Emerging treatments for common mental health conditions affecting Veterans: Stellate ganglion block interventions
Abstract: There are a number of treatments that have an emerging evidence base and could be considered in the management of common mental health conditions affecting veterans. Emerging and adjunct treatments are typically considered when an individual’s adherence or response to accepted or conventional treatment/s is poor (i.e., chronic, treatment-resistant, or treatment-refractory mental health conditions). The aim of the rapid evidence assessment (REA) was to identify and critically evaluate the current evidence on emerging and adjunct treatments for posttraumatic stress disorder (PTSD) and common mental health conditions affecting veterans. From the four databases that were searched, two (2) studies met the inclusion criteria: one randomised controlled trial (RCT) and one systematic review (SR). The studies within this SR were extracted to a database and compared with the primary source (i.e., the RCT). From this set of articles (22 in total), all studies that did not meet the inclusion criteria were excluded (e.g., cohort and case-control studies), and all duplicate studies were removed (i.e., the one study in the SR that met the REA inclusion criteria was also directly retrieved by the search strategy). The final set of articles included one (1) RCT. The findings from this study were narratively synthesised, and a risk of bias assessment was conducted for the study. Strengths of the REA include the focus on peer-reviewed Level I and Level II evidence (NHMRC, 2009) from scientific journals in the fields of health, medicine, psychiatry, and psychology (including a specialist database developed by the US Department of Veterans’ Affairs focusing on literature relevant to veterans with PTSD). Limitations of the REA include the exclusion of potentially relevant papers that were published prior to 2017 and the exclusion of non-English language papers. The SGB procedure has been performed for neurological indications since the 1940’s. An examination of the recently published literature on SGB interventions for common mental health conditions affecting veterans identified one study that met the REA inclusion criteria. This study was judged to have a high risk of bias. The REA identified three (3) ongoing studies examining an SGB intervention for PTSD. The findings from these studies may be relevant to future reports. SGB remains an emerging intervention for PTSD and common mental health conditions affecting veterans. Given the invasive nature of the procedure, and the potential for adverse events (particularly without radiological guidance), we are not, at this time, in a position to recommend its use for the aforementioned clinical indications.