Ashwagandha May Help to …

Anxiety disorders are the most prevalent type of psychiatric disorder. The lifetime incidence is estimated to be 16.6% worldwide. 

Anxiety is the space between the “now” and the “then.”  — Richard G. Abell, M.D. 

Common anxiety is a normal reaction to stress because it can help a person to deal with a tense situation at work or when studying for an exam or when focused on an important meeting or presentation. Generally, it helps one to cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it becomes a debilitating disorder. Among its major types are:Anxiety disorders are the most prevalent type of psychiatric disorder. The lifetime incidence is estimated to be 16.6% worldwide. With the planet population rapidly approaching 7 billion, this adds up to a colossal figure, of people who suffer (or who have suffered) anxiety stress in their lives. They never can be sure that they are free of it.

These disorders are associated with considerable chronicity, morbidity, and disability; they may develop over time and last a long time, they may result in a diseased state, and they may leave one unable to take care of oneself. In fact, anxiety may place one at increased risk for other disease conditions and lower the overall quality of life, as well as ability to function in normal daily living. Additionally, anxiety disorders impose high individual and social burdens, tend to be chronic, and can be as disabling as somatic disorders.

  • Generalized Anxiety Disorder

  • Obsessive-Compulsive Disorder (OCD)

  • Panic Disorder

  • Post-Traumatic Stress Disorder (PTSD)

  • Social Phobia (or Social Anxiety Disorder)

The Huge Economic Repercussions of Anxiety Disorders

It is curious, but understandable when you think about it, that people with anxiety disorders, compared to those with other psychiatric disorders, are far more likely to seek out general practitioners rather than psychiatric professionals.

Nevertheless, the economic costs of anxiety disorders include psychiatric as well as nonpsychiatric emergency care, as well as prescription drugs, hospitalization, reduced productivity, work absenteeism, and suicide. Just in the workplace alone, there are huge economic repercussions, demonstrating both the medical and productivity costs of anxiety disorders.

One study investigating the impact of anxiety disorders in large businesses found that employees so diagnosed were much more apt to have additional diagnoses, use a greater number of services, require hospitalization, and visit the emergency room more frequently, compared with other classes of disease or morbidity.1 After controlling for differences in comorbidities, employees diagnosed with anxiety disorders had significantly higher productivity costs, medical costs, and overall costs. Using data from the World Health Organization Collaborative Study on Psychological Problems in General Health Care, researchers also found that the mean number of work loss days with marked disability (during the past 30 days) due to any anxiety disorder to be 19, which was higher than diabetes and heart disease.

CAM Inclination Toward Combination Therapy

Unfortunately, although complementary and alternative medicine (CAM) is popular, including for those suffering from anxiety, to date there is limited evidence supporting the CAM approach.2 Prior research on anxiety has more often than not focused on single interventions or therapies. Indeed, there have been few studies investigating multi-therapeutic CAM approaches.

At the same time, in the non-CAM world, recent trends in anxiety treatment disclose a noteworthy superiority from combination psychotherapy and drug intervention over monotherapy (either psychotherapy or pharmacological treatment). Collaterally, movement towards multiple types of treatment for anxiety in clinical practice mirrors the values and practices inherent to CAM therapies. It also offers lots of research challenges using the randomized trial design.

Remarkably, CAM research frequently employs a degree of pragmatism in designing randomized controlled trials, which is of value to determine whether an intervention works under real-life conditions. Moreover, such an approach can help determine whether it is effective for outcomes that are important to the patient. No previous studies have investigated the impact of a multi-therapeutic CAM approach for anxiety.

Behavioral Interventions, As Combination Therapy Component

Keeping with this approach are behavioral interventions, such as diaphragmatic breathing, which have been demonstrated to lower anxiety levels while enhancing coping capability in stressful situations. Also, therapies that identify negative stress coping patterns and replace them with positive alternatives have been shown to be an effective means of controlling and treating anxiety. Stress reduction counseling is an effective primary care treatment for widespread health concerns, including mental health, anxiety, self-esteem, physical health, and job satisfaction in the workplace. This has been shown in a large meta-analysis.3

Additionally, anxiety disorders 
impose high individual and 
social burdens, tend to be chronic, 
and can be as disabling as 
somatic disorders.

Anxiolytic Benefits from an Ancient Indian Herb

In a recent study utilizing a multi-therapeutic combination approach, Withania somnifera, which has been an important herb within the Ayurvedic and indigenous medical systems for over 3000 years, was found to offer significant anxiolytic (anti-anxiety) benefits.4 Known as ashwagandha (the word is from Sanskrit), W. somnifera is an Indian herb also known as winter cherry. This shrub is cultivated in India where its roots have been used for thousands of years by Ayurvedic practitioners. The root contains flavonoids and many active ingredients of the withanolide class. Despite studies done over the past few years finding that this herb has anti-inflammatory, anti-tumor, anti-stress, antioxidant, mind-boosting, immune-enhancing, and rejuvenating properties, the anxiety/combination study is the first of its kind. It is worth mentioning that historically ashwagandha root has also been noted to have sex-enhancing properties (see sidebar). Furthermore, studies with ashwagandha have been done for Parkinson’s disease, cognitive and neurological disorders, and as a useful adjunct for patients undergoing radiation and chemotherapy. Ashwagandha is also used therapeutically as an adaptogen—a natural herb product that is traditionally used to increase resistance to stress, trauma, anxiety, and fatigue—for patients with nervous exhaustion, insomnia, debility due to stress, and as an immune stimulant in patients with low white blood cell counts.5,6 It sounds like an urban legend.

