Ashwagandha

    Fact-checked

    by:

    Last Updated: November 2, 2023

    Ashwagandha has been called the king of Ayurvedic herbs. It’s best known for reducing stress and anxiety. It may also modestly enhance various aspects of physical performance, increase testosterone levels, and improve reproductive health, but more research is needed to confirm these effects.

    Ashwagandha is most often used for .

    What is ashwagandha?

    Ashwagandha (Withania somnifera), also known as Indian ginseng, is an herb used in Ayurveda, the traditional medicine of India. Its root has a horsey smell and is said to confer the strength and virility of a horse. In Sanskrit, ashva means “horse” and gandha means “smell.”[8] Various parts of the plant are used, but the most common supplemental form is an extract of its roots. Its use as part of the Ayurvedic system usually involves more than just the herb alone.

    Ashwagandha is classified as an adaptogen, meaning it’s purported to enhance the body’s resilience to stress. Rodent and cell culture studies suggest that ashwagandha may provide a wide range of health benefits,[9][10] but evidence in human studies has thus far varied depending on the health state and population of interest. [11][12][13][14][15][6]

    What are ashwagandha’s main benefits?

    Ashwagandha is best known for its anxiolytic (anti-anxiety) and stress-relieving effects.[16][17][18][19][20] It also seems to reduce cortisol levels.[8][21][18][19][22][20] In addition, a growing body of evidence supports the efficacy of ashwagandha for improving total sleep time and sleep quality in people with and without insomnia.[5]

    Since the stress response has a wide range of effects on the human body, it is possible this action is where ashwagandha’s reputation for being a ‘cure all’ originated. There is increasing support for the use of ashwagandha in the context of health states that are typically affected by a chronic stress response.[23] Ashwagandha research in cardio-respiratory and musculoskeletal performance enhancements has shown promise for both athletes and non-athletes.[24][25][26][27][28][15][6] Similarly, ashwagandha may also improve immune health, women’s health, men’s health, and sexual health. Unfortunately, due to inconsistencies in the research, it has been difficult to form any direct conclusions.[29][4][30][31][32][33][7][34]

    What are ashwagandha’s main drawbacks?

    Ashwagandha appears to be safe, but more long-term research specifically designed to evaluate its safety is needed. Ashwagandha may cause mild drowsiness and sedation for some people.[35][36][10][37]

    Some case reports have suggested adverse effects such as rash or thyroid dysregulation may occur with ashwagandha use, but the same has not yet been observed by safety studies with larger samples.[38][39][35] Several case reports have also raised concerns regarding the rare occurrence of liver toxicity with ashwagandha use, but similarly, toxicity has not been observed in clinical safety trials. In the reports, liver toxicity was usually reported within 2–12 weeks of ashwagandha use, and liver function returned to normal in all but one case following medical support and ashwagandha discontinuation.[40][41][42][43][44][45] An in vitro study suggested that withanone (one type of withanolide in ashwagandha), may have toxic effects in the context of low levels of the cellular antioxidant glutathione (GSH), which is involved in drug detoxification.[46] However, this research is far from conclusive and the mechanisms underlying this possible adverse effect are unclear.

    How does ashwagandha work?

    Ashwagandha contains numerous bioactive compounds, namely alkaloids, flavonoids, glycosides, steroids, and steroidal lactones.[10] Within the steroidal lactones are withanolides, which are considered to be responsible for most of the plant’s benefits.

    A prevailing theory that is proposed to explain ashwagandha’s effects in humans involves the plant’s influence on the hypothalamic-pituitary-adrenal (HPA) axis as evidenced by its ability to affect cortisol levels.[47]

    Current evidence on the effects of ashwagandha in humans tends to implicate the HPA axis. A majority of the related studies focus on stress and stress-related conditions, which are frequently tied to cortisol, other neuroendocrine hormones, and neurotransmitters. Much research has been devoted to understanding the ability of ashwagandha to mitigate the effects of both healthy and detrimental stress, which, in turn, could affect other outcomes and or health states. Anxiety, depression, fertility, obesity, sleep, exercise recovery, immune health, and cognition are just a few examples. The HPA stress response may also explain some of the varied results seen in the body of evidence. This variance could be the result of ashwagandha affecting the HPA axis differently in different people. It may also be due to the complex relationship between stress and health conditions. If stress isn’t the precipitating factor for a negative health state, ashwagandha may not be an effective treatment for it either.

