Ashwagandha for anxiety and stress: effects, studies and risks

Ashwagandha extracts may ease stress and anxiety symptoms in some adults. Controlled studies show positive signals, but most of them are small, short and very different from one another. That is why the supplement is not a reliable substitute for effective treatment of an anxiety disorder, and it is not something to reach for in the middle of a panic attack. The decision should rest on your symptoms, possible interactions and safety risks; a single cortisol reading is not enough.

What ashwagandha is and how it might affect the stress response

Ashwagandha, botanically Withania somnifera, is a plant used in Ayurvedic medicine. It is often called an adaptogen, a label for the idea that it helps the body adjust to strain. The term does not describe a standardized medical effect, nor any disease for which the remedy would automatically be suitable.

Its constituents include withanolides, which are chemically steroidal lactones. Other components may also contribute to its effects. One major line of research concerns the hypothalamic-pituitary-adrenal axis, or HPA axis, which among other things controls the release of cortisol.

In some clinical studies, certain extracts lowered both reported stress symptoms and cortisol levels. That fits the hypothesis that ashwagandha influences the stress response. It does not prove that everyone with anxiety has an overactive HPA axis, or that the extract repairs a clearly measurable “dysregulation.” Chronic stress does not lead to persistently raised cortisol in everyone. NIH research overview

The composition matters for interpreting the evidence:

Root extracts such as KSM-66 are often standardized to about 5 percent withanolides.
Root-and-leaf extracts such as Sensoril can have different profiles and concentrations of up to about 10 percent.
The same number of milligrams therefore does not automatically mean the same amount of active compounds or the same effect.

What clinical studies show about anxiety

Several randomized trials report improvements on validated scales such as the Hamilton Anxiety Rating Scale (HAM-A) or the Beck Anxiety Inventory. These scales record how severe symptoms are; they do not directly measure a hormonal mechanism.

A 2024 meta-analysis pooled five randomized trials with a total of 254 participants. On average, HAM-A scores were 5.96 points lower with ashwagandha than with placebo. The 95 percent confidence interval ran from 1.59 to 10.34 points in favor of the extract. At the same time, results varied enormously between the trials, with a heterogeneity of I² = 98 percent. The average figure is therefore not a reliable prediction for any one person. Meta-analysis on anxiety and sleep

The groups studied range from people with self-reported stress to people with anxiety or sleep complaints. Not all of them amount to a diagnosed anxiety disorder. It would also be too sweeping to describe every participant as demonstrably hormonally “dysregulated.”

Many studies last about 8 to 12 weeks. They can show short-term changes, but they say little about long-term benefit, relapse, rare side effects or the best way to combine the extract with psychotherapy and medication. Positive results deserve to be taken seriously, without concluding that the effect is established for every form of anxiety.

What role cortisol and other pathways might play

The HPA axis is a feedback loop. Under stress, the hypothalamus releases CRH. This signal prompts the pituitary gland to release ACTH, which stimulates the adrenal glands to produce cortisol. Cortisol in turn acts back on the higher control centers. This feedback normally helps keep the response in check.

One hypothesis holds that ashwagandha alters certain parts of this system and so dampens an excessive stress response. Falling cortisol in individual studies fits that idea. It does not fully explain, in humans, whether the sensitivity of the feedback is actually restored. A general blockade of cortisol would be neither the goal nor an accurate description.

GABA and NMDA pathways are also being studied. GABA mostly has an inhibitory effect in the nervous system, while NMDA receptors are involved in excitatory signaling. Preclinical findings may help explain why certain extracts show calming or nerve-protecting effects in models. Which constituents are responsible, and how much of the effect in humans they account for, remains an open question.

Inflammation is another line of research. Stress and inflammatory signals can influence each other, and some papers discuss changes in markers such as CRP. A lower inflammatory marker, however, would be neither specific proof of reduced anxiety nor automatically the explanation for it. A review brings together the wider research on these mechanisms. Review of ashwagandha

Forms, doses and timing in the research

Type of extract

KSM-66 contains root material and is often described as having about 5 percent withanolides. Sensoril contains root and leaf material with a different ratio of constituents and, in some cases, a higher standardization. Both have been studied in clinical settings, but without a head-to-head comparison they cannot simply be ranked by effectiveness.