Ashwagandha Enhances Semen Quality

Stress and anxiety have been identified as contributory factors for male infertility. Withania somnifera (ashwagandha) has been documented in the Ayurveda and Unani medicine system for its ability to combat stress.1 Nevertheless, there is a paucity of scientific literature on this aspect of W. somnifera. In a new study, scientists at CSM Medical University, Lucknow, India undertook a study designed to understand the role of stress in male infertility, while testing whether W. somnifera could treat male infertility.

Selecting 60 normozoospermic (having normal sperm production) but infertile individuals, who were further categorized in three groups: 20 normozoospermic heavy smokers, 20 normozoospermics under psychological stress, and 20 normozoospermics with infertility of unknown etiology. As controls, 60 other normozoospermic fertile men were recruited.

The test subjects were given root powder of W. somnifera at a rate of 5 g/day for 3 months. The researchers measured various biochemical and stress parameters before and after treatment, which suggested a strong role for stress in male infertility. Moreover, W. somnifera was found to treat stress-related infertility resulting in a decrease in stress, improving the level of antioxidants, and importantly boosting overall semen quality in a significant number of individuals. To top things off, pregnancy occurred in the partners of 14% of the subjects receiving ashwagandha, a significant success.

  1. Mahdi AA, Shukla KK, Ahmad MK, Rajender S, Shankhwar SN, Singh V, Dalela D. Withania somnifera Improves Semen Quality in Stress-Related Male Fertility. Evid Based Complement Alternat Med 2009 Sep 29. [Epub ahead of print]

Combination Therapy

The conductors of the anxiety/combination study set out to explore the effectiveness of multi-therapeutic CAM care for anxiety symptoms. Drawing upon a large employee database of Canadian postal workers, 41 employees with moderate to severe anxiety of duration of at least 6 weeks were randomized, based on age and gender, to receive “naturopathic care.” As a control group, 40 received standardized psychotherapy intervention. The study spanned a period of 12 weeks. Both investigators and participants were blinded during randomization and allocation.

After controlling for 
differences in comorbidities, 
employees diagnosed with 
anxiety disorders had significantly 
higher productivity costs, 
medical costs, and overall costs.

Participants in the naturopathic care group received dietary counseling, deep breathing relaxation techniques, a standard multi-vitamin, and the herbal medicine, ashwagandha (300 mg, twice per day). The ashwagandha was standardized to 1.5% withanolides and prepared from the root of the plant (for an analysis of ashwagandha constituents, see sidebar). The other group received just the psychotherapy part, with matched deep breathing relaxation techniques, and placebo.

Constituents and Activity of Ashwaganda

Ashwagandha’s major constituents are steroidal alkaloids and steroidal lactones in a class of constituents called withanolides. Presently, 12 alkaloids, 35 withanolides, and several sitoindosides from this plant have been isolated and studied. Despite this, much of ashwagandha’s pharmacological activity is attributed to two main withanolides, withaferin A and withanolide D.

In theory, withanolides serve as important hormone precursors which may be convertible into human physiologic hormones as needed.1 Ashwagandha is thought to help regulate important physiologic processes. When there is an excess of a certain hormone, it is currently thought, the plant-based hormone precursor occupies cell membrane receptor sites preventing the actual hormone from attaching and exerting its effect. As an adaptogen, ashwagandha may facilitate the ability to withstand stressors; it also has antioxidant properties. Another important mechanism explaining Withania somnifera’s activity is thought to be its immunostimulatory effect.

  1. Monograph. Withania somnifera. Altern Med Rev 2004 Jun;9(2):211-4.

The outcomes included a primary measure, the Beck Anxiety Inventory, and secondary measures included the Short Form 36, Fatigue Symptom Inventory, and Measure Yourself Medical Outcomes Profile. The goal was to determine the effects of therapies on anxiety, mental health, and quality of life, respectively. The placebo-controlled intervention was blinded to the participants as well.

No previous studies have investigated 
the impact of a multi-therapeutic 
CAM approach for anxiety.

Of 75 participants (93% of the starting number) who were followed for 8 or more weeks on the trial, the final Beck Anxiety Inventory scores decreased by 56.5% in the naturopathic care group (with ashwagandha), while just 30.5% were found to have decreased scores in the psychotherapy group (with placebo). The ashwagandha group outperformed the placebo group by 85%. The Beck Anxiety Inventory scores were significantly decreased with ashwagandha compared to placebo.