    The strongest evidence to date suggests ashwagandha has cortisol and corticosteroid lowering effects.[47][8][21][18][20][22][19][48][49][50] In studies where cortisol was lowered, other outcomes, such as anxiety, weight management, fertility, cognition, sleep, and/or quality of life, have also shown some improvement.[22][19][49][21][48][8][18][20]

    What are other names for Ashwagandha

    Note that Ashwagandha is also known as:
    • Withania somnifera
    • Indian ginseng
    • Smell of Horse
    • Winter cherry
    • Dunal
    • Solanaceae
    Ashwagandha should not be confused with:
    • Withania coagulans (Different Plant)
    • Panax ginseng (different plant)

    Dosage information

    Studies on ashwagandha have used daily dosages ranging from 120–5,000 mg of a root extract. The most common dosing protocol is 600 mg daily, divided into two doses, with one taken in the morning with breakfast and the other in the evening.

    Since withanolides are considered to be the major active component in ashwagandha, some extracts are standardized to contain a certain or minimum amount. Clinical trials have used standardized extracts containing anywhere from 1.5% to 35% withanolides,[1][2][3][4][5][6][7] but many studies do not disclose this information and the optimal amount of withanolides is not yet clear. Note that while studies may use standardized extracts or proprietary formulas, variations in extraction methods, formulation, or composition can affect physiological response.

    Evidence suggests that 600 mg daily is superior to lower doses for improving sleep.[5] Similarly, 600–1,000 mg daily may be more beneficial than lower doses for athletes undergoing an intensive exercise regimen.[6] However, more research is needed to confirm whether doses above 600 mg daily yield greater benefits.

    It is unknown if ashwagandha loses its potency with daily long-term usage, but due to its possible drug-like effects on neurotransmission, this possibility cannot be ruled out. It’s also unknown if taking breaks from ashwagandha or taking it every other day prolongs its effectiveness.

    Examine Database: Ashwagandha

    What works and what doesn't?

    Unlock the full potential of Examine

    Get started

    Research FeedRead all studies

    Frequently asked questions

    What is ashwagandha?

    Ashwagandha (Withania somnifera), also known as Indian ginseng, is an herb used in Ayurveda, the traditional medicine of India. Its root has a horsey smell and is said to confer the strength and virility of a horse. In Sanskrit, ashva means “horse” and gandha means “smell.”[8] Various parts of the plant are used, but the most common supplemental form is an extract of its roots. Its use as part of the Ayurvedic system usually involves more than just the herb alone.

    Ashwagandha is classified as an adaptogen, meaning it’s purported to enhance the body’s resilience to stress. Rodent and cell culture studies suggest that ashwagandha may provide a wide range of health benefits,[9][10] but evidence in human studies has thus far varied depending on the health state and population of interest. [11][12][13][14][15][6]

    What are the known traditional, historical, and cultural uses of ashwagandha?

    Withania somnifera (of the family Solanaceae) is a highly esteemed medicinal herb in Ayurveda and is most popularly known as ashwagandha, although other common names include the King of Ayurveda,[53][54] Indian ginseng (not related to Panax ginseng), and wintercherry.[55] The herb is classified as rasayana in Ayurvedic medicine, which suggests it has the ability to affect health, wellness, and vitality. It is also classified as bhalya (increases strength) and vajikara (aphrodisiac).[56] In modern terms, it is called an adaptogen for similar reasons.[57]

    Beyond those uses, it has been traditionally used as an analgesic, astringent, antispasmodic, and immunostimulant while being used to treat inflammation, cancer, stress, fatigue, diabetes, and cardiovascular complications.[58][59] The adaptogenic properties of ashwagandha have been emphasized for treating people with stress-related insomnia, debility, and nervous exhaustion.[60] Ashwagandha has also been reported to have immunostimulant properties that may help to mitigate the negative effects of stress on the immune system.[60]

    What are ashwagandha’s main benefits?

