Since ancient times, people all over the world have used herbal medicine to prevent, control or treat various illnesses and diseases. This practice has continued to the present day, despite the popularity of conventional medicine. In fact, the herbal medicine market has seen rapid growth in recent years amid a rising demand from consumers for all-natural, chemical-free, and process-free alternatives. One of the more prominent herbs that has been extensively studied is ashwagandha, an ancient herb used extensively in Ayurveda.

But what, exactly, is Ashwagandha?

Among the thousands of medicinal herbs available worldwide is ashwagandha or Withania somnifera. Also known as Indian “winter cherry” or “Indian ginseng,” the shrub is common in India and very popular in Ayurvedic medicine as its parts treat a wide range of ailments. Ashwagandha roots are considered a tonic, astringent, aphrodisiac, thermogenic, and anthelmintic, and are recommended to treat rheumatism, constipation, nervous breakdown, and insomnia, among many other ailments <1>. With all its healing and restorative properties, ashwagandha has, for centuries, been administered to children and the elderly alike for all of the following reasons:

• to treat diseases
• to promote long life
• to improve memory
• to boost reproductive and nervous system functions
• to relieve stress
• to protect the body against cellular damage <1>.

Clinical Trials of Ashwagandha

Clinical trials to evaluate the effectiveness of ashwagandha in treating illnesses have also been carried out. In these studies, it has been proven that ashwagandha can help improve the condition of patients with psychiatric disorders such as anxiety, obsessive-compulsive disorder (OCD), depression, and schizophrenia.

Ashwagandha for Anxiety

Anxiety is a common stress response. It involves feelings of tension and worry, and can sometimes involve physical manifestations such as high blood pressure. Anxiety can contribute to chronic respiratory disorders, heart disease, and gastrointestinal conditions <2>. While a wide range of conventional treatments are readily available, ashwagandha can be an excellent alternative option to calm anxiety. Five human trials concluded that those with ashwagandha intervention had higher score improvements than placebo in terms of the stress and anxiety scales <3>. In 2006, a group of naturopathic doctors in Toronto, Canada conducted a randomized controlled trial on Canada Post employees with moderate to severe anxiety lasting over six weeks. The subjects were randomly grouped based on age and gender, and given naturopathic care (NC) or standardized psychotherapy intervention (PT) over a 12-week duration. NC participants were given the herbal medicine ashwagandha, dietary counseling, deep breathing relaxation tips, and a standard multivitamin, while PT participants received a placebo, psychotherapy and deep breathing relaxation exercises. After the trial period, both NC and PT participants experienced improvement in anxiety symptoms. However, the NC group showed a significant drop in anxiety levels <4>. Another randomized, double-blind, placebo-controlled study on the efficacy of the ashwagandha root extract in reducing stress and anxiety in adults, subjected 64 individuals with a history of chronic stress. They were divided into two groups. The study group took ashwagandha capsules while the control group placebo capsules, twice a day for 60 days <5>. Results showed that the treatment group that received the high-concentration full-spectrum ashwagandha root extract demonstrated a significant reduction in scores on all stress-assessment scales. The conclusion of the study suggested that the herb can greatly help in fighting stress, with mild adverse effects <5>.

Ashwagandha for OCD

Ashwagandha has also been found to be a safe option in the treatment of OCD. OCD refers to uncontrollable obsessions and compulsions such as frequent cleaning or handwashing. According to the Mental Health America, when the actions are not performed, those suffering from OCD experience elevated anxiety levels <6>. In the US, about 2.2 million adults or 1% of the population are affected by OCD <7>. A 2014 study was conducted to show the effects of ashwagandha on OCD in mice. Extracts of ashwagandha effectively decreased OCD activity while not having any effect on mice motor activity, thereby showing its efficacy in treating obsessive-compulsive behavior <8>. Thirty individuals diagnosed with OCD participated in a 2015 randomized, double-blind, placebo-controlled trial to check the efficacy of the ashwagandha root extract as an adjunct remedy to standard OCD treatment. The participants were assigned randomly to the treatment group or the placebo group, and were treated with Selective Serotonin Re-uptake Inhibitors (SSRIs). They were asked to take four capsules of the extract or placebo each day for six weeks. At the end of the study, they found that ashwagandha taken alongside SSRIs may be effective in the treatment of OCD. The beneficial effect of ashwagandha as an antidepressant was significantly greater versus that of the placebo used in this study <8>.

