The stress response is sophisticated physiological and neurological response designed to combat environmental, chemical and psychological stressors and to return the body to homeostasis once the stressor has passed. An acute stress response is crucial for survival during dangerous conditions and triggers temporary physiological changes that are reversible once the initial trigger has been removed or neutralised. On the other hand, chronic stress is a response to persistent environmental and social conditions that can induce irreversible health complications such as, cardiovascular disorders, mental health disorders, metabolic syndrome, and increased susceptibility to infections. ^1,2 One of the most notable responses to acute and chronic stress is decreases in cognitive performance and mood disorders such as anxiety and depression. ³ These health conditions may be due to altered hormonal secretions of cortisol, adrenaline, and norepinephrine along with deviations in the normal sleep-wake cycle, further impacting the level of circadian cortisol that is seen in stressed individuals. ¹

With a majority of Australians reporting that stress impacts their physical (72%) and mental health (64%)⁵ , it is no surprise a large group of medications are dedicated to trying to alleviate symptoms of persistent stress, most notably, mood disorders. However, reports suggest that these medications are associated with multiple side effects including drowsiness, weight gain and/or a dry or watery mouth, as well as a source of addiction due to altered or adaptive behaviour, warranting the need for natural solutions. ^1,6 

Adaptogens are herbs that improve the responses to stress and help the body adapt by normalising physiological processes in times of increased stress. Withania (Withania somnifera) is an adaptogen that is purported to prevent and treat the effects of mood disorders exacerbated by stress. Research reveals that Withania decreases cortisol levels, perceived stress, anxiety, and blood pressure in people under chronic stress. Withania also improves cognitive function in adults with mild cognitive impairment, making it an ideal herbal medicine to assist with altered mood from acute and chronic stress. ³ 

Dosing recommendations: 

• Clinically effective dose: 225 mg/day to 400 mg/day 
• Duration: 4 weeks 
• Form: Withania somnifera 
• Drug interactions: 
  • Theoretically, Withania may counteract the immunosuppresive effects of drugs. Short-term use (1 to 2 weeks) is recommended concomitantly. ⁷ Contraindicated in organ and bone marrow transplant recipients, leukaemia, lymphoma, and myeloma. 
  • Additive thyroid effects. Studies suggest increased thyroid hormone production with concomitant Withania use. A beneficial interaction is possible under professional supervision. Monitor thyroid stimulating hormone (TSH) levels every 12 weeks. Refer for drug dose adjustment if necessary. ⁸
• Safe dosing: 1250 mg/day (equivalent to 10 g) for 10 days. ⁹

Efficacy of Withania supplementation on cognition and mood 

In a randomised controlled trial by Remenapp et al., researchers set out to examine the effects of a Withania extract supplementation for improving cognitive abilities, cortisol levels, and self-reported mood, stress, food cravings, and anxiety in adults with perceived stress. Fifty-eight healthy adults who reported experiencing perceived stress were randomised to the following groups: Withania (400 mg/day), Withania (225 mg/day), or placebo for 30 days.³ Outcomes were assessed at Day 0, 15, and 30, and included saliva cortisol levels, cognitive performance (e.g. CNS vital signs), and the self-reported measures of Trait Anxiety Inventory, Depression Anxiety Stress Scale, Perceived Stress Scale, and Food Cravings Questionnaire-15. Researchers found one month of Withania supplementation (225 mg/day and 400 mg/day) was safe and had a positive effect on the participants’ cortisol levels, cognitive ability, and self-reported stress, anxiety, depression, and food cravings.

For the CNS vital signs, significant time effect differences were observed in reaction time, complex attention, cognitive flexibility, processing speed, executive functioning, and visual memory (Figures 2-5). Cognitive flexibility, complex attention, executive functioning, and processing speed improved significantly from Day 0 when compared to both Day 15 and Day 30 for all groups, including both Withania 225 mg/day and 400 mg/day groups.

Withania for a healthy stress response and mood 

Stress affects a large percentage of the Australian population and can lead to a variety of health complications, including cognitive impairment and mood disorders. Withania supplementation may be useful in stressed individuals due to its ability to improve physiological, cognitive, and psychological effects of stress, without any adverse effects. 

To help support a healthy stress response, practitioners should consider supplementing Withania at a dose of 400 mg/day to assist in reducing cortisol levels while supporting cognitive ability, and self-reported stress, anxiety, and depression.

References

1. Salve J, Pate S, Debnath K et al. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Cureus. 2019 Dec 25;11(12):e6466. doi: 10.7759/cureus.6466.
2. Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019 Sep;15(9):525-534. doi: 10.1038/s41574-019-0228-0.
3. Remenapp A, Coyle K, Orange T et al. Efficacy of Withania somnifera supplementation on adult’s cognition and mood. Journal of Ayurveda and Integrative Medicine. 2022 Apr 1;13(2):100510. doi: 10.1016/j.jaim.2021.08.003.
4. Oster H. The interplay between stress, circadian clocks, and energy metabolism. J Endocrinol. 2020 Oct;247(1):R13-R25. doi: 10.1530/JOE-20-0124.
5. NIB. The impact of stress in Australia. 2021. Available from: https://www.nib.com.au/the-checkup/impact-of-stress-in-australia#:~:text=The%20majority%20of%20Australians%20feel,their%20overall%20levels%20of%20stress.
6. Waterreus A. Medication for psychosis--consumption and consequences: the second Australian national survey of psychosis. Aust N Z J Psychiatry. 2012 Aug;46(8):762-73. doi: 10.1177/0004867412450471.
7. Tharakan A, Shukla H, Benny IR et al. Immunomodulatory Effect of Withania somnifera (Ashwagandha) Extract-A Randomized, Double-Blind, Placebo Controlled Trial with an Open Label Extension on Healthy Participants. J Clin Med 2021;10(16):3644.doi: 10.3390/jcm10163644.
8. Sharma AK, Basu I, Singh S. Efficacy and safety of Ashwagandha root extract in subclinical hypothyroid patients: a double-blind, randomized placebo-controlled trial. J Altern Complement Med. 2018 Mar;24(3):243-248. doi: 10.1089/acm.2017.0183.
9. Raut AA, Rege NN, Tadvi FM et al. Exploratory study to evaluate tolerability, safety, and activity of Ashwagandha (Withania somnifera) in healthy volunteers. J Ayurveda Integr Med. 2012 Jul;3(3):111-4. doi: 10.4103/0975-9476.100168

The information contained within is intended to be used as an educational tool and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.