Beyond meds

Beyond Medication: rTMS, Ketamine & SGB for Veterans

Medically reviewed · Updated 2026

If you've done the therapy and taken the medications and you're still struggling, nobody may have told you what exists next. Quite a lot does. As an anesthesiologist who works in this space, here's the interventional tier, explained plainly.

rTMS — magnetic stimulation, no sedation

Repetitive transcranial magnetic stimulation uses a magnetic coil against the scalp to stimulate brain regions involved in mood regulation. You're awake, there's no anesthesia, and you drive yourself home. It's FDA-cleared for depression that hasn't responded to medication, delivered as a course of sessions over several weeks, and available at many VA facilities.

Ketamine and esketamine — the rapid-acting option

Ketamine works through a completely different mechanism than standard antidepressants, and its defining feature is speed — many people notice change within days rather than weeks. Esketamine (Spravato) is the FDA-approved nasal form for treatment-resistant depression, administered under monitoring, and is available within the VA system for eligible veterans. When time matters, this class exists precisely for that.

Stellate ganglion block — quieting the alarm

SGB is an image-guided injection of local anesthetic near a cluster of sympathetic nerves in the neck that helps run the fight-or-flight response. It's performed by anesthesiologists and pain physicians, takes minutes, and has drawn particular attention for PTSD hyperarousal in veterans — several trials report meaningful reductions in symptoms like hypervigilance and startle. The evidence is still maturing, and it works best paired with trauma-focused therapy, but it's a real option most veterans have never been told about.

Vagus nerve stimulation approaches

Approaches that stimulate the vagus nerve — the main highway of the body's "stand down" system — are an emerging area, including non-invasive transcutaneous versions (tVNS). Early-stage, but worth knowing the name.

The whole tier, in plain language

Service & Recover covers rTMS, ECT, ketamine, SGB, and VNS in its neuromodulation section, alongside side-by-side treatment comparisons and appointment prep for asking exactly the question above. Free, no account, nothing collected.

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