Could a simple injection rewire PTSD in Israel?

When Tal Hartuv set out for a hike in 2010 with her friend, American Christian Kristine Luken, she never imagined the day would end in terror. A Palestinian terrorist attacked the two women; Luken was murdered, and Hartuv barely survived.

In the immediate aftermath, Hartuv turned to cognitive behavioral therapy to cope with rage, terror, survivor’s guilt and crushing low self-esteem. For years, her chronic insomnia slowly improved, until it suddenly worsened again a couple of years ago.

“I experienced again an increase in hypervigilance, sensitivity to noise, social isolation, outbursts of rage — all set off by insomnia,” Hartuv said. Stella Israel is part of Stella Global, which also operates in the United States and Australia. Since 2022, treatments have been available at Medica hospitals in Tel Aviv and Haifa.

Jason Blankfield, special forces IDF combat veteran and Stella general manager explained to The Media Line that the way PTSD is understood has shifted dramatically over the last decade. For years, it was viewed as “a problem of the soul” or strictly a mental health disorder. But growing research and advances in imaging technology show that trauma also triggers measurable biological changes that contribute to the development and persistence of PTSD symptoms.

The Stella treatment targets those physical pathways. Using ultrasound guidance, a pain specialist or anesthesiologist injects a small amount of local anesthetic into two nerve bundles at the base of the neck. These nerves are central to the feedback loop between the brain and the sympathetic nervous system, which controls the body’s fight-or-flight response.

The protocol involves two short procedures, each lasting about 10 minutes: first on the right side of the neck, followed about a week later on the left. By temporarily “blocking” these nerves, the treatment reduces norepinephrine and nerve growth factors, essentially giving the system a reset. Patients often describe an immediate calm, with notable improvements in hyperarousal, panic attacks, irritability and sleep.

“We inject a low amount of a local anesthetic, just like you get at the dentist or like an epidural for a lady about to give birth,” Blankfield said. “We do something called a nerve block.” He likens the effect to restarting a heart. When someone goes into cardiac arrest, doctors may deliver an electric shock to get the heart pumping again.

Similarly, the anesthetic temporarily switches off ganglion nerve cells in the peripheral nervous system — relay stations that carry signals between the brain and body. For six to eight hours, those nerves are quiet. When their function returns, they can operate as they did before trauma disrupted them.

While this technique has been used for roughly a century to treat pain disorders — particularly conditions like complex regional pain syndrome, a chronic pain affecting the upper limbs — it was only about 20 years ago that doctors in the US and Australia began exploring its potential for PTSD. Traditional first-line treatments for PTSD, such as medication and talk therapy, succeed less than half the time. In contrast, Stella reports a success rate of 68% to 78%.

One peer-reviewed study published in 2023 tracked more than 280 patients who received the stellate ganglion block treatment. At the start, participants had an average GAD-7 score of 15.9, which reflects severe anxiety. Within a week, scores dropped by an average of nine points, with 211 patients showing clinically meaningful improvement. After a month, the average decline was 8.3 points, and 200 patients continued to experience significant relief.

To put that in perspective, the improvement was more than double the minimum threshold doctors consider meaningful in treating anxiety. The GAD-7, or Generalized Anxiety Disorder-7, is a simple seven-question survey used worldwide to measure the severity of anxiety symptoms. Results in Israel mirror those findings.

According to Stella Israel, among 150 local patients, the average PCL score — a widely used tool to measure PTSD symptom severity — fell from 51 to 33. A drop of just 10 points is considered clinically significant, meaning most patients saw benefits well beyond that threshold. Blankfield noted that one reason first-line PTSD therapies often fail is that patients are too “triggered” or hypervigilant to benefit from them.

By calming the nervous system, the stellate ganglion block lowers the intensity of those reactions, making it possible for patients to engage in the deeper therapeutic work that follows. He compared it to other emerging treatments, such as MDMA, which in 2023 was reclassified from Schedule 9 to Schedule 8 for use in PTSD therapy in Australia.

