What are the benefits and risks of using Ashwagandha for stress and anxiety?

Ashwagandha for Stress and Anxiety: Benefits and Risks

Ashwagandha can effectively reduce stress and anxiety symptoms while improving quality of life, but should be discontinued at least 2 weeks before surgery due to potential sedative effects and interactions with anesthetics. 1

Benefits of Ashwagandha

• High-concentration full-spectrum Ashwagandha root extract (300mg twice daily for 60 days) significantly reduces stress scores and serum cortisol levels compared to placebo, with minimal adverse effects 2

• Ashwagandha root extract standardized for 2.5% withanolides (500mg daily for 60 days) significantly improves:

  • Perceived stress scores
  • Generalized anxiety disorder symptoms
  • Quality of life measures
  • Cognitive function (multitasking, concentration, decision-making)
  • Stress hormone regulation (reduced cortisol, increased serotonin) 3

• Even lower doses (125mg daily) of Ashwagandha formulations containing 1.5% withanolides can significantly improve both subjective and objective measures of stress, anxiety, mood, and sleep quality 4

• Dose-response studies show significant reductions in stress and anxiety with both 250mg/day and 600mg/day, with the higher dose showing more pronounced effects on cortisol reduction and sleep quality improvement 5

• Meta-analysis of randomized controlled trials confirms Ashwagandha's beneficial effects on both stress and anxiety, with optimal dosing for anxiety reduction up to 12,000mg/day and stress reduction at 300-600mg/day 6

Risks and Considerations

• Ashwagandha has sedative properties that may interact with anesthetics and should be discontinued at least 2 weeks before surgery 1

• It may potentiate the effects of sedatives, benzodiazepines, and opiates, potentially causing excessive sedation 1

• Herbal supplements like Ashwagandha contribute to medication burden and expense, with potential drug interactions and limited regulatory oversight 1

• The certainty of evidence for Ashwagandha's effects on anxiety and stress is considered low, indicating a need for more high-quality studies 6

Clinical Application Algorithm

1. Patient Assessment:

   • Evaluate stress and anxiety severity using validated tools (PSS, GAD-7)
   • Screen for upcoming surgical procedures (discontinue 2 weeks prior) 1
   • Check for concurrent use of sedatives, benzodiazepines, or anesthetics (potential interactions) 1

2. Dosing Recommendations:

   • For mild to moderate stress: Start with 250mg daily 5
   • For more significant symptoms: Consider 300-600mg daily 6
   • Monitor for 4-8 weeks for clinical response 2, 3

3. Monitoring:

   • Assess improvement in stress scores, anxiety symptoms, and sleep quality
   • Watch for adverse effects, though clinical trials show these are generally mild and comparable to placebo 2
   • Consider objective measures like cortisol levels if available 3

4. Precautions:

   • Avoid combining with other sedatives or CNS depressants 1
   • Discontinue at least 2 weeks before any surgical procedure 1
   • Use caution in patients with polypharmacy, especially the elderly 1

Clinical Pearls

• Ashwagandha appears most effective when used consistently over 4-8 weeks, with benefits potentially increasing over time 2, 3

• The adaptogenic properties of Ashwagandha may help improve resilience to stress rather than simply masking symptoms 4

• While Ashwagandha shows promise for stress and anxiety management, it should be considered as part of a treatment approach that may include other evidence-based interventions 2

• When recommending Ashwagandha, standardized extracts with specified withanolide content provide more consistent clinical effects 3, 4