Ashwagandha for Stress and Anxiety: What Trials Found and Their Limits
What pooled reviews and individual trials of ashwagandha found for stress and anxiety scores and cortisol, which extracts were tested, who paid, and where the evidence is weak.
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Quick answer
Ashwagandha (Withania somnifera (L.) Dunal, family Solanaceae, accepted name per GBIF) is a shrub. [1] Supplements typically contain root, leaf, or root and leaf extracts. [2] NIH's National Center for Complementary and Integrative Health (NCCIH) says some preparations may be effective for stress, but that the evidence is unclear for anxiety, and that many studies were small and used different preparations. [2] Our label for the evidence: promising but limited. The word "adaptogen" is used loosely and is debated; see What are adaptogens?.
Traditional use is one thing, trials are another
Ashwagandha has been used as a medicinal plant for a very long time, especially in traditional Ayurvedic medicine. [2] That is traditional use. It tells us why researchers tested the plant. It is not proof that it works, and the trials below do not prove the traditional claims either. For the tradition itself, see Ashwagandha in Ayurveda.What the pooled reviews found
Reviews combine many small trials. Their scores depend on which trials they include.| Review | What it pooled | What it found | Cautions the authors or we note |
|---|---|---|---|
| Phytotherapy Research, 2022 | 12 papers, 1,002 participants [3] | Lower anxiety and stress scores than placebo [3] | Anxiety results varied widely between trials (I2 = 93.8%); certainty of evidence was low for both outcomes [3] |
| Explore, 2024 | 9 randomized trials, 558 patients [4] | Lower Perceived Stress Scale, Hamilton Anxiety Scale and serum cortisol than placebo [4] | Four of the included studies reported mild to moderate adverse events [4] |
| Human Psychopharmacology, 2024 | 5 trials, 254 people with anxiety or insomnia [5] | Lower Hamilton Anxiety scores [5] | The authors say larger studies are needed [5] |
| BJPsych Open, 2025 | 14 studies, 360 treated and 353 controls [6] | Lower anxiety and stress symptoms [6] | Mostly anxiety disorders, median follow-up 8 weeks, large differences between studies [6] |
| Journal of Alternative and Complementary Medicine, 2014 | 5 human trials [7] | Two of three dose-comparison trials showed significant benefit on anxiety scores [7] | All studies had unclear or high risk of bias, so the results could not be pooled [7] |
Cortisol is a lab marker, not a feeling
Cortisol is a hormone that can be measured in blood or saliva. The 2024 review above found serum cortisol lower with ashwagandha. [4] One 60-day trial of 60 stressed adults gave a standardized extract (240 mg a day in that trial) or placebo. It reported a statistically significant fall on the Hamilton Anxiety scale (P = .040), only a near-significant change on the DASS-21 stress scale (P = .096), and a larger fall in morning cortisol (P < .001). [8] The authors suggested an effect on the stress-hormone (HPA) axis. [8] A lab change is not the same as feeling or functioning better, and these results do not show that ashwagandha "lowers cortisol" or "heals the adrenals" in people generally. See adrenal fatigue claims.Different extracts, different results
Trials used different products, and a result for one does not transfer to another.| Trial | Extract and population | Result | Funding |
|---|---|---|---|
| 12-week trial, 2023 | Root extract, 200 mg twice daily, overweight or mildly obese adults aged 40 to 75 with stress and fatigue [9] | Stress score fell, but not differently from placebo (p = 0.867) [9] | Funded by the extract's supplier [9] |
| 60-day trial, 2012 | High-concentration root extract, 64 adults with a history of chronic stress [10] | Significant reduction on all stress scales versus placebo [10] | Funding not checked |
| 60-day trial, 2023 | Standardized root extract, 54 randomized, 50 finished [11] | Perceived stress, GAD-7 anxiety and quality-of-life scores improved versus placebo [11] | Funding not checked |
| 8-week trial, 2024 | Root and leaf water extract, 131 enrolled, 98 analyzed [12] | Reported reduced stress at three amounts [12] | Funded by the extract's supplier [12] |
| 30-day trial, 2022 | Root and leaf extract [13] | Group differences on self-report measures were non-significant [13] | Funding not checked |
The 60-day trial in the previous section was funded by the extract's manufacturer. [8]
Frequently asked questions
Does ashwagandha lower cortisol?