    Ashwagandha is best known for its anxiolytic (anti-anxiety) and stress-relieving effects.[16][17][18][19][20] It also seems to reduce cortisol levels.[8][21][18][19][22][20] In addition, a growing body of evidence supports the efficacy of ashwagandha for improving total sleep time and sleep quality in people with and without insomnia.[5]

    Since the stress response has a wide range of effects on the human body, it is possible this action is where ashwagandha’s reputation for being a ‘cure all’ originated. There is increasing support for the use of ashwagandha in the context of health states that are typically affected by a chronic stress response.[23] Ashwagandha research in cardio-respiratory and musculoskeletal performance enhancements has shown promise for both athletes and non-athletes.[24][25][26][27][28][15][6] Similarly, ashwagandha may also improve immune health, women’s health, men’s health, and sexual health. Unfortunately, due to inconsistencies in the research, it has been difficult to form any direct conclusions.[29][4][30][31][32][33][7][34]

    Does ashwagandha affect hormone health?

    Ashwagandha has shown mixed effects on hormone health measures such as cortisol, testosterone, estrogen, luteinizing hormone, follicle-stimulating hormone, prolactin, and thyroid hormones in human studies. In animal models, ashwagandha appears to reduce the stress-related increase in corticosteroids in serum, and at the higher doses of supplementation (though still within the doses humans use), to fully normalize cortisol to control levels.[61][62][63] The cortisol reductions seen in chronically stressed adults with ashwagandha (300–500 mg over 60–90 days) tend to be in the range of 20%–50% from baseline values, with more of an effect seen in people who self-report high levels of stress.[8][49]

    Ashwagandha’s effects on hormones are not limited to cortisol. Preliminary evidence suggests that 500–600 mg of ashwagandha root extract per day may increase testosterone levels in men when taken over 3–6 months. Improvements in testosterone levels, luteinizing hormone, follicle-stimulating hormone, sperm quality parameters, quality of life, and sexual functioning have been seen with ashwagandha use.[64][7][31][52][65][66] Effects on testosterone are more pronounced in men with infertility and low testosterone levels, though ashwagandha may also boost testosterone levels in healthy men as well.[18][24][31][67][52][49] When supplemented by infertile men, ashwagandha enhanced seminal parameters (e.g. sperm count, motility, quality, and vitality), suggesting that it may help to improve fertility. It’s possible that increased testicular and sperm cell antioxidant status may be partially responsible for these effects.[49][52][66][65]

    Ashwagandha may also have beneficial effects on hormone health in women. Though current evidence suggests these beneficial effects are less pronounced than those seen in men, there still isn’t enough evidence to say this conclusively. Ashwagandha apparently also improves sexual function in women, but it’s not clear yet whether subjective well being is similarly enhanced.[68] One study did find that ashwagandha use in women with menopause increased estrogen while simultaneously lowering follicle-stimulating hormone and luteinizing hormone levels to produce an overall improvement toward menopausal symptom related quality of life.[32]

    Does ashwagandha affect general mental and brain health?

    Since stress levels are associated with neuroendocrine function, ashwagandha may affect general mental and brain health by reducing stress.[69][70][71][72] In studies where ashwagandha improved subjective signs and symptoms of stress, factors such as anxiety, cognition, and sleep quality also improved, along with cortisol.[22][11][19] It should be noted that the efficacy of ashwagandha is more pronounced in people reporting both a negative health state and high stress levels.[73][8]

    Ashwagandha is best known as an adaptogen, which are compounds that are believed to mitigate physiologic responses and reduce perceived stress. While ashwagandha’s mechanisms of action aren’t well understood in humans, preclinical studies (animal and cell studies) suggest that it may affect regulation of neuronal excitation (with implications for stress resilience) and/or neuroendocrine receptors (with implications for stress-sensitive psychiatric illnesses, such as depression, schizophrenia, and anxiety). [74][75][76][77] If ashwagandha affects neuroendocrine activity by modulating the HPA axis, that may be how it purportedly affects the known neuroendocrine system moderators GABA, DHEA, serum BDNF, cortisol, CRP, testosterone, and serotonin. These neuroendocrine moderators are also tied to stress anxiety, depression, schizophrenia, sleep, cognition, and memory outcomes.

    Ashwagandha’s ability to enhance GABAergic (neurotransmitter) activity, as shown in preclinical studies, may be responsible for its apparent anxiolytic effects.[78][79][80][81][82][83][84] [85][77] Effectiveness for sleep has been mirrored in some human studies, where a significant increase in sleep quality (among other sleep related parameters such as improvements in sleep latency, efficiency, duration, alertness, and reduced disturbance) occurred when ashwagandha (120–700mg) was taken daily for periods ranging from 1–3 months. [86][87][5][88][89] It should be noted, however, that prior studies using higher doses of ashwagandha extract (750–2,000 mg, alone or combined with other herbs) did not result in further significant improvements in sleep.[90][91][92]

    Does ashwagandha affect specific mental health conditions?

