Evidence review
Ashwagandha for Anxiety
Withania somnifera
The short answer
Promising clinical evidenceProbably a little, mainly for everyday stress and milder anxiety. Small trials of standardized root extracts found lower stress and anxiety scores than placebo over 6 to 12 weeks, and a 2022 psychiatry taskforce provisionally recommends it, but most volunteers were stressed rather than diagnosed, many trials were tied to extract makers, and reviewers rate the evidence low certainty. Rare liver injury and thyroid effects mean it is not for everyone.
7 key studies reviewed
Updated October 12, 2026
Key points
-
01
Promising but low-certainty evidence
Meta-analyses of small trials find lower anxiety and stress scores than placebo, but reviewers rate certainty low because results vary widely and negative trials may be missing.
-
02
Mostly stressed volunteers, not patients
Most trials enrolled stressed but otherwise healthy adults for 6 to 12 weeks and measured questionnaire scores. Only a few small trials tested people diagnosed with an anxiety disorder.
-
03
Many trials are company-linked
The KSM-66 maker supplied extract for key trials, and the makers of Shoden and of a 2000 trial’s extract paid for those studies. A company-funded 12-week trial found no stress benefit.
-
04
Liver and thyroid risks
Rare cholestatic liver injury appears 2 to 12 weeks in, and deaths occurred in people with existing liver disease. Ashwagandha can also raise thyroid hormone levels.
-
05
Not a replacement for treatment
CBT and SSRIs are first-line for anxiety disorders. Avoid ashwagandha in pregnancy and breastfeeding. For suicidal thoughts in the US, call or text 988.
Ashwagandha probably eases stress and milder anxiety a little, but the evidence is less solid than its popularity suggests. Several meta-analyses (studies that pool the results of several trials) find that standardized ashwagandha extracts, mostly from the root, lowered anxiety and stress scores more than a placebo (dummy pill), and a 2022 international psychiatry taskforce provisionally recommends it for anxiety disorders. Yet most trials were small, lasted 6 to 12 weeks, took place in India, used different branded extracts often supplied or paid for by their makers, and enrolled stressed but otherwise healthy adults rather than people diagnosed with an anxiety disorder. Reviewers rate the certainty of the evidence as low, and the US National Center for Complementary and Integrative Health (NCCIH) still calls its effect on anxiety unclear. Rare liver injury and thyroid effects mean it is not a harmless calm-down supplement.
Stress and anxiety overlap but are not the same. Stress is a response to pressure. Anxiety disorders, such as generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder, involve worry or fear that does not go away, is felt in many situations, and can get worse over time, according to the US National Institute of Mental Health (NIMH), which estimates that about a third of US adolescents and adults have one at some point. Ashwagandha (Withania somnifera) is a shrub of the nightshade family whose root has been used for centuries in Ayurveda, India’s traditional medicine, as a rasayana (rejuvenating tonic). It is often called an adaptogen, a loose term for something said to help the body resist stress. Supplements are now sold mainly for stress, anxiety, and sleep, as capsules, powders, and gummies made from root, leaf, or root-and-leaf extracts. The best-known trial extracts are KSM-66, a root-only extract, and Shoden and Sensoril, which the NIH Office of Dietary Supplements (ODS) describes as root-and-leaf extracts. Claims that ashwagandha “lowers cortisol,” the main stress hormone, drive much of the marketing.
This page looks closely at what the trials measured and in whom, who paid for them, the null results, what guidelines and regulators say, and the doses and products tested. It then covers the safety questions people search for most: liver injury, thyroid effects, pregnancy, drug interactions, and Denmark’s ban. Nothing here is medical advice. Persistent anxiety deserves a proper assessment, both because it is very treatable with therapy and medication and because symptoms such as a racing heart, shakiness, and weight loss can also come from an overactive thyroid, heart rhythm problems, medicines, or other substances, none of which a herb treats.
02 The trials
Key studies
The trials and reviews that carry the most weight for this question, with the product and dose each one tested. Results apply to the preparation studied.