In a 2024 pooled review of nine trials, serum cortisol was lower with ashwagandha than placebo, and one 60-day trial found lower morning cortisol. [4][8] Cortisol is a lab marker, and a lower reading does not by itself mean a person feels or functions better.
Is ashwagandha proven for anxiety?
No. NCCIH says evidence is unclear for anxiety. [2] Pooled reviews found lower anxiety scores, but one rated the certainty of evidence as low, and another found all included studies had unclear or high risk of bias. [3][7]
How long have the trials lasted?
The pooled mental-health trials had a median follow-up of 8 weeks, and the individual trials above ran 30 days to 12 weeks. [6][9][13] NCCIH says there is not enough information on long-term safety. [2]
Do results for one extract apply to another?
No. One 12-week root extract trial found no difference from placebo on its main stress score, while others using different root or root-and-leaf extracts reported benefit. [9][11][12] Compare the plant part, extract and population, not just the plant name.
Can I take it with anxiety or depression medicine?
Ask the prescriber or pharmacist before combining anything. NCCIH says ashwagandha might interact with sedatives and several other medicine groups, and no one should stop a prescribed medicine on their own. [2]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Limits and uncertainty
- Many studies were small and used a variety of preparations. [2]
- Follow-up in the pooled mental-health trials was short, a median of 8 weeks. [6]
- Where we could check, several of the trials above were paid for by the maker or supplier of the tested extract. [8][9][12] That does not make a result wrong, but independent repeat trials are what would settle it.
- Long-term safety is not established. [2]
- "Proper evidence not found" for head-to-head trials against prescribed anxiety treatments. We searched PubMed for pooled ashwagandha reviews; see Adaptogens vs prescription treatments.
Safety and who should ask first
NCCIH lists drowsiness, stomach upset, diarrhea and vomiting as possible effects, and rare reports of liver injury. [2] It says ashwagandha should be avoided in pregnancy and not used while breastfeeding, and is not recommended before surgery or for people with autoimmune or thyroid disorders. [2] It may interact with medicines for diabetes and high blood pressure, immunosuppressants, sedatives, anti-seizure medicines and thyroid hormone medicines. [2] See medicine interactions and side effects and liver injury reports. Anyone taking medicine for anxiety or depression should ask the prescriber or pharmacist first. Related guides: Ashwagandha overview, ashwagandha for sleep, stress and anxiety: when to get help.
References
- GBIF species match, queried 2026-10-23: GBIF Backbone Taxonomy: Withania somnifera. Read 2026-10-23.
- NIH National Center for Complementary and Integrative Health, page last updated March 2023: Ashwagandha: Usefulness and Safety. Read 2026-10-23.
- Phytotherapy Research, 2022: Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials. Read 2026-10-23.
- Explore, 2024: Effects of Ashwagandha (Withania Somnifera) on stress and anxiety: A systematic review and meta-analysis. Read 2026-10-23.
- Human Psychopharmacology, 2024: Safety and efficacy of Withania somnifera for anxiety and insomnia: Systematic review and meta-analysis. Read 2026-10-23.
- BJPsych Open, 2025: The effect of Withania somnifera (Ashwagandha) on mental health symptoms in individuals with mental disorders: systematic review and meta-analysis. Read 2026-10-23.
- Journal of Alternative and Complementary Medicine, 2014: An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). Read 2026-10-23.
- Medicine (Baltimore), 2019: An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: a randomized, double-blind, placebo-controlled study. Read 2026-10-23.
- Journal of Psychopharmacology, 2023: Exploring the efficacy and safety of a novel standardized ashwagandha root extract in adults experiencing high stress and fatigue in a randomized, double-blind, placebo-controlled trial. Read 2026-10-23.
- Indian Journal of Psychological Medicine, 2012: A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Read 2026-10-23.
- Medicine (Baltimore), 2023: A standardized Ashwagandha root extract alleviates stress, anxiety, and improves quality of life in healthy adults by modulating stress hormones: results from a randomized, double-blind, placebo-controlled study. Read 2026-10-23.
- Nutrients, 2024: Effects of Withania somnifera Extract in Chronically Stressed Adults: A Randomized Controlled Trial. Read 2026-10-23.
- Journal of Ayurveda and Integrative Medicine, 2022: Efficacy of Withania somnifera supplementation on adult's cognition and mood. Read 2026-10-23.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.