A large industry trial reports gains that outpace most anxiety medications
STUDY: Gajwani P et al, Neuropsychiatr Dis Treat 2026
STUDY TYPE: Randomized controlled trial
FUNDING: Himalaya Wellness Company
Background
Ashwagandha is an Indian medicine classified as an adaptogen, meaning it reduces anxiety while improving people’s ability to manage stress. That use is supported by five large and ten small placebo controlled trials, 87% of which were positive. This one adds another large trial to the count.
The Study
- 226 adults at eight Indian psychiatric centers with mild to moderate stress or anxiety and no recent psychiatric medications; 222 completed the trial.
- Randomized to a 670 mg ashwagandha caplet or placebo nightly for 8 weeks.
- Outcomes: Anxiety scale (HAM-A), Stress scale (PSS-10), and a general distress scale (GHQ-12).
Results
Anxiety scores fell 60% on ashwagandha (19 to 7.8) and 30% on placebo (19 to 13.6), a difference of about 6 points on the clinician-rated HAM-A. Stress scores fell 39% versus 17%.
Those gains are large. By comparison, SSRIs usually beat placebo by 2 to 3 HAM-A points in generalized anxiety disorder.
Side Effects
Adverse events were equal (22% vs 21%), mostly headaches.
Risks
There are reports of liver and thyroid abnormalities with ashwagandha. In this study, liver labs stayed normal. TSH rose in two patients who had stopped their thyroid medication.
Limitations
- Sponsored and co-authored by the manufacturer.
- Only 8 weeks long.
- Mild cases: symptoms needed to last just 2 weeks.
Practice Implications
- This trial is larger than most ashwagandha studies, but its effect size is hard to accept at face value. An herb that doubles the benefit of an SSRI needs replication by researchers without a stake in the product.
- Adaptogens are a reasonable alternative to benzodiazepines for stress, although therapy is ideal. Stick with lab-tested products to get the right ratio of ingredients, particularly with ashwagandha, whose liver risks may be due to product quality.
- Learn how to use ashwagandha in the Complementary and Alternative Medicine in Psychiatry Fact Book.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