-
Marchi et al., 2025
Systematic review and meta-analysis of 14 randomized trials; no funding
- Who
- 713 people with diagnosed mental disorders (360 on ashwagandha), mostly anxiety disorders
- What and how much
- Mostly oral ashwagandha extracts, median 600 mg a day; one trial used Shirodhara oil therapy
- How long
- Median follow-up 8 weeks
Anxiety improved more than with comparators (pooled SMD −1.96; −1.13 after removing an outlying trial), with similar side effects, but evidence of publication bias (Egger p < 0.001) and high heterogeneity left certainty low.
-
Akhgarjand et al., 2022
Systematic review and dose-response meta-analysis of 12 randomized trials
- Who
- 1,002 adults aged 25 to 48
- What and how much
- Various ashwagandha extracts and root preparations; doses differed widely
- How long
- Literature searched to December 2021
Anxiety (SMD −1.55, 95% CI −2.37 to −0.74) and stress (SMD −1.75, −2.29 to −1.22) fell more than with placebo, but the trials disagreed sharply (I² 93.8% and 83.1%) and certainty was rated low.
-
Andrade et al., 2000
Randomized, double-blind, placebo-controlled; manufacturer-funded
- Who
- 39 outpatients with ICD-10 anxiety disorders, mostly generalized anxiety disorder (India)
- What and how much
- Ethanolic extract tablets (Aswal), 250 mg; started at 1,000 mg a day and adjusted between 2 and 10 tablets
- How long
- 6 weeks
Anxiety scores only trended in ashwagandha’s favor, but 88.2% versus 50% met the response criteria. Supported by a grant from Gufic, the extract’s maker.
-
Fuladi et al., 2021
Randomized, double-blind, placebo-controlled add-on trial
- Who
- 40 adults with generalized anxiety disorder already taking SSRIs (Mashhad, Iran)
- What and how much
- Root extract, 1 g a day, one capsule
- How long
- 6 weeks
HAM-A anxiety scores fell 14 points with ashwagandha versus 8 with placebo (P < 0.05); no side effects were observed. The abstract does not state funding.
-
Chandrasekhar et al., 2012
Randomized, double-blind, placebo-controlled
- Who
- 64 adults with chronic stress, screened free of psychiatric disorders (61 analyzed; Hyderabad, India)
- What and how much
- KSM-66 root extract (at least 5% withanolides), 300 mg twice daily
- How long
- 60 days
Perceived stress fell 44.0% versus 5.5% with placebo (P < 0.0001) and serum cortisol 27.9% versus 7.9%. Extract supplied by its maker, Ixoreal Biomed; no funding source declared.
-
Lopresti et al., 2019
Randomized, double-blind, placebo-controlled; manufacturer-funded
- Who
- 60 stressed but healthy adults (India)
- What and how much
- Shoden extract (35% withanolide glycosides), 240 mg once daily
- How long
- 60 days
HAM-A scores fell 41% versus 24% (P = .040); the DASS-21 difference was not significant (P = .096); morning cortisol fell more. Funded by Arjuna Natural, Shoden’s maker.
-
Smith et al., 2023
Randomized, double-blind, placebo-controlled; manufacturer-funded
- Who
- 120 overweight or mildly obese adults aged 40 to 75 with high stress and fatigue
- What and how much
- Witholytin root extract (1.5% withanolides), 200 mg twice daily
- How long
- 12 weeks
Perceived stress, the main outcome, fell on ashwagandha but not significantly more than on placebo (p = 0.867); fatigue improved more. Funded by Verdure Sciences, which supplied the extract.
03 Evidence
What the research shows
Our rating for Ashwagandha for Anxiety, based on the studies below.
Pooled analyses agree on direction but not on confidence. Akhgarjand and colleagues at Tehran University of Medical Sciences (Phytotherapy Research 2022) combined 12 randomized trials with 1,002 participants aged 25 to 48 and found that ashwagandha lowered anxiety (standardized mean difference, or SMD, −1.55; 95% confidence interval −2.37 to −0.74) and stress (SMD −1.75) more than placebo. An SMD expresses the gap between groups in units of the natural variation between people, so these figures look large, but the trials disagreed far more than chance would explain (I² 93.8% for anxiety), and the authors rated the certainty of the evidence as low. Arumugam and colleagues (Explore 2024) pooled nine trials with 558 people and reported an average drop of 4.72 points on the Perceived Stress Scale (PSS, a 0–40 questionnaire), 2.19 points on the Hamilton Anxiety Rating Scale (HAM-A, a clinician-rated scale scored 0–56), and lower serum cortisol compared with placebo. Fatima and colleagues (Human Psychopharmacology 2024), pooling five trials with 254 people, found a larger HAM-A difference of 5.96 points, but with near-total disagreement between trials (I² 98%).
