Question from a Member:
Can you tell me if patients can use ashwagandha for anxiety?
It is not essential but can be helpful for us to know at least a little bit about nutraceuticals and phytoceuticals that are commonly taken by patients—on their own or on the advice of a health professional.
Several of my patients have told me—usually, after the fact—that they were taking ashwagandha.
What is ashwagandha?
Ashwagandha is a plant that grows in India, where it has been used for medicinal purposes since ancient times, and in some other countries including Nepal and Iran. Its scientific name is Withania somnifera and it is sometimes also called “Indian Ginseng” because it supposedly has benefits similar to Chinese ginseng.
Ashwagandha is available most commonly in the form of pills containing a powder of its dried root (and other parts of the plant) or, sometimes, a standardized extract.
It is marketed with claims about a long list of health-related benefits. These claimed benefits are believed to be due to substances called withanolides contained in the plant.
What is ashwagandha used for?
Claims have been made that the use of ashwagandha may be associated with improvement in various psychiatric/ neurological and non-psychiatric problems (D’Cruz and Andrade, 2022; Tandon and Yadav, 2020).
– Cognitive functioning, for example, memory, concentration
– Chronic stress
– Sleep (notice that its scientific name is Withania somnifera)
– Sexual functioning
– Male infertility
– Female infertility
– Inflammation, for example, rheumatoid arthritis
– Reduces blood sugar
– Reduces blood pressure
– Reduces weight gain associated with high cortisol levels due to stress
– Physical strength and endurance
– General resistance to disease.
I agree with what the Merck Manual (source) notes: “Any single compound, including ashwagandha, is highly unlikely to have such a broad range of health benefits.”
What kind of evidence do I need?
Unfortunately, complementary and alternative (CAM) interventions are not as carefully studied as mainstream medications are.
Before I recommend the clinical use of a nutraceutical or phytoceutical to any of my patients, I need to see:
1. Randomized, controlled clinical trials…
2. …done in Western countries… (I won’t get into it here, but I feel unsure about the rigor with which clinical trials are carried out in non-Western countries to evaluate complementary and alternative medicine products.)
3. …and, replicated by at least one independent research group. (Independent verification is a long-standing pillar of evidence-based medicine.)
In a separate article on this website, we’ll answer our Member’s question about whether ashwagandha should be used for the treatment of anxiety by looking for research evidence that meets the rigorous criteria that I specified above.
Please see the following article on this website:
And, please also see the following article on this website:
Sarris J, Ravindran A, Yatham LN, Marx W, Rucklidge JJ, McIntyre RS, Akhondzadeh S, Benedetti F, Caneo C, Cramer H, Cribb L, de Manincor M, Dean O, Deslandes AC, Freeman MP, Gangadhar B, Harvey BH, Kasper S, Lake J, Lopresti A, Lu L, Metri NJ, Mischoulon D, Ng CH, Nishi D, Rahimi R, Seedat S, Sinclair J, Su KP, Zhang ZJ, Berk M. Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce. World J Biol Psychiatry. 2022 Jul;23(6):424-455. doi: 10.1080/15622975.2021.2013041. Epub 2022 Mar 21. PMID: 35311615.
Systematic reviews and Review articles
Akhgarjand C, Asoudeh F, Bagheri A, Kalantar Z, Vahabi Z, Shab-Bidar S, Rezvani H, Djafarian K. Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials. Phytother Res. 2022 Nov;36(11):4115-4124. doi: 10.1002/ptr.7598. Epub 2022 Aug 25. PMID: 36017529.
Andrade C. Ashwagandha for anxiety disorders. World J Biol Psychiatry. 2009;10(4 Pt 2):686-7. doi: 10.1080/15622970902792365. PMID: 19363747.
Bonilla DA, Moreno Y, Gho C, Petro JL, Odriozola-Martínez A, Kreider RB. Effects of Ashwagandha (Withania somnifera) on Physical Performance: Systematic Review and Bayesian Meta-Analysis. J Funct Morphol Kinesiol. 2021 Feb 11;6(1):20. doi: 10.3390/jfmk6010020. PMID: 33670194; PMCID: PMC8006238.
Cheah KL, Norhayati MN, Husniati Yaacob L, Abdul Rahman R. Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. PLoS One. 2021 Sep 24;16(9):e0257843. doi: 10.1371/journal.pone.0257843. PMID: 34559859; PMCID: PMC8462692.
D’Cruz M, Andrade C. Potential clinical applications of Ashwagandha (Withania somnifera) in medicine and neuropsychiatry. Expert Rev Clin Pharmacol. 2022 Sep;15(9):1067-1080. doi: 10.1080/17512433.2022.2121699. Epub 2022 Sep 8. PMID: 36062480.
Ng QX, Loke W, Foo NX, Tan WJ, Chan HW, Lim DY, Yeo WS. A systematic review of the clinical use of Withania somnifera (Ashwagandha) to ameliorate cognitive dysfunction. Phytother Res. 2020 Mar;34(3):583-590. doi: 10.1002/ptr.6552. Epub 2019 Nov 19. PMID: 31742775.
Paul S, Chakraborty S, Anand U, Dey S, Nandy S, Ghorai M, Saha SC, Patil MT, Kandimalla R, Proćków J, Dey A. Withania somnifera (L.) Dunal (Ashwagandha): A comprehensive review on ethnopharmacology, pharmacotherapeutics, biomedicinal and toxicological aspects. Biomed Pharmacother. 2021 Nov;143:112175. doi: 10.1016/j.biopha.2021.112175. Epub 2021 Sep 27. PMID: 34649336.
Pratte MA, Nanavati KB, Young V, Morley CP. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J Altern Complement Med. 2014 Dec;20(12):901-8. doi: 10.1089/acm.2014.0177. PMID: 25405876; PMCID: PMC4270108.
Speers AB, Cabey KA, Soumyanath A, Wright KM. Effects of Withania somnifera(Ashwagandha) on Stress and the Stress- Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia. Curr Neuropharmacol. 2021;19(9):1468-1495. doi: 10.2174/1570159X19666210712151556. PMID: 34254920; PMCID: PMC8762185.
Tandon N, Yadav SS. Safety and clinical effectiveness of Withania Somnifera (Linn.) Dunal root in human ailments. J Ethnopharmacol. 2020 Jun 12;255:112768. doi: 10.1016/j.jep.2020.112768. Epub 2020 Mar 19. PMID: 32201301.
Copyright © 2023, Simple and Practical Medical Education, LLC. All rights reserved. May not be reproduced in any form without express written permission.
Disclaimer: The content on this website is provided as general education for medical professionals. It is not intended or recommended for patients or other laypersons or as a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified healthcare professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most recently updated information.