Ashwagandha for Anxiety

By the clinical team at Next Step Psychiatry • Lilburn, GA

Why Patients Ask About Ashwagandha

Ashwagandha (Withania somnifera) is an adaptogenic herb that has been used in Ayurvedic medicine for centuries. In recent years it has surged in popularity as a natural anxiety remedy, with wellness influencers and supplement companies promoting it heavily. Many patients at Next Step Psychiatry ask whether ashwagandha could help their anxiety, and it is a fair question. The herb does have real pharmacological activity, and dismissing it outright would be doing patients a disservice.

What the Clinical Research Shows

Several randomized controlled trials have examined ashwagandha for anxiety. A 2019 systematic review in the Journal of Alternative and Complementary Medicine analyzed five trials totaling 400 participants and found a significant reduction in anxiety scores compared to placebo. A 2021 study published in Cureus showed that 600 mg daily of standardized root extract reduced perceived stress and cortisol levels over eight weeks. However, most of these studies are small (under 100 participants), short-term (6 to 12 weeks), and funded by supplement companies, which introduces potential bias. The evidence is promising but not yet strong enough to replace FDA-approved treatments.

How Ashwagandha May Work

The proposed mechanism involves modulation of the hypothalamic-pituitary-adrenal (HPA) axis, the body's primary stress response system. Ashwagandha's active compounds, withanolides, appear to reduce cortisol production and may also act on GABA receptors in the brain, which are the same receptors targeted by benzodiazepines. This dual mechanism could explain why some people experience both physical relaxation and mental calming effects.

Safety Concerns and Drug Interactions

Ashwagandha is generally well tolerated, but it is not risk-free. Reported side effects include gastrointestinal upset, drowsiness, and rare cases of liver toxicity. It may interact with thyroid medications because it can increase thyroid hormone levels. It can also enhance the sedative effects of benzodiazepines and sleep medications. Pregnant and breastfeeding women should avoid it entirely. The FDA does not regulate supplements with the same rigor as prescription medications, so purity and dosing can vary significantly between brands.

A Psychiatrist's Perspective

At Next Step Psychiatry, we take an evidence-based but open-minded approach to supplements. If a patient wants to try ashwagandha for mild anxiety, we generally support that decision while monitoring their progress. However, for moderate to severe anxiety, generalized anxiety disorder, or panic disorder, we recommend FDA-approved medications like SSRIs or SNRIs as the primary treatment. Ashwagandha may serve as a complementary approach alongside therapy and medication but should not replace professional treatment for diagnosable anxiety disorders.

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider. If you or someone you know is in crisis, call 911 or the 988 Suicide & Crisis Lifeline.