From the Guidelines
Ashwagandha should be discontinued prior to surgery due to its potential to alter the safety profile of prescribed medications and interact with anesthesia. When considering the use of ashwagandha, it is essential to weigh its potential benefits against the risks, particularly in the context of surgical procedures. As noted by Leonberg-Yoo et al 1, certain dietary supplements, including ashwagandha, have sedative properties that can interact with anesthesia and prescribed medications, potentially altering their safety profiles. Key points to consider include:
- Ashwagandha's sedative effects, which can be independent of anesthesia, may enhance the sedative properties of certain anesthetics 1.
- The potential for ashwagandha to interact with medications metabolized by the cytochrome P-450 (CYP450) pathway, which could either attenuate or enhance the sedative properties of certain anesthetics 1.
- The recommendation for perioperative cessation of dietary supplements associated with theoretical or known higher risk for myositis or rhabdomyolysis, as suggested by Leonberg-Yoo et al 1. Given these considerations, discontinuing ashwagandha prior to surgery is the most prudent course of action to minimize potential risks and ensure optimal outcomes.
From the Research
Ashwagandha Effects on Anxiety and Stress
- Ashwagandha supplementation has been found to significantly reduce anxiety and stress levels in several studies 2, 3, 4.
- A systematic review and meta-analysis of randomized controlled trials found that Ashwagandha supplementation reduced anxiety (SMD: -1.55,95% CI: -2.37, -0.74; p = .005) and stress levels (SMD: -1.75; 95% CI: -2.29, -1.22; p = .005) compared to placebo 2.
- A randomized, double-blind, placebo-controlled study found that Ashwagandha root extract alleviated stress, anxiety, and improved quality of life in healthy adults by modulating stress hormones 3.
- Another study found that Ashwagandha root extract improved memory and focus, psychological well-being, and sleep quality, reduced stress levels, and was safe and well-tolerated in healthy, stressed adults 4.
Comparison to Traditional Anxiety Treatments
- Traditional treatments for anxiety disorders, such as selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT), have been found to be effective in reducing anxiety symptoms 5, 6.
- A review of anxiety disorders found that SSRIs and SNRIs are associated with small to medium effect sizes compared to placebo, while CBT has been found to have a large effect size in reducing anxiety symptoms 5.
- A study on emotion-based brain mechanisms and predictors for SSRI and CBT treatment of anxiety and depression found that both treatments reduced limbic activity during emotion perception, which predicted anxiety and depression symptom improvement 6.
Dosage and Efficacy
- The optimal dosage of Ashwagandha for reducing anxiety and stress levels is not established, but studies have used doses ranging from 300-600 mg/day 2, 3, 4.
- A non-linear dose-response analysis found that Ashwagandha supplementation had a favorable effect on anxiety until 12,000 mg/d and stress at a dose of 300-600 mg/d 2.