Ashwaganda for Depression

Meanwhile, over 300 million people of all ages suffer from depression, making it the top cause of disability globally, according to the World Health Organization <9>. Depression may involve feelings of sadness, guilt and tiredness, loss of interest or appetite, poor concentration, low self-worth and disturbed sleep. In many cases, this also hinders the person from performing well at work or in school. The symptoms can range from mild, to moderate and severe. At its worst, depression can lead to suicide. Although psychological and pharmacological treatments are accessible, clinical studies suggest ashwagandha may hold promise as an alternative treatment as it has been widely used to control the mood in patients with behavioral disturbances <10>. A University of Pittsburgh Medical Center study on the effects of a standardized extract of ashwagandha on depression and anxiety symptoms in patients with schizophrenia found that the herb may be effective in treating depression in schizophrenic patients. However, the study also suggested additional trials to investigate its clinical efficacy <11>. Another experimental study conducted in rats by the Banaras Hindu University in India probed the anxiolytic and antidepressant actions of the bioactive glycowithanolides (WSG) from the roots of ashwagandha. The study found that WSG demonstrated an antidepressant effect. The study concluded that ashwagandha can be used “as a mood stabilizer in clinical conditions of anxiety and depression in Ayurveda” <10>.

Ashwaganda for Schizophrenia

Schizophrenia is a severe brain disorder that involves delusions, hearing voices and psychotic experiences. It affects a patient’s sense of self, thinking, perception and language, and leads to the loss of the ability to hold a job or study <12>. Schizophrenia affects about 1.1% of the global population and defies race, ethnicity and economic background. About three-quarters of individuals diagnosed with schizophrenia develop the disorder between 16 and 25 years of age <13>. A University of Pittsburgh Medical Center study has shown that ashwagandha can relieve the symptoms associated with schizophrenia. The medical center conducted a randomized, double-blind, placebo-controlled study on the adjunctive use of a standardized extract of ashwagandha to treat exacerbation symptoms of schizophrenia in 66 patients over a 12-week period <14>. The study sought to prove if the anti-inflammatory and immunomodulating properties of the plant could alleviate the symptoms and stress in patients with mental disorder. The participants were either placed on placebo or ashwagandha treatment, in addition to their antipsychotic medication <14>. The results show that a standardized extract of ashwagandha is effective in reducing the negative, general and total symptoms of schizophrenia as well as stress in subjects who experienced a flare-up of the disorder, with minimal side effects <14>.

Safety, Side Effects and Precautions

Clinical studies in humans, while limited, reveal that ashwagandha is generally safe and effective in the treatment of the mentioned psychological disorders. However, some studies suggest more needs to be done to prove its clinical efficacy <1, 15>. In addition, long-term studies are required to check its possible side effects. The studies above suggest it is okay as an adjunct therapy with SSRIs for OCD. However, to be on the safe side, patients currently prescribed with anxiety or depression drugs are urged to continue taking them unless advised by a healthcare professional.

The Bottom Line

With the resurgence of herbal medicine of late, more studies on ashwagandha are still being conducted. Studies on its pharmaceutical potential remain limited, with some being done on animals. However, researchers have acknowledged its multiple benefits. As a whole, ashwagandha cannot be considered a miracle pill for all patients with anxiety, OCD, depression and schizophrenia, but it does show a lot of promise. References: <1> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252722/ <2> https://www.health.harvard.edu/staying-healthy/anxiety_and_physical_illness <3> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270108/ <4> https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0006628 <5> https://www.ncbi.nlm.nih.gov/pubmed/23439798 <6> https://www.mentalhealthamerica.net/conditions/ocd <7> https://adaa.org/about-adaa/press-room/facts-statistics <8> https://www.ncbi.nlm.nih.gov/pubmed/22546655 <9> https://www.ncbi.nlm.nih.gov/pubmed/27515872 <10> https://www.who.int/news-room/fact-sheets/detail/depression <11> https://www.ncbi.nlm.nih.gov/pubmed/11194174 <12> https://www.ncbi.nlm.nih.gov/pubmed/31046033 <13> https://www.who.int/mental_health/management/schizophrenia/en/ <14> https://sardaa.org/resources/about-schizophrenia/ <15> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/