The exact preparation belongs in every description of a study. A result for one particular extract cannot reliably be applied to any powder, tea or blend. Nor does “more withanolides” automatically mean “better for anxiety.”

Dose

Studies commonly use 300 to 600 mg of extract a day, sometimes split into two doses. With more concentrated products, amounts of 125 to 250 mg are also used. Taking 300 mg twice a day is therefore one dosing pattern that has been studied, not a universal recommendation.

Ashwagandha is not an essential nutrient whose deficiency needs correcting. It contains biologically active substances. A larger amount does not have to work more strongly, but it can change how well it is tolerated. Reports of liver injury also cannot be brushed aside with the comforting assumption that they only happen at high doses.

Timing

Some studies split the intake between morning and evening; others use a different schedule. If you get stomach or gut complaints, taking it with a meal may help in practice. A general claim that food has been shown to improve absorption of every extract would go too far.

Drowsiness may affect the time of day some people choose. The data so far, however, do not point to a universally best time for anxiety symptoms. The remedy should not be seen as an as-needed product for acute panic.

Combinations

Combinations with rhodiola, magnesium or other products are on the market. Whether they add anything is a separate research question; the effect of a blend cannot be worked out by adding up its ingredients. If you start several products at once, it also becomes harder to tell what helps or what causes side effects.

Particular caution is needed with sedating medicines, thyroid medication or immunosuppressants. For possible effects on liver enzymes such as CYP3A4, laboratory findings need to be kept separate from clinical interactions that have actually been demonstrated. Labeling every drug broken down by that route as safe or dangerous across the board would not be appropriate; the specific medicine should be checked.

Who the results apply to, and who should be careful

Many studies were done in people with high self-reported stress or related symptoms. The findings say more about such groups than about people who are not under strain. A high cortisol level, however, is not an established selection test for ashwagandha treatment. Conversely, a normal reading does not prove that the symptoms are unimportant or that a possible effect is ruled out.

Possible benefits are also being studied in perimenopause. A small randomized trial found improvements in menopausal symptoms and certain hormonal changes. That justifies further interest, but not a blanket claim that women at this stage of life respond especially well to it as an anxiety treatment. Study in perimenopausal women

Key groups and risks:

Pregnancy and breastfeeding: Safety has not been adequately established; avoid ashwagandha.
Current or past liver disease: Avoid it because of reported liver injury.
Children: There are not enough safety data for use without medical guidance.
Overactive thyroid or Graves’ disease: Possible hormonal effects may be a problem.
Immunosuppressants: Immune-modulating effects could interfere with treatment.
Sedating medicines or certain anti-anxiety drugs: Increased drowsiness is possible.
Hormone-sensitive prostate cancer: Possible hormonal changes should be discussed with the oncology team; do not take it on your own.

The German Federal Institute for Risk Assessment (Bundesinstitut für Risikobewertung, BfR) stresses the limited safety data and in particular the risks for children, pregnant and breastfeeding women, and people with liver disease. BfR statement

Older age alone does not make anyone a particularly good candidate. If anything, more frequent coexisting conditions and multiple medications can make the decision more complicated. If anxiety persists, it is worth getting a proper assessment and discussing established treatments, including psychotherapy.

How to judge whether anything has changed

For anxiety treatment, what counts is whether the symptoms ease and daily life gets easier: less avoidance, better sleep or more room to act, for example. A symptom diary or a suitable validated scale can make such changes easier to follow. A lab value does not replace this assessment.

Cortisol is often high in the morning, roughly around 8 a.m., depending on when you sleep and get up. But it fluctuates a great deal. A single reading, or several higher morning readings, does not prove a general disorder of the stress axis. DHEA-S and the cortisol-to-DHEA-S ratio are being studied scientifically, but they are not generally validated tests of whether ashwagandha is working against anxiety.

hs-CRP is also nonspecific. If it falls after you start a supplement, a cleared infection, weight changes or other factors may be involved. The timing alone does not prove a causal effect of the supplement.