“We are starting to see people going back to work, reapplying for reserves, moving back home with their kids,” Blankfield said. “Here, we understand there are parts of the symptoms we can treat. They are treatable, full stop. Does that mean that someone is perfect after Stella? No, but they can have significant relief.”

Jason Blankfield, General Manager of Stella

(Photo: Courtesy of Elad Rachlis)

Beyond symptom reduction, Blankfield stressed, the treatment restores something even more essential: hope. Many patients living with PTSD, he said, lose that sense of possibility when conventional options fail.

Blankfield moved from Australia to Israel in 2010 and served in the IDF in a small, high-impact unit. During his service and subsequent reserve duty, he witnessed firsthand the toll PTSD took on fellow soldiers — as well as on their unit, families and communities as a whole. In 2021, he came across a clinical research paper on Stella. “I could not believe it. It sounded too good to be true,” he recalled.

Determined to explore the option, Blankfield contacted the CEO of Stella US to ask about bringing the treatment to Israel. The response was immediate: He was given a few months to secure a sponsoring hospital, a doctor and the first patient. Once he did, he was given the go-ahead to launch.

The process was complex, but the urgency grew dramatically after Oct. 7. The war unleashed a surge of trauma across the country, with skyrocketing rates of anxiety, depression and PTSD symptoms. Some studies estimate that as many as 3 million of Israel’s 10 million citizens may show signs of PTSD by the time the conflict ends.

In the United States, stellate ganglion block is FDA-approved for pain management and can be used off-label for PTSD. In Israel, Stella holds a 29A approval from the Ministry of Health, which allows the treatment using FDA-approved local anesthetics such as ropivacaine or bupivacaine.

Because the treatment is not yet included in Israel’s official health basket, Stella Israel has relied on philanthropy to make it accessible. To date, nearly $2 million has been raised from private donors in the United States. “This is purely from unbelievably generous Jewish individuals based in the US,” Blankfield said.

Thanks to data collected over the past year, soldiers now receive the treatment fully covered by the Defense Ministry. Reservists pay only 10% of the cost, Nova festival survivors receive it free of charge, and evacuees from the north and south are offered the treatment at heavily discounted rates.

Blankfield said the company will need to conduct larger-scale clinical trials to secure full approval and eventual inclusion in the health basket. Still, he is confident that “one day it will be there.” Blankfield reflected on the progress made in just a few short years. “When I started with Stella, zero patients had access to it. Now, thousands do. I won’t stop until millions have access.”

One of those patients is 32-year-old Josh Malchman. He served in the IDF’s Special Operations Engineering Unit, known as Yahalom, in a field intelligence role between 2011 and 2014. He was stationed near the front lines in Gaza during Operations Pillar of Defense and Protective Edge. Later, while in reserves, he also served during 2018’s Operation Northern Shield. The Defense Ministry officially recognizes him as having PTSD.

For years, Malchman struggled with severe insomnia and night terrors. After Oct. 7, his symptoms worsened dramatically. He relied on heavy doses of medication and also suffered from tremors and hypertension in certain limbs.

Eventually, he left Israel for six months with his wife and daughter and entered rehab. It was during that time that he learned about Blankfield and Stella. Upon returning home, he secured the necessary referral and began the treatment. The results were immediate: He no longer needed medication to fall asleep, drastically cut back his medical cannabis use and was able to stop taking most of his other drugs.

“I could not believe the quiet I had in my head,” Malchman said. “You are so used to the noise and all of a sudden everything is quiet. I can sleep through the night.” He acknowledged that Stella is not a “magic pill” and that while many people he knows shared his positive experience, others found it less effective.

Still, Malchman was unequivocal about its impact on his life. “I would do Stella again 1,000 times. It would have saved me a lot of hardship if I had had it years ago.”

The story is written by Maayan Hoffman and reprinted with permission from The Media Line.