Ashwagandha (Withania somnifera)

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Published August 17, 2025•Updated February 20, 2026•Reviewed February 20, 2026

Indications

Primary Indications

Stress and anxietySleep disturbances (insomnia, poor sleep quality)Mild depressionCognitive performance supportHormonal balance (testosterone, thyroid modulation)

Mechanism

Withanolides modulate the hypothalamic–pituitary–adrenal (HPA) axis, reducing cortisol and stress responses. Ashwagandha may also enhance GABAergic signaling, contributing to anxiolytic and sleep-promoting effects. It has antioxidant and neuroprotective properties and may support testosterone production in men.

Dosing

Adult Dosing

sleep: 300–500 mg/day, often in evening

cognition: 300–500 mg/day

usual range: 300–600 mg/day of standardized extract (withanolides 5–10%)

stress anxiety: 300–600 mg/day divided

testosterone support: 600 mg/day (divided)

Dosage Forms

Capsules (standardized extracts, e.g., KSM-66, Sensoril)
Powder (root powder, commonly in milk or water)
Tincture

Onset Duration

Effects on stress and anxiety typically observed within 2–8 weeks. Sleep improvements may occur within weeks of daily use.

Adverse Effects

Common Side Effects

• GI upset

• drowsiness

• headache

⚠️ Serious Side Effects

liver injury (rare case reports)
abortifacient effects (pregnancy)

Warnings

Critical Safety Information

→Avoid during pregnancy due to potential uterine stimulation.
→Use caution in thyroid disorders; may increase thyroid hormone levels.
→Possible additive sedation with CNS depressants.

Interactions

With: Benzodiazepines or sedatives

Risk: Additive sedation

Action: Monitor closely

With: Thyroid medications

Risk: Potential additive thyroid effects

Action: Monitor thyroid function

With: Immunosuppressants

Risk: May reduce effectiveness due to immunostimulation

Action: Avoid or monitor

Monitoring

Stress/anxiety symptoms
Sleep quality
Thyroid function (if relevant)
Signs of sedation

Special Populations

👶Pregnancy

Avoid due to potential abortifacient effects

🤱Breastfeeding

Not recommended; insufficient safety data

👧Children & Adolescents (Under 18)

Not well studied; not routinely recommended

👴Older Adults (65+)

Generally well tolerated; start low and monitor

Tapering

No formal taper required; may discontinue without withdrawal effects.

Clinical Notes

One of the most studied Ayurvedic adaptogens for stress and anxiety.
KSM-66 and Sensoril are the most common standardized extracts with different withanolide concentrations.
Has shown testosterone-supporting effects in some clinical trials in men.

This treatment information is for educational purposes only. Treatment decisions should be made in consultation with qualified healthcare professionals based on individual circumstances, symptoms, and medical history. Do not attempt treatment without professional guidance.

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