The trials behind most stress claims enrolled stressed but healthy volunteers. Chandrasekhar, Kapoor, and Anishetty (Indian Journal of Psychological Medicine 2012) recruited 64 adults with chronic stress in Hyderabad, after a psychiatrist screened out anyone with a psychiatric disorder, and gave 300 mg of KSM-66 root extract or placebo twice daily for 60 days. Perceived stress fell 44.0% on ashwagandha versus 5.5% on placebo (P < 0.0001), and morning serum cortisol fell 27.9% versus 7.9%; only the 61 people who followed the protocol were analyzed for efficacy. Salve and colleagues (Cureus 2019) randomized 60 adults with PSS scores above 20 to 125 mg or 300 mg of KSM-66 twice daily or placebo for eight weeks. Stress scores and cortisol fell on both doses, but anxiety changed modestly: HAM-A scores went from 24.1 to 20.2 on the higher dose and from 23.3 to 21.4 on placebo, a significant difference only at 600 mg a day. In both trials the extract was supplied by its maker, Ixoreal Biomed, while the papers declared no funding source or competing interests. Lopresti and colleagues (Medicine 2019) gave 60 stressed but healthy Indian adults 240 mg of Shoden once daily or placebo for 60 days. HAM-A scores fell 41% versus 24% (P = .040), the difference on the Depression, Anxiety and Stress Scale (DASS-21) did not reach significance (P = .096), and morning cortisol fell more with ashwagandha. That trial was funded by Arjuna Natural, which makes Shoden.
Only a few small trials tested people with a diagnosed anxiety disorder. Andrade and colleagues at India’s National Institute of Mental Health and Neurosciences (Indian Journal of Psychiatry 2000) randomized 39 outpatients with ICD-10 anxiety disorders, mostly GAD, to an ethanolic ashwagandha extract or placebo for six weeks. Anxiety scores only trended in ashwagandha’s favor, but 88.2% versus 50% met the study’s response criteria; the trial was supported by a grant from Gufic, which made the extract. Fuladi and colleagues (Current Reviews in Clinical and Experimental Pharmacology 2021) added 1 g a day of root extract or placebo to SSRI treatment (selective serotonin reuptake inhibitors, the usual first antidepressants for anxiety) in 40 people with GAD in Mashhad, Iran; after six weeks HAM-A scores had fallen 14 points versus 8 (P < 0.05). In a Canadian trial by Cooley and colleagues (PLoS One 2009), a naturopathic package of dietary counseling, breathing techniques, a multivitamin, and 300 mg of root extract twice daily cut Beck Anxiety Inventory scores by 56.5%, against 30.5% for psychotherapy with placebo, but with so many components the effect of ashwagandha itself cannot be separated. The most useful summary of trials like these is by Marchi and colleagues at the University of Modena and Reggio Emilia (BJPsych Open 2025), who received no funding and included only people with mental disorders: 14 trials, 713 participants, a median dose of 600 mg a day, and a median follow-up of eight weeks. Anxiety improved more than with comparators (pooled SMD −1.96, shrinking to −1.13 when one outlying trial was removed), and side effects and dropouts were similar. But the team found evidence of publication bias (Egger test p < 0.001), meaning unfavorable trials may never have been published; none of the anxiety trials reported a negative result, and the team rated certainty low because results varied so widely.
