Ashwagandha for Anxiety Disorders

Introduction

Ashwagandha, also known as Indian ginseng, winter cherry, or Withania somnifera, is a small evergreen shrub that is native to India, the Middle East, and parts of Africa.¹ It is one of the most essential herbs in Ayurveda (the holistic medicine in India).² Ashwagandha was traditionally used to relieve stress, increase energy levels, and improve concentration.² Currently, ashwagandha is used as an herbal supplement for stress, anxiety, neurodegenerative diseases (such as Parkinson’s disease and Alzheimer’s disease).^1,2,3 

What are anxiety disorders?

Anxiety is a feeling of fear, dread, and uneasiness.⁴ It is a normal reaction to stress. Occasional anxiety is an expected part of life and can be beneficial in some situations.⁵ Anxiety disorders are conditions in which the anxiety does not go away and even get worse over time.⁴ Anxiety disorders can affect various aspects of life such as relationships, job performance, and schoolwork. Factors such as genetics, biology and chemistry of the brain, stress, and environment can contribute to anxiety disorders.⁴ 

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Symptoms of anxiety disorders are uncontrolled anxious thoughts or beliefs, rapid heartbeat, unexplained aches, dizziness, shortness of breath, difficulty concentrating, sleep problems, and changes in behavior.^4,6 The most common types of anxiety disorders include generalized anxiety disorder (GAD), social anxiety disorder, separation anxiety disorder, panic disorder, and phobias.^4,5 Treatments for anxiety disorders are psychotherapy, stress management techniques, and anti-anxiety medicines.^4,6 

How does ashwagandha reduce anxiety?

Ashwagandha belongs to a select group of herbs called adaptogens, which support the body’s natural ability to deal with stress.² Ashwagandha is shown to modulate GABA neurotransmission, producing a calming effect. This can help with feeling of anxiety and stress.⁷

Numerous studies have been done to evaluate the efficacy of ashwagandha in reducing anxiety. A 2000 double-blind, placebo-controlled study assessed the efficacy of ashwagandha in patients with anxiety disorders.⁷ The participants received either ashwagandha 500 mg daily for 6 weeks or placebo daily for 6 weeks. Compared to placebo, ashwagandha exhibited superior anxiolytic effect.

A 2012 randomized controlled trial assessed the safety and efficacy of ashwagandha root in reducing stress and anxiety in adults with a history of chronic stress.⁸ The participants were randomly assigned to ashwagandha 600 mg daily for 60 days or placebo daily for 60 days. The participants in the ashwagandha group showed significant reduction in scores on all the stress-assessment scales, compared to placebo. In addition, the cortisol (stress hormone) levels in the blood of the participants in the ashwagandha group were significantly reduced.

A 2014 systemic review looked at 5 clinical trials on the use of ashwagandha as an alternative treatment for anxiety.⁹ In these trials, the participants were given ashwagandha or either placebo or psychotherapy. All 5 trials conclude that ashwagandha significantly improved anxiety and stress, compared to placebo or psychotherapy.

Lastly, a 2019 randomized controlled trial investigated the adaptogenic and anxiolytic effects of ashwagandha in healthy adults.¹⁰ The participants received ashwagandha 250 mg daily for 8 weeks, ashwagandha 600 mg daily for 8 weeks, or placebo daily for 8 weeks. Significant reduction in the stress and anxiety was observed in participants receiving ashwagandha. In addition, the serum cortisol levels were greatly reduced and sleep quality was significantly improved.

How do you take ashwagandha?

Ashwagandha supplement is made from the root and berry of the ashwagandha plant.¹ The supplement is available as powder, tablets, capsules, gummies, and liquid extract.² Ashwagandha is not approved as a drug by the Food and Drug Administration (FDA). It can be difficult to determine how much ashwagandha to take as there are no official recommended dosages. It is recommended to start with a low dosage and increase slowly until the desired effect is reached. And, before using ashwagandha, have a discussion with your doctor to make sure it is safe and appropriate to use.

Safety of ashwagandha

Ashwagandha is safe and generally well tolerated. Side effects of ashwagandha are mild-moderate drowsiness, upset stomach, diarrhea, and vomiting.^1,3 Less common side effects include giddiness, vertigo, nasal congestion, blurry vision, and nocturnal cramps.³

Ashwagandha may cause irritation in the gastrointestinal tract, so it is not recommended in people with stomach ulcer.¹ Ashwaghanda might activate the immune system, so it can increase the symptoms of autoimmune diseases such as multiple sclerosis, lupus, and rheumatoid arthritis.¹ Ashwagandha may also increase testosterone levels, so it should be used with caution in hormone-sensitive prostate cancer.² The safety of ashwagandha in pregnancy and lactation has not been well studied. There is evidence that ashwagandha can cause miscarriages.^1,3

Ashwagandha does not have serious interactions with any medication. Ashwagandha might activate the immune system, so taking it with immunosuppressants may decrease the effectiveness of the immunosuppressants.¹ Concurrent use of ashwagandha and sedative medications such as clonazepam, diazepam, and lorazepam results in too much sleepiness.¹ In addition, ashwagandha may lower blood pressure, so it should be used with caution in patients taking anti-hypertensive medications.¹ 

Conclusion

Ashwagandha is used as an herbal supplement for anxiety disorders. It helps reduce anxiety via modulation of GABA neurotransmission. The study findings showed that ashwagandha significantly reduce anxiety. Before using ashwagandha for anxiety disorders, please consult your doctor to ensure that it is safe and appropriate for you.

References:

1. “Ashwagandha.” WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-953/ashwagandha. Accessed Oct. 27, 2020.
2. Singh, Narendra et al. “An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda.” African journal of traditional, complementary, and alternative medicines : AJTCAM vol. 8,5 Suppl (2011): 208-13. doi:10.4314/ajtcam.v8i5S.9
3. “Ashwagandha.” Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/ashwagandha. March 26, 2020. Accessed Oct. 27, 2020.
4. “Anxiety.” MedLinePlus. https://medlineplus.gov/anxiety.html. Accessed Oct. 27, 2020.
5. “What are Anxiety Disorders?” American Psychiatric Association. https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders. Jan. 2017. Accessed Oct. 27, 2020.
6. “Anxiety Disorders.” National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml. Accessed Oct. 27, 2020.
7. Andrade, C et al. “A double-blind, placebo-controlled evaluation of the anxiolytic efficacy ff an ethanolic extract of withania somnifera.” Indian journal of psychiatry vol. 42,3 (2000): 295-301.
8. Chandrasekhar, K et al. “A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults.” Indian journal of psychological medicine vol. 34,3 (2012): 255-62. doi:10.4103/0253-7176.106022
9. Pratte, Morgan A et al. “An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera).” Journal of alternative and complementary medicine (New York, N.Y.) vol. 20,12 (2014): 901-8. doi:10.1089/acm.2014.0177
10. Salve, Jaysing et al. “Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study.” Cureus vol. 11,12 e6466. 25 Dec. 2019, doi:10.7759/cureus.6466