NAD Supplementation for Anxiety: Limited Evidence for Effectiveness
There is inconclusive evidence to recommend NAD supplementation for anxiety reduction, with only preliminary research showing modest benefits in specific populations.
Current Evidence on NAD and Anxiety
The most recent systematic review examining NAD supplementation (2024) found limited evidence for anxiety reduction 1:
- A systematic review of 10 studies with 489 participants across various conditions showed some decrease in anxiety and maximum heart rate after stress tests
- However, these studies were heterogeneous in design and population, making firm conclusions difficult
Specific Findings in Clinical Studies
One randomized controlled trial specifically examined NAD effects on anxiety:
- In patients with chronic fatigue syndrome, NADH (20mg daily) was associated with a modest 1.0-point decrease in anxiety scores compared to 0.2-point decrease with placebo (p<0.05) 2
- This same study showed decreased maximum heart rate after stress testing in the NADH group (-8.1 beats/min, p<0.05) versus placebo (+1.7 beats/min, p=0.73)
- However, no significant differences were found in most other variables measured 2
Preclinical Evidence and Related Compounds
Some animal studies suggest potential mechanisms:
- Nicotinamide riboside (NR), an NAD precursor, corrected social deficits and anxiety-like behaviors in CD157 knockout mice 3
- NR supplementation improved contextual fear memory in Alzheimer's disease model mice 4
- These animal studies cannot be directly extrapolated to human anxiety disorders
Guidance from Clinical Guidelines
Current clinical guidelines do not specifically recommend NAD for anxiety:
- The Society for Integrative Oncology-ASCO guideline (2023) lists "inconclusive evidence for... melatonin, or other natural products and supplements to improve anxiety symptoms" 5
- The Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement (2021) does not include NAD among supplements with established effects on anxiety 5
Safety Considerations
NAD supplementation appears generally well-tolerated:
- Common side effects include muscle pain, nervous disorders, fatigue, sleep disturbance, and headaches 1
- No serious adverse events were reported in the systematic review of NAD supplementation 1
Conclusion
While preliminary evidence suggests potential benefits of NAD supplementation for anxiety in specific populations like those with chronic fatigue syndrome, the current evidence is insufficient to recommend it as a primary treatment for anxiety disorders. More robust clinical trials are needed to determine optimal dosing, specific indications, and long-term effects.