The clearest null result came from a 12-week trial. Smith, Lopresti, and Fairchild (Journal of Psychopharmacology 2023) gave 120 overweight or mildly obese adults aged 40 to 75 with high stress and fatigue 200 mg of the root extract Witholytin or placebo twice daily. Perceived stress, the main outcome, fell on ashwagandha but not significantly more than on placebo (p = 0.867), although fatigue improved more. Verdure Sciences, which supplied the extract, funded the study, so even company-funded trials do not all succeed. Other limits run through the evidence. The ODS notes that a 2021 review of seven stress and anxiety trials found all 491 participants were from India, that treatment lasted 6 to 8 weeks, and that preparations ranged from 240 to 1,250 mg of extract a day to 12,000 mg of root granules. Most outcomes are questionnaires that participants fill in themselves, which are sensitive to expectations, and the cortisol results come from single morning blood samples. We found no trial comparing ashwagandha alone with an SSRI or with cognitive behavioral therapy (CBT), and the trials described here lasted no longer than 12 weeks.
Guideline bodies are cautiously positive. The 2022 taskforce of the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Treatments (CANMAT), led by Sarris (World Journal of Biological Psychiatry 2022), rated ashwagandha “provisionally recommended” for anxiety disorders, the same rating as lavender, while kava was not recommended for GAD. According to the ODS, the taskforce specified 300 to 600 mg a day of root extract standardized to 5% withanolides for GAD and said more data were needed for a stronger recommendation, and the taskforce advised using such products mainly alongside standard care. NCCIH says some preparations may help stress but that evidence on anxiety is unclear. The UK’s National Institute for Health and Care Excellence (NICE) recommends stepped care for GAD, from education and guided self-help up to CBT, applied relaxation, or an SSRI, with sertraline offered first, and asks clinicians to discuss over-the-counter remedies, their interactions, and the lack of evidence for their safe use. Regulators have not endorsed ashwagandha: the European Medicines Agency’s herbal committee did not adopt a monograph for the root, issuing only a public statement in 2013, and Denmark banned its sale in foods and supplements in 2023 after a 2020 risk assessment by the Technical University of Denmark (DTU) concluded that no risk-free intake could be set.
04 In practice
How it was taken in studies
Trials used standardized extracts, mostly of the root, not kitchen powders or gummies. KSM-66, a root-only extract standardized to at least 5% withanolides, was given at 300 mg twice daily in the 2012 stress trial and at 125 mg or 300 mg twice daily in the 2019 dose trial, where the lower dose did not clearly reduce anxiety. Shoden, standardized to 35% withanolide glycosides, was given as one 240 mg capsule after dinner. The two trials in diagnosed anxiety disorders used larger amounts of other products: an ethanolic extract started at 1,000 mg a day and adjusted between two and ten 250 mg tablets a day, and 1 g a day of root extract added to an SSRI. The WFSBP and CANMAT taskforce’s provisional dose for GAD, as reported by the ODS, is 300 to 600 mg a day of root extract standardized to 5% withanolides. These figures do not transfer between products: a percentage of withanolides and a percentage of withanolide glycosides are not the same measurement, root and leaf differ in chemistry, and gummies, teas, and multi-herb “cortisol” blends often do not state the plant part, extract, or dose.
Trials measured results after 6 to 12 weeks, so there is no evidence about longer use for anxiety. NCCIH describes ashwagandha as possibly safe for up to three months and says there is not enough information to judge long-term safety, so open-ended daily use goes beyond the evidence. If you and a clinician decide to try it, the closest match to the research is a single-ingredient root extract that names its standardization and dose, taken for a fixed period no longer than the trials, with a simple record of anxiety and sleep before and during use. If symptoms are not clearly better, or anxiety is affecting work, relationships, or sleep, the next step is an assessment and a proven treatment rather than a higher dose or a different brand.
05 Caution
Before you try ashwagandha
In trials lasting up to about three months, ashwagandha was generally well tolerated, and side effects were usually mild. NCCIH lists drowsiness, stomach upset, diarrhea, and vomiting, and the ODS adds loose stools and nausea. In the 2012 KSM-66 trial, six mild adverse events occurred on ashwagandha (including drowsiness and decreased appetite) and five on placebo, and the Shoden and 2019 KSM-66 trials reported none. Marchi’s 2025 review found similar rates of side effects and dropouts on ashwagandha and comparators. These trials were too small and short to catch rare problems, and NCCIH says there is not enough information to judge long-term safety. Drowsiness matters for anyone who drives or already takes something sedating.
