Nervous System Conditions We Treat: A Physician's Guide

Many of the conditions below are named and treated as if they were entirely separate problems. In my experience they often share a single underlying feature: a nervous system that has become stuck in survival mode. Different diagnoses, the same nervous system. For the full picture of how we think about healing and the treatments we use, start with our main guide, A Physician's Guide to Nervous System Healing. Below, we look at the specific conditions we most often help with.

Anxiety, Hypervigilance, and the Overactive Nervous System

Many patients who come to us do not name depression as their main concern. Instead they describe constant worry, difficulty relaxing, hypervigilance, irritability, a feeling of being on edge, trouble sleeping, and a sense that their nervous system is always scanning for danger. Some describe a kind of functional freeze, where they feel shut down and stuck at the same time.

In these situations, the issue is often not a simple lack of neurotransmitters. It is an overactive sympathetic nervous system. For some patients, ketamine alone creates meaningful improvement. For others, Stellate Ganglion Block becomes an important addition because it targets the fight-or-flight system directly. Often, the most durable results come from combining nervous system regulation with therapy and lifestyle change. For practical starting points, see our posts on how to manage anxiety and grounding techniques for panic.

Can ketamine therapy help with anxiety?

For some people, yes. Ketamine can ease the rigidity and reactivity that drive chronic anxiety, and create a window in which new, calmer patterns can take hold. It is not right for everyone, which is why we begin with a consultation.

Can a stellate ganglion block help with anxiety?

SGB can be helpful when anxiety is driven by sympathetic overactivation, the physical fight-or-flight state. It is one reason we sometimes recommend SGB alongside or before ketamine.

PTSD and Trauma

PTSD is not simply a collection of memories. It is a nervous system state. Many people with PTSD describe living as though danger is still present, even when they know intellectually that they are safe.

Research suggests ketamine may help disrupt rigid trauma-related patterns and support emotional processing, while Stellate Ganglion Block may reduce hyperarousal by calming excessive sympathetic activity. SGB has been studied for PTSD in both military and civilian populations, and we explore that evidence in our own articles on stellate ganglion block for PTSD and how effective SGB is for PTSD. At Soft Reboot Wellness we frequently combine trauma-informed therapy, ketamine therapy, and SGB to address both the psychological and physiological sides of trauma. Our article on the role of ketamine in PTSD treatment goes deeper on the ketamine side.

How effective is ketamine therapy for PTSD?

Results vary from person to person. Many patients experience meaningful relief, particularly when ketamine is paired with trauma-informed therapy and, where appropriate, SGB. We focus on realistic expectations and a plan tailored to you.

Is SGB used for PTSD?

Yes. SGB is one of the tools we use for trauma-related hyperarousal, and it can be especially helpful for the physical symptoms of being constantly on guard.

Long COVID, Dysautonomia, and POTS

Long COVID has brought new attention to the autonomic nervous system. Many patients develop fatigue, brain fog, exercise intolerance, POTS, a racing heart, sleep disruption, anxiety, and heightened sensory sensitivity. While the mechanisms are still being studied, autonomic dysfunction appears to play a significant role in many Long COVID presentations.

Stellate Ganglion Block has emerged as a promising option for select Long COVID patients, particularly those with dysautonomia, altered taste and smell, and persistent sympathetic activation. As an anesthesia-trained physician who works with the autonomic nervous system directly, I am well positioned to evaluate whether this approach may help. We reflect on this further in our article on stellate ganglion block for anxiety, PTSD, and Long COVID.

Can ketamine or SGB help with Long COVID symptoms?

For some patients, especially those with dysautonomia and persistent sympathetic activation, SGB may help, and ketamine can support the mood and sleep symptoms that often accompany Long COVID. A consultation is the place to start.

What is dysautonomia?

Dysautonomia is dysfunction of the autonomic nervous system, the part of the body that regulates things like heart rate, blood pressure, and digestion. POTS is one common form.