Importantly, significant differences between groups were also observed in mental health, concentration, fatigue, social functioning, vitality, and overall quality of life with the naturopathic group (ashwagandha) demonstrating greater clinical benefit. There were no serious adverse reactions in either group.

As we have mentioned, many people seek alternatives and/or complementary care rather than conventional treatments, and that’s true for anxiety too. Yet, to date, there have been no studies that have assessed what a naturopathic treatment protocol can do to effectively treat anxiety, until now. So the knowledge of this trial’s efficacy and safety using natural health products ought to be of deep interest to natural healthcare physicians, as well as the public.

The ashwagandha group 
outperformed the placebo 
group by 85 percent.

Both therapies led to significant improvements in patients’ anxiety, although the ashwagandha group rose above the other therapy on most counts. There was a significant decrease in anxiety levels in the ashwagandha group compared to the psychotherapy-only group. Noteworthy improvements in secondary quality of life measures were also observed in the ashwagandha group as compared to the psychotherapy-only group. It is clear that each of the components needs further investigation to more accurately weigh the whole system of naturopathic care for anxiety needs, and especially within the context of their additive effect, such as clearly appears to be the case for ashwagandha.

Other Evidence for Anxiolytic and Antidepressive Properties

In an animal study designed to assess its anxiolytic and antidepressive activity, ashwagandha was compared to the pharmaceuticals, lorazepam and imipramine.7 The former, a benzodiazepine, is prescribed for anxiolytic activity, and the latter, a tricyclic antidepressant, is given for depression. An extract of the root was administered orally to rats once daily for five days. The results were compared to a group administered lorazepam for anxiolytic activity, and imipramine for antidepressant benefit. Both the ashwagandha and lorazepam groups demonstrated lower brain levels of a marker of clinical anxiety. Ashwagandha also exhibited an antidepressant effect comparable to imipramine in forced swim-induced “behavioral despair” and “learned helplessness” tests. Other studies, confirming similar results, have built the case for the use of ashwagandha as an antistress adaptogen.8–11

There was a significant decrease in 
anxiety levels in the 
ashwagandha group compared to 
the psychotherapy-only group.

However you cut to the root (pardon the pun) of the growing number of studies that have been done with ashwagandha, it seems clear that this is a material whose time has come. W.H. Auden’s poem, The Age of Anxiety: A Baroque Eclogue won the Pulitzer Prize for Poetry in 1948. It also inspired a symphony by composer Leonard Bernstein, The Age of Anxiety (Symphony No. 2 for Piano and Orchestra) and a 1950 ballet by Jerome Robbins based on the symphony. “The Age of Anxiety” also appears as the title of the first chapter of The Wisdom of Insecurity by Alan W. Watts (1951). That was then. This is now. Perhaps ashwagandha will lead the way.


  1. Marciniak M, Lage MJ, Landbloom RP, Dunayevich E, Bowman L. Medical and productivity costs of anxiety disorders: case control study. Depress Anxiety2004;19:112–20.
  2. Rafferty AP, McGee HB, Miller CE, Reyes M. Prevalence of complementary and alternative medicine use: state-specific estimates from the 2001 Behavioral Risk Factor Surveillance System. Am J Public Health 2002;92:1598–1600.
  3. Faragher EB, Cass M, Cooper CL. The relationship between job satisfaction and health: a meta-analysis. Occup Environ Med 2005;62: 105–112.
  4. Cooley K, Szczurko O, Perri D, Mills EJ, Bernhardt B, Zhou Q, Seely D. Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974. PLoS One 2009 Aug 31;4(8):e6628.
  5. Monograph. Withania somnifera. Altern Med Rev 2004;9:211–4.
  6. Mishra LC, Singh BB, Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Altern Med Rev 2000;5:334–46.
  7. Bhattacharya SK, Bhattacharya A, Sairam K, Ghosal S. Anxiolytic-antidepressant activity of Withania somnifera glycowithanolides: an experimental study. Phytomedicine 2000 Dec;7(6):463-9.
  8. Bhattacharya A, Ghosal S, Bhattacharya SK. Antioxidant effect of Withania somnifera glycowithanolides in chronic footshock stressinduced perturbations of oxidative free radical scavenging enzymes and lipid peroxidation in rat frontal cortex and striatum. J Ethnopharmacol 2001;74:1-6.
  9. Singh B, Saxena AK, Chandan BK, et al. Adaptogenic activity of a novel, withanolide-free aqueous fraction from the root of Withania somnifera. Phytother Res 2001;15:311-8.
  10. Archana R, Namasivayam A. Antistressor effect of Withania somnifera. J Ethnopharmacol 1999;64:91-3.
  11. Dhuley JN. Adaptogenic and cardioprotective action of ashwagandha in rats and frogs. J Ethnopharmacol 2000;70:57-63.