Liver injury is rare but well documented. Björnsson and colleagues (Liver International 2020) described five people in Iceland and the US who developed jaundice, itching, nausea, lethargy, and abdominal discomfort 2 to 12 weeks after starting ashwagandha supplements. The injury was cholestatic (affecting bile flow) or mixed, itching and jaundice lasted 5 to 20 weeks, and liver tests returned to normal within 1 to 5 months in the four who were followed up; chemical testing confirmed ashwagandha in the products. In a series from India, Philips and colleagues (Hepatology Communications 2023) reported eight people injured by single-ingredient ashwagandha products. Five already had chronic liver disease, and three of them developed acute-on-chronic liver failure and died. LiverTox, the NIH liver-injury database, now lists ashwagandha as a cause of clinically apparent liver injury. Ashwagandha can also raise thyroid hormones. In a trial of 50 people with subclinical hypothyroidism (a mildly underactive thyroid), 600 mg a day of root extract for eight weeks lowered TSH and raised T3 and T4 compared with placebo; small rises in T4 were seen in a bipolar disorder trial; and the ODS notes three case reports of thyrotoxicosis (an overactive thyroid state) in women, which resolved after they stopped. Because it may raise testosterone, NCCIH advises people with hormone-sensitive prostate cancer to avoid it.
Avoid ashwagandha in pregnancy and while breastfeeding, as NCCIH advises. DTU’s risk assessment cites reports that women have used the root to induce abortion, notes that the World Health Organization advises against its use in pregnancy and breastfeeding, and found no data to set a safe level; the ODS adds that the American Herbal Pharmacopoeia says its own monograph was misrepresented and that there is no evidence the root causes abortion. NCCIH also advises against ashwagandha for people with autoimmune or thyroid disorders and before surgery, and the Indian liver series suggests particular danger for anyone with existing liver disease. NCCIH warns of possible interactions with sedatives, anti-seizure medicines, thyroid hormone, immunosuppressants, and medicines for diabetes and high blood pressure. Denmark’s ban followed DTU’s conclusion that the plant may affect sex hormones and reproduction, the thyroid, the immune system, and the nervous system, and France’s food safety agency, ANSES, recommended in 2024 that pregnant and breastfeeding women and people with endocrine disorders avoid it, according to the ODS. Do not stop or cut down an SSRI or a benzodiazepine to switch to ashwagandha without your prescriber, because stopping these medicines suddenly can cause withdrawal problems.
Some situations need prompt help rather than a supplement. If you or someone you know has thoughts of suicide or self-harm, in the US call or text 988, the Suicide & Crisis Lifeline, or chat at 988lifeline.org, and call 911 in a life-threatening situation. Panic attacks, chest pain, fainting, or a racing or irregular heartbeat should be checked by a doctor, since heart and thyroid problems can feel like anxiety. Anxiety that interferes with work, school, relationships, or sleep, or that comes with low mood or heavy alcohol or drug use, deserves a professional assessment; CBT and SSRIs are first-line treatments, and NICE advises against benzodiazepines for GAD except briefly during a crisis. Stop ashwagandha and seek medical care for yellow skin or eyes, dark urine, pale stools, unusual itching, or abdominal discomfort, and for palpitations, tremor, or unexplained weight loss, which can signal an overactive thyroid.
06 Questions
Frequently Asked Questions
It may help a little, especially with everyday stress. Small trials of standardized ashwagandha root extracts found lower anxiety and stress scores than placebo over 6 to 12 weeks, and a 2022 psychiatry taskforce provisionally recommends it for anxiety disorders. But most volunteers were stressed rather than diagnosed with an anxiety disorder, many trials were linked to extract makers, and reviewers rate the evidence low certainty. Oral lavender received the same taskforce rating. For an anxiety disorder, therapy and prescribed treatment come first.
In several trials, yes. In a 2012 trial of 64 stressed adults, morning serum cortisol fell 27.9% on 600 mg a day of KSM-66 root extract versus 7.9% on placebo, and a 2024 meta-analysis of nine trials also found lower cortisol than with placebo. But these were mostly single morning blood tests in healthy volunteers, and a lower cortisol number is not proof of less anxiety or better health. “High cortisol” is not something to diagnose or treat yourself; persistent symptoms deserve a medical assessment.
