What are the uses and precautions of Ashwagandha (Withania somnifera) as a dietary supplement for stress relief and anxiety?

Ashwagandha for Stress Relief and Anxiety: Uses and Precautions

Ashwagandha (Withania somnifera) is effective for reducing stress and anxiety with a favorable safety profile, but should be discontinued at least 2 weeks before surgery due to its sedative properties that may interact with anesthetics. 1

Therapeutic Benefits

Stress and Anxiety Reduction

• High-concentration full-spectrum Ashwagandha root extract (300mg twice daily) significantly reduces stress scores and serum cortisol levels compared to placebo 2
• Standardized root extract (500mg daily with 2.5% withanolides) effectively improves:
  • Perceived stress scale scores
  • Generalized anxiety disorder symptoms
  • Quality of life measures
  • Cognitive function (multitasking, concentration, decision-making) 3
• Dose-response studies show effectiveness at both 250mg/day and 600mg/day, with stronger effects at higher doses 4

Additional Benefits

• Helps with body weight management in adults under chronic stress 5
• Improves sleep quality compared to placebo 4
• May increase serotonin levels and reduce morning cortisol 3

Dosage and Administration

• Effective dosage range: 250-600mg daily of standardized root extract
• Typical regimen: 300mg twice daily for 60 days 2
• Dose-response analysis indicates favorable effects on anxiety up to 12,000mg/day and on stress at doses of 300-600mg/day 6

Precautions and Contraindications

Perioperative Considerations

• Must be discontinued 2 weeks before surgery due to sedative properties that may potentiate anesthetics 1
• Ashwagandha has sedative properties independent of anesthesia and may interact with medications used during anesthesia 1
• May inhibit γ-aminobutyric acid metabolism, potentially enhancing effects of sedatives 1

Special Populations

• Limited data on use in pregnancy, breastfeeding, and pediatric populations
• Caution in patients taking other sedatives or CNS depressants
• No serious adverse events reported in clinical trials, with mild adverse effects comparable to placebo 2

Quality Considerations

• Choose standardized extracts (typically standardized to 2.5-5% withanolides)
• Quality can vary significantly between products
• Look for products that have been tested for purity and potency

Monitoring

• Regular assessment of stress and anxiety symptoms using validated scales (PSS, GAD-7)
• Monitor for potential side effects, though these are typically mild
• If using for perioperative stress management, ensure proper discontinuation before surgery

Clinical Decision Algorithm

1. Assess baseline stress and anxiety using validated scales (PSS > 20 indicates significant stress)
2. Start with 300mg standardized extract twice daily
3. Evaluate response after 4-8 weeks
4. If inadequate response and no side effects, consider increasing to 600mg daily
5. Discontinue at least 2 weeks before any surgical procedure
6. Reassess periodically for continued need and effectiveness

Ashwagandha appears to be a safe and effective option for stress and anxiety management in adults, but proper timing of discontinuation before surgical procedures is essential to avoid potential interactions with anesthetics.