Serum cortisol, daytime sleepiness, fatigue, triglycerides, and blood pressure-related parameters also improved when supplemented with 600mg of Ashwagandha daily during the study period.
Writing in Stress, researchers from India pointed out that ashwagandha could serve as a potential natural therapy for stress-related symptom burden in patients with cardiovascular risk, based on findings from this study.
600mg daily for 60 days
Sixty individuals diagnosed with mild to moderate levels of anxiety, perceived stress, hypertension, alongside cardiometabolic risk factors, such as higher waist circumference, triglycerides, blood pressure, blood glucose, or HDL cholesterol, took part in this randomized, double-blind, two-arm, placebo-controlled clinical study.
They took a capsule containing 300mg of ashwagandha or placebo twice daily during the study. The total daily dose of 600mg ashwagandha was selected based on previously published clinical studies of standardized Ashwagandha root extracts in adults, where daily doses within the range of 250 to 600 mg have shown favourable efficacy and tolerability profiles.
The ashwagandha used in this study is commercially available as Ashwagen, an extract derived from the roots of the ashwagandha (Withania somnifera Dunal) plant provided by Dr. Willmar Schwabe India Pvt. Ltd.
To evaluate the effects of ashwagandha, serum cortisol levels, lipid profile, triglycerides, blood pressure and other cardiometabolic parameters were measured on day 30 and day 60 of the study.
Tools such as the Hamilton anxiety rating scale (HAM-A), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Perceived Stress Scale (PSS) and the 7 item questionnaire (GAD-7) for generalised anxiety disorder were used to detect changes to stress and anxiety.
Improvements in stress and anxiety parameters
Ashwagandha supplementation was found to have significantly reduced anxiety and stress markers compared to the placebo group.
For example, HAM-A scores, which indicate the severity of anxiety symptoms, was down 26.94% from 21.90 to 16.00 in the Ashwagen group. The placebo group also saw a decrease in HAM-A scores, albeit to a lower extent, with the score reduced by 14.70% to 18.40.
Similarly, GAD-7 scores for measuring anxiety levels declined from 13.07 to 6.43 in the Ashwagen group, amounting to a 50.77% reduction, compared to the placebo group, which was down by 22.96% to 10.07.
For perceived stress, PSS scores decreased from 23.73 to 16.50 in the Ashwagen group, down by 30.47%, while the placebo group showed a smaller decrease of 23.73 to 20.77, down by 12.47% reduction.
For serum cortisol levels, the Ashwagen group reported a 28.99% reduction by the end of the study, compared to a 6.6% reduction in the placebo group.
Commenting on the findings, the researchers hypothesized that ashwagandha works by modulating the hypothalamic–pituitary–adrenal (HPA) axis activity, which is “strongly implicated in stress-induced hypertension and metabolic dysfunction.”
Beyond psychological outcomes, Ashwagen supplementation was linked to lower Clinical Global Impression-Improvement (CGI-I), ESS, and FSS scores, indicating improvements in global clinical status, daytime sleepiness, and fatigue, compared to the placebo group.
“Improvements in CGI-I, ESS, and FSS scores suggest that attenuation of anxiety and perceived stress translated into enhanced functional well-being, which is particularly relevant in individuals with chronic hypertension, where fatigue, sleep disturbance, and reduced daytime functioning are common comorbid complaints,” the researchers wrote.
Improvements in cardiometabolic markers
The ashwagandha group also reported improvements in several cardiometabolic markers as compared to placebo.
Specifically, triglycerides decreased 13.00% in the Ashwagen group, while the placebo group reported an increase of 2.35%.
LDL cholesterol had a slight but not significant decrease in both groups.
Systolic blood pressure reduced by 7.11% in the Ashwagen group while the placebo group saw a slight increase.
Similarly, diastolic blood pressure saw a 9.2% decrease in the Ashwagen group, while the placebo group reported a slight decrease.
“These findings are clinically relevant, as chronic anxiety and stress are known to exacerbate sympathetic activation, dyslipidaemia, and blood pressure dysregulation in hypertensive individuals,” the researchers wrote.
A viable treatment
No serious adverse events were reported in either treatment group, indicating that Ashwagen was well tolerated in participants with pre-existing stress, anxiety, hypertension and cardiometabolic risk factors.
The researchers thus suggested that a 600mg dose of Ashwagen for 60 days could serve as a safe and effective treatment option for this patient population, as it does so not only through improving stress-related symptoms but also stress-associated cardiometabolic parameters.
Future studies could explore larger and more diverse populations and longer follow-up periods to further confirm long-term efficacy and safety, as well as the pathways through which Ashwagen exerts its effects.
Source: Stress,29(1). doi: 10.1080/10253890.2026.2669544. “Safety and efficacy of ashwagen (a standardized withania somnifera extract) in stress and anxiety with hypertension and associated cardiometabolic risk factors: a randomized, placebo-controlled trial.” Authors: Pattojoshi, A. et al.