Rarely, yes. Case series from Iceland, the US, and India describe jaundice and severe itching, usually starting 2 to 12 weeks after beginning ashwagandha. Most people recovered within months of stopping, but in an Indian series three people with existing liver disease developed liver failure and died. The NIH’s LiverTox database lists ashwagandha as a cause of liver injury. Stop taking it and see a doctor for yellow skin or eyes, dark urine, pale stools, or unexplained itching, and avoid it entirely if you have liver disease.
It can. In a small trial of people with a mildly underactive thyroid, 600 mg a day of root extract for eight weeks raised T3 and T4 and lowered TSH compared with placebo, and three case reports describe thyrotoxicosis, an overactive thyroid state, in women taking ashwagandha, which settled after stopping. NCCIH advises against it for people with thyroid disorders and warns of interactions with thyroid hormone medicines. Do not use it as homemade thyroid treatment, and get checked if you develop palpitations, tremor, or weight loss.
Only with your prescriber’s agreement. One small Iranian trial added 1 g a day of root extract to SSRIs in 40 people with generalized anxiety disorder for six weeks and reported more improvement and no side effects, but that is far too little to show the combination is safe for everyone. NCCIH warns that ashwagandha may interact with sedatives and with anti-seizure, thyroid, diabetes, blood pressure, and immune-suppressing medicines. Never stop an SSRI or benzodiazepine to switch to a herb. Kava, another anxiety herb, carries its own serious liver warnings.
In 2020 the Technical University of Denmark assessed ashwagandha root for the Danish food authority and concluded that no intake level could be set that would be free of risk of harm. It pointed to animal and human data suggesting effects on sex hormones and reproduction, thyroid hormones, the immune system, and the nervous system, plus traditional use of the root to induce abortion. Denmark then made it illegal to sell ashwagandha as a food or supplement, in 2023 according to the NIH Office of Dietary Supplements. Other countries still allow it, but these concerns are a firm reason to avoid it in pregnancy.
07 References
Sources
These references support the claims on this page. They are not an endorsement of any product. The ashwagandha monograph carries its own full source list.
-
Ashwagandha: Usefulness and Safety
National Center for Complementary and Integrative Health (NIH), 2023
Updated March 2023: some preparations may help insomnia and stress, anxiety evidence unclear; possibly safe up to 3 months; drowsiness and GI effects; rare liver injury; avoid in pregnancy, breastfeeding, autoimmune or thyroid disorders, before surgery, and in hormone-sensitive prostate cancer; listed interactions.
-
Ashwagandha: Is it helpful for stress, anxiety, or sleep? Health Professional Fact Sheet
NIH Office of Dietary Supplements, 2025
Updated May 2025: WFSBP/CANMAT provisional 300–600 mg/day 5% root extract for GAD; 2021 review of 7 Indian trials (491 adults); Witholytin null on stress; liver cases; thyroid trial and 3 thyrotoxicosis cases; DTU 2020, Danish ban 2023, ANSES 2024; AHP abortion response.
-
Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The WFSBP and CANMAT Taskforce
World Journal of Biological Psychiatry (PubMed 35311615), 2022
Sarris et al.: ashwagandha (++) and lavender (++) modestly supported for anxiety disorders; kava not recommended for GAD; use primarily adjunctively within standard care; product quality and standardization a key limitation.
-
The effect of Withania somnifera (Ashwagandha) on mental health symptoms in individuals with mental disorders: systematic review and meta-analysis
BJPsych Open (PubMed 41140145), 2025
Marchi et al.: 14 RCTs, 713 participants, mostly anxiety disorders, median 600 mg/day for 8 weeks; anxiety SMD −1.96 (outlier-corrected −1.13); publication bias (Egger p < 0.001); low certainty; similar tolerability; no funding.
-
Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials
Phytotherapy Research (PubMed 36017529), 2022
Akhgarjand et al.: 12 RCTs, 1,002 participants aged 25–48; anxiety SMD −1.55 (I² 93.8%), stress SMD −1.75 (I² 83.1%); certainty of evidence low for both outcomes.
