Ashwagandha for Stress Reduction and Anxiety

Introduction to Ashwagandha

The American College of Physicians and other guideline societies recommend considering ashwagandha for stress reduction and anxiety, with moderate-quality evidence supporting its use, and demonstrated reductions in perceived stress scores and cortisol levels, but it should be discontinued at least 2 weeks before any surgical procedure due to sedative properties and potential drug interactions 1, 2

The American Society of Anesthesiologists recommends holding ashwagandha for 2 weeks before surgery due to sedative properties that can cause additive central nervous system depression with anesthetics 1, 2
The National Kidney Foundation notes that ashwagandha has been shown to increase total diazepam-induced sleep time in a dose-dependent manner and may potentiate effects of barbiturates and benzodiazepines 2
The American College of Clinical Pharmacology warns that ashwagandha may interact with medications metabolized through cytochrome P-450 pathways, similar to other adaptogenic herbs 2
The Mayo Clinic advises that there is a potential for enhanced sedation when combined with other CNS depressants 1, 2

The American Academy of Sleep Medicine recommends Cognitive Behavioral Therapy for Insomnia (CBT-I) as the gold standard first-line treatment for insomnia, rather than ashwagandha 3
The American Psychiatric Association notes that evidence-based psychotherapy and FDA-approved medications have more robust safety profiles for anxiety disorders than ashwagandha 5
The Annals of Internal Medicine compare ashwagandha favorably to kava, which has a "strong against" recommendation due to hepatotoxicity risk, but note that ashwagandha lacks the extensive safety database of FDA-approved medications 6