Thyroid values matter if you have a relevant history or symptoms. A small randomized trial in subclinical hypothyroidism looked at ashwagandha and thyroid parameters. This particular population must not be equated with healthy people or with people who have an overactive thyroid. Whether TSH, free T4 or other values should be monitored depends on the medical situation. Study in subclinical hypothyroidism

Heart rate variability (HRV) describes the variation in the time intervals between heartbeats. It is influenced by breathing, fitness, sleep, the measuring device and many other factors. A rise on a smartwatch may be interesting, but it confirms neither a normalized HPA axis nor an established effect of ashwagandha. Studies of HRV remain a relevant research question; personal conclusions need suitable measuring conditions and clinical context.

Frequently asked questions

What is the HPA axis and why is it being studied?

It links the hypothalamus, the pituitary gland and the adrenal glands, and controls part of the stress response. Ashwagandha might influence this regulation. Lower cortisol levels in individual studies support the hypothesis, but they do not prove a general “recalibration” in everyone with anxiety.

What do studies show about anxiety scores?

There are positive results compared with placebo. A meta-analysis of five trials with 254 participants found scores on the HAM-A scale that were 5.96 points lower on average, although results varied widely between trials. That points to a possible signal whose size and applicability still need to be clarified.

How do KSM-66 and Sensoril differ?

KSM-66 is a root extract, often with about 5 percent withanolides. Sensoril contains root and leaf, sometimes at concentrations of up to 10 percent. Studies have used, for example, 300 mg twice a day or lower amounts of 125 to 250 mg. These figures do not allow a direct comparison of effectiveness without a suitable comparative trial.

Does it work like a benzodiazepine?

No. Benzodiazepines act on GABA-A receptors through a well-described mechanism and can work quickly. For ashwagandha, several pathways are under discussion, and clinical studies mostly look at use over weeks. It is not an established substitute for the immediate treatment of an acute anxiety or panic episode.

Which biomarkers show whether it works?

None of the commonly promoted markers confirms reduced anxiety on its own. Cortisol, DHEA-S, hs-CRP and HRV can be of interest in research or in certain medical situations. For personal treatment, what matters most are symptoms, daily life, side effects and an appropriate medical assessment.

Are interactions with medications possible?

Yes, including with sedatives, immunosuppressants and thyroid medication. The combination should also be checked with blood pressure or diabetes medicines. Changes in liver enzymes in the lab are not automatically clinically relevant interactions with every drug; the specific situation is what counts.

Does it help with anxiety during menopause?

Individual studies on menopausal symptoms offer positive hints. They do not answer reliably how well a diagnosed anxiety disorder is treated at this stage of life. Thyroid disease, sleep problems and other causes should also be considered when symptoms appear.

Who should avoid it?

In particular pregnant and breastfeeding women, children, and people with current or past liver disease. Taking it on your own also makes no sense if you have an overactive thyroid, hormone-sensitive cancer or medications with possible interactions. Calling something “herbal” says nothing about whether it is risk-free.

Sources

Guo S, Rezaei MJ (2024). The benefits of ashwagandha (. Frontiers in nutrition, 11, 1439294. https://doi.org/10.3389/fnut.2024.1439294 Source link
Kelaiditis CF, Gibson EL, Dyall SC (2022). Effects of long-chain omega-3 polyunsaturated fatty acids on reducing anxiety and/or depression in adults; A systematic review and meta-analysis of randomised controlled trials. https://doi.org/10.1101/2022.10.17.22281092 Source link
Patan MJ, Kennedy DO, Husberg C, Hustvedt SO, Calder PC, Middleton B, Khan J, Forster J, Jackson PA (2021). Differential Effects of DHA- and EPA-Rich Oils on Sleep in Healthy Young Adults: A Randomized Controlled Trial. Nutrients, 13(1). https://doi.org/10.3390/nu13010248 Source link
Sharma AK, Basu I, Singh S (2018). Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. Journal of alternative and complementary medicine (New York, N.Y.), 24(3), 243-248. https://doi.org/10.1089/acm.2017.0183 Source link
Fatima K, Malik J, Muskan F, Raza G, Waseem A, Shahid H, Jaffery SF, Khan U, Zaheer MK, Shaikh Y, Rashid AM (2024). Safety and efficacy of Withania somnifera for anxiety and insomnia: Systematic review and meta-analysis. Human Psychopharmacology, 39(6), e2911. https://doi.org/10.1002/hup.2911 Source link