-
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 (PubMed 23439798), 2012
Chandrasekhar et al.: 64 stressed adults without psychiatric disorders, KSM-66 300 mg twice daily for 60 days; PSS −44.0% vs −5.5%, cortisol −27.9% vs −7.9%; mild adverse events similar; extract provided by Ixoreal Biomed; source of support nil (full text).
-
An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study
Medicine (Baltimore) (PubMed 31517876), 2019
Lopresti et al.: 60 stressed healthy adults, Shoden 240 mg (35% withanolide glycosides) daily for 60 days; HAM-A −41% vs −24% (P = .040); DASS-21 P = .096; cortisol lower; no adverse events; funded by Arjuna Natural (full text).
-
Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study
Cureus (PubMed 32021735), 2019
Salve et al.: 60 stressed adults, KSM-66 125 or 300 mg twice daily or placebo for 8 weeks; PSS and cortisol fell on both doses; HAM-A 24.10 to 20.15 at 600 mg vs 23.32 to 21.42 on placebo, significant only at 600 mg; extract gifted by Ixoreal Biomed (full text).
-
A double-blind, placebo-controlled evaluation of the anxiolytic efficacy of an ethanolic extract of Withania somnifera
Indian Journal of Psychiatry (PubMed 21407960), 2000
Andrade et al.: 39 outpatients with ICD-10 anxiety disorders (24 GAD); 250 mg tablets, 2 twice daily, titrated 2–10 a day, for 6 weeks; responders 88.2% vs 50%; supported by a grant from Gufic Ltd, the maker (full text).
-
Assessment of the Efficacy of Withania somnifera Root Extract in Patients with Generalized Anxiety Disorder: A Randomized Double-blind Placebo-Controlled Trial
Current Reviews in Clinical and Experimental Pharmacology (PubMed 32282308), 2021
Fuladi et al.: 40 patients with DSM-IV-TR GAD on SSRIs, root extract 1 g/day or placebo for 6 weeks; HAM-A reduction 14 vs 8 points (P < 0.05); no adverse effects observed.
-
Exploring the efficacy and safety of a novel standardized ashwagandha (Withania somnifera) root extract (Witholytin®) in adults experiencing high stress and fatigue
Journal of Psychopharmacology (PubMed 37740662), 2023
Smith, Lopresti, and Fairchild: 12-week RCT, 200 mg twice daily in adults aged 40–75; perceived stress not significantly different from placebo (p = 0.867); fatigue improved; funded by Verdure Sciences (full text).
-
Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network
Liver International (PubMed 31991029), 2020
Björnsson et al.: 5 patients, jaundice after 2–12 weeks; cholestatic or mixed injury; pruritus and hyperbilirubinemia 5–20 weeks; no liver failure; tests normal within 1–5 months in 4; ashwagandha confirmed chemically.
-
Ashwagandha-induced liver injury: A case series from India and literature review
Hepatology Communications (PubMed 37756041), 2023
Philips et al.: 8 single-ingredient cases among 23; mostly cholestatic hepatitis; 5 had chronic liver disease, 3 developed acute-on-chronic liver failure and died; no adulteration found.
-
Ashwagandha
LiverTox, National Institute of Diabetes and Digestive and Kidney Diseases (PubMed 31643854), 2024
Updated 3 December 2024: ashwagandha has not been implicated in enzyme elevations during therapy but has been implicated in cases of clinically apparent liver injury.
-
Risikovurdering af roden fra Withania somnifera (Risk assessment of Withania somnifera root)
DTU Fødevareinstituttet (National Food Institute, Technical University of Denmark), for the Danish Veterinary and Food Administration, 2020
Dated 15 May 2020: no intake limit free of risk can be set; reported use of the root to induce abortion; WHO advises against use in pregnancy and lactation; possible effects on sex hormones, thyroid, immune system, and nervous system.
-
Generalised anxiety disorder and panic disorder in adults: management (CG113)
National Institute for Health and Care Excellence (NICE), 2020
Stepped care for GAD: education and monitoring, low-intensity self-help, then CBT, applied relaxation, or an SSRI (sertraline first); discuss over-the-counter preparations and lack of safety evidence; no benzodiazepines except short-term in crises.