Ashwagandha (Withania somnifera, Solanaceae) root is also known as Indian ginseng, although it does not belong to the ginseng family. This plant has been used in Ayurvedic medicine for centuries as a compound or product that increases the ability of a person to resist, adapt, or become resilient to biological, physical, or chemical stressors. The chemical composition of ashwagandha root and leaf differ and commercial ashwagandha supplements utilize extracts from the roots. although some contain extracts from both the root and leaf.
The species name somnifera comes from the Latin word for sleep-inducing, indicating another property. I do not see it as a sedative, but as a circadian rhythm regulator. In addition to sleep, ashwagandha is commonly promoted for stress and anxiety reduction.
The authors of the current study conducted a randomized, double-blinded, placebo-controlled clinical trial (RCT) to investigate the effects of a standardized ashwagandha root extract (ARE) in adults with mild to moderate anxiety and depression.
Patients studied were from two clinical sites in India, ages 18-69 and had Hamilton Depression Rating Scale (HDRS) scores of 8-19 and Hamilton Anxiety Rating Scale (HARS) scores of 6-24. These were individuals who did not have other psychiatric medical or neurocognitive disorders and were not taking medications, supplements or using psychotherapy for mental health.
A total of 70 patients were randomized to the ARE (n = 34) or placebo (n = 36) group. One site recruited 36 patients, 18 in both ARE and placebo; the second site recruited 34, with 16 in ARE and 18 in placebo. At a baseline visit (day 0), patients received a 30-day supply of their study pills, with follow-up visits on days 30, 60, and 90 and a telephone follow-up 15 days later.
The treatment group took a standardized extract of ARE containing 2.5% withanolides. Each capsule contained 500 mg ARE (12.5 mg withanolides) and 5 mg of 95% piperine from black pepper. The piperine was added to enhance bioavailability by increasing absorption and slowing metabolization and efflux.
In addition to the HDRS and HARS, study measures on days 0, 30, 60, and 90 included the Groningen Sleep Quality Scale (GSQS) and WHO-Quality of Life (QoL) index. Serum serotonin levels were analyzed on days 0 and 90, as were additional hematology and urine profiles. The mean age of patients was 40.69 ± 11.34 years and 61.42% were men.
There was a significant decrease in HARS scores by day 30 for ARE, with significant decreases also on days 60 and 90. The mean HARS scores also decreased, and scores in ARE were significantly lower on days 60 and 90. HDRS scores decreased in both groups by day 30 but they continued to drop in ARE on days 60 and 90, while the scores in the placebo group plateaued. On days 60 and 90, decreases were significantly better in ARE vs. placebo. All the patients taking ARE reported improved anxiety and depression vs. 66.6% in the placebo group. GSQS scores improved in both groups, and placebo scores were slightly better than ARE on day 30. The placebo scores plateaued through day 90, and those in ARE continued to improve, with significant differences between ARE and placebo on days 60 and 90.
QoL scores improved in both groups similarly by day 30 and continued to improve in ARE but declined in the placebo group. By day 90, ARE was significantly better than the placebo. Serum serotonin levels rose significantly in ARE vs. falling significantly in the placebo group.
Commentary: Overall, we can say that this study showed improvement in mild to moderate anxiety and depression with the Ashwagandha extract. This is compatible with results from other studies on ashwagandha that suggest it has beneficial impact on stress. Overall, these studies have found that ashwagandha significantly reduced stress and anxiety levels, reduced sleeplessness and fatigue and reduced the stress hormone, serum cortisol levels. Doses in studies have ranged from 240 mg to 1,250 mg/day of extract or 12,000 mg/day of whole root granules equivalent to 6,000 mg of powder. In several studies, the benefits were greater with doses of 500 to 600 mg/day than with lower doses.
A 2021 systematic review identified seven studies that investigated the use of ashwagandha to treat stress and anxiety. (Lopresti AL, Smith SJ. Ashwagandha (Withania somnifera) for the treatment and enhancement of mental and physical conditions: A systematic review of human trials. Journal of Herbal Medicine 2021;28:100434.
I often use Ashwagandha in combination with St John’s wort for depression and/or herbals and nutraceuticals for anxiety (kava, lavender, lemon balm, L-theanine). In addition, Ashwagandha can be used to bring about circadian rhythm regulation in sleep disorders while also using direct sleep aids such as tryptophan, valerian, melatonin and others.
Reference: Majeed M, Nagabhushanam K, Murali A, Vishwanathan DT, Mamidala RV, Mundkur L. A standardized Withania somnifera (Linn.) root extract with piperine alleviates the symptoms of anxiety and depression by increasing serotonin levels: A double-blind, randomized, placebo-controlled study. J Integr Complement Med. October 25, 2023
The study was funded by SSGL. Authors MM, KN, AM, and LM are employees of SSGL; the remaining authors declare no conflicts of interest.