Perimenopause and the Nervous System

Many women entering perimenopause are surprised to find their symptoms reach well beyond hot flashes. Anxiety, irritability, sleep disruption, mood changes, brain fog, and a lower tolerance for stress are all common. Hormones and the autonomic nervous system are deeply interconnected, and shifting hormones can leave the nervous system more easily pushed into overdrive.

We often evaluate the broader picture, including sleep, hormones, nutrition, inflammation, and nervous system regulation, when helping women through this transition. Ketamine can help with the treatment-resistant anxiety and mood changes that often accompany perimenopause, and there is emerging interest in Stellate Ganglion Block for vasomotor symptoms such as hot flashes. The evidence there is still developing, and we are honest about what is and is not yet known.
Dr. Herman holds an Integrative Women's Health Certification from The Integrative Psychiatry Institute (2025, 56 hours), covering hormonal, genomic, metabolic, and lifespan-related approaches to women's mental health — making her uniquely equipped to address the psychiatric dimensions of perimenopause and menopause.

Can a stellate ganglion block help with hot flashes?

There is emerging research on SGB for vasomotor symptoms such as hot flashes, and some patients have found it helpful. The evidence is still early, and we will give you an honest picture during your consultation.

How is this different from hormone replacement therapy?

These approaches work on different systems. HRT replaces or supplements hormones. Our focus is on calming and regulating the nervous system. For some patients the two approaches are complementary, and we are glad to coordinate with your other physicians.

Burnout and High Achievement

Many of our patients are physicians, executives, founders, engineers, attorneys, and caregivers. They are often high-functioning on the outside while feeling depleted within. Burnout is not simply stress. It is often a state of chronic nervous system activation combined with a depleted capacity to recover. Many high achievers spend years overriding their body's signals before they seek help.

One of our goals is to help patients move beyond merely surviving, and reconnect with a sense of meaning, vitality, creativity, and joy. Nervous system regulation, ketamine, and integration work can each play a part. We write more about this in why burnout does not improve with rest and burnout treatment for Silicon Valley professionals.

Can ketamine therapy help with burnout?

For many high-achieving patients, ketamine combined with nervous system regulation and integration can help interrupt the cycle of chronic activation and depletion. As always, we begin with a consultation to see whether it fits.

I am high-functioning but exhausted. Am I a candidate?

Quite possibly. Many of our patients look fine on paper while feeling burned out underneath. A consultation is the best way to find out whether our approach is right for you.

Treatment-Resistant Depression

Depression is called treatment-resistant when a person has not responded to two or more antidepressant trials. Standard antidepressants work slowly and through a different mechanism. Ketamine often works more quickly, and the neurotrophic hypothesis suggests it may do more than lift mood acutely, by supporting the brain's capacity to form new connections. Our blog post Understanding the Depressed Brain explores what is happening underneath.

We screen carefully and talk openly about realistic expectations, including the difference between full responders, partial responders, and those who benefit from ongoing maintenance. You can also read how ketamine helps where antidepressants do not and our comparison of ketamine versus SSRIs.

How quickly does ketamine work for depression?

Some people notice shifts within hours to days, which is much faster than traditional antidepressants. Responses vary, and durability is supported by integration and, for some, maintenance sessions.

Am I a candidate if I have tried several antidepressants without success?

Often yes. Treatment-resistant depression, meaning two or more failed antidepressant trials, is one of the most established uses of ketamine. A consultation will help us assess your history and goals.

Do I have to stop my current medications?

Not necessarily. Many patients continue their current medications, though some specific medications can blunt ketamine's effect. We review this carefully during your consultation rather than making changes on your own.

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If you recognize yourself in any of these, the next step is a conversation. You can start your journey here or contact our team. For the full picture of how these treatments work and how we keep them safe, return to A Physician's Guide to Nervous System Healing.

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This guide is for informational purposes only and is not a substitute for individualized medical advice. Reviewed by Dr. Sara Herman, MD, ABOIM.