. By blocking these nerves (ideally under ultrasound guidance), SGB dampens the activity of the sympathetic nervous system, leading to a decrease in the production of stress hormones, including cortisol. This reduction helps alleviate symptoms of anxiety, PTSD, and other stress-related conditions.

2. HPA Axis Influence: Similar to ketamine, SGB can modulate the HPA axis. By reducing the input from the sympathetic nervous system to the hypothalamus, SGB decreases the release of corticotropin-releasing hormone (CRH), which in turn reduces the secretion of adrenocorticotropic hormone (ACTH) from the pituitary gland. This chain reaction ultimately leads to lower cortisol levels.

3. Improvement in Mood and Anxiety: By decreasing cortisol levels and modulating the stress response, SGB can have significant positive effects on mood and anxiety. Patients undergoing SGB often report immediate relief from anxiety and a sense of calmness, which further supports the reduction of cortisol production.

Implications for Mental Health and Well-being

The reduction of cortisol levels through treatments like ketamine and SGB has several important implications for mental health and overall well-being:

1. Reduction of Anxiety and Depression: Elevated cortisol levels are strongly associated with anxiety and depression. By lowering cortisol, ketamine and SGB help alleviate the symptoms of these conditions, providing rapid and effective relief.

2. Improved Cognitive Function: Chronic stress and high cortisol levels can impair cognitive function, leading to difficulties with memory, attention, and executive functioning. By reducing cortisol, ketamine and SGB can help improve cognitive performance and overall mental clarity.

3. Enhanced Physical Health: Lowering cortisol levels can also have beneficial effects on physical health. Chronic stress and high cortisol are linked to numerous health issues, including cardiovascular disease, metabolic disorders, and immune dysfunction. By modulating cortisol, ketamine and SGB can contribute to better physical health and reduced risk of stress-related illnesses.

4. Enhanced Neuroplasticity: Both ketamine and SGB promote neuroplasticity, the brain's ability to adapt and reorganize itself. This neuroplasticity is crucial for recovery from mental health conditions and supports the development of healthier behavioral patterns and coping mechanisms.


Ketamine and stellate ganglion block are emerging as promising treatments for a variety of conditions, thanks in part to their ability to decrease cortisol levels and modulate the body's stress response. By targeting the HPA axis and sympathetic nervous system, these treatments offer rapid relief from anxiety, depression, and other stress-related conditions, while also promoting neuroplasticity and overall mental and physical well-being.  In upcoming blogs, we will also discuss the use of intravenous NAD+ (nicotinic adenine dinucleotide) as a promising innovative therapy for anxiety and cortisol control.  

As research continues to explore the full potential of these treatments, they hold promise for providing new avenues of hope and healing for individuals struggling with the detrimental effects of chronic stress and elevated cortisol levels. If you or someone you know is dealing with these issues, consulting with a qualified healthcare provider trained in Anesthesiology and/or Pain Medicine at StrIVeMD Wellness and Ketamine in Chicagoland Illinois, Dublin Ohio, Greater Dallas area Texas, or Champaign Illinois about the potential benefits of ketamine or SGB could be a valuable step toward recovery and improved quality of life.