    Ashwagandha’s potential to moderate the HPA axis, as well as GABAergic and serotonergic activity, may explain at least some of its proposed effects on mental health, but more research is needed to better understand the underlying mechanisms.[77] In a rodent study, ashwagandha promoted social interaction and attenuated the negative effects of prolonged isolation on social function in rats.[93] It is not clear whether the same effects might be seen in humans, but this could be a well-timed avenue for further research to explore. Ashwagandha’s anti-stress effects seem to be related to corticosterone signaling and suppression of neuronal excitation (through modulating nNOS and glutamate signaling) in response to stress. It may also exert some anxiety-reducing effects secondary to the anti-stress properties, via serotonergic and GABAergic signaling. Even lower doses of ashwagandha appear to potentiate the effects of any GABAergic anxiolytic, including alcohol consumption.[94][74][95][96][97][75][76][93][98] In human trials, reduced anxiety has been observed with doses starting at 300 mg, daily up to 12,000 mg/day of ashwagandha over periods ranging from 4–8 weeks. For general stress reduction that hasn’t reached the point of anxiety, 300–600 mg daily appears to be sufficient. [11][13][8][1][99][33][100]

    In animal studies, ashwagandha appears to exert antidepressant effects on its own with a potency comparable to antidepressant medication.[101][93][102] In human studies, 200–400 mg of ashwagandha daily over the course of 30–60 days reduced symptoms of depression in participants with elevated levels of stress.[18][22]

    Ashwagandha may also be helpful in mitigating the signs and symptoms associated with other psychological conditions such as schizophrenia, bipolar disorder, and/or obsessive compulsive disorder. However, more evidence is needed to establish whether any clear effect exists for these specific conditions.[14][12][103][104]

    Does ashwagandha affect brain health?

    Ashwagandha may have beneficial effects on brain health by promoting the formation of neurons and enhanced neuroprotection. . In animal models, ashwagandha increased antioxidant activity in the brain and prevented excessive levels of corticosterone, which may confer neuroprotection from a variety of cognitive diseases associated with oxidative stress.[105][106][107][108][109][110][74][111] When looking at the mechanisms behind neurogenesis in preclinical models, several of ashwagandha’s chemical components have been shown to stimulate the production of BDNF (a neurotrophic growth agent).[112][113][114][115] In vitro cell studies suggest that ashwagandha’s constituents may induce neurogenesis at dosages that are reasonably seen in oral supplements, but this effect has not yet been confirmed in humans.[116][117][118][119][112][120][113]

    In humans, the effects of ashwagandha on brain health are somewhat mixed. In studies where ashwagandha (200–400 mg daily over 1–3 months) enhanced CNS activity and cognition, other factors such as cortisol, quality of life, sleep quality, and subjective measures of stress signs and symptoms also improved. It should also be noted that outcomes such as appetite, anxiety symptoms, short-term memory, serum BDNF, impulsivity, and alertness also saw some benefits in these studies, but to a much lesser extent that can’t be generalized to the broader population at this time.[22][121][19][122][57][85]

    Does ashwagandha affect immune health?

    It is uncertain whether ashwagandha affects immune health by reducing stress, but chronic stress does tend to suppress healthy immune function.[123][71][77] Ashwagandha’s general immunomodulatory capability (as exerted by 60–500 mg for 1–4 weeks) has been explored through direct assessment of immune parameters (immunoglobulins A, M, G, cytokines, natural killer cell content/activity, and lymphocytes) with encouraging results for fighting infection.[4][124][29][125][126][127] These findings, however, still require replication with more robust methodological approaches.

    When examining the prevention or treatment of respiratory infection, studies tended to take a more complete ayurvedic approach by using ashwagandha alongside additional therapies and/or herbs. While these studies indicate promising initial results, variation in methods and intervention used may need to be addressed before conclusions can be drawn or generalized.[124][128][129][126][127]

    Animal studies suggest that some of ashwagandha’s benefits for immune health may also be due to its antioxidant and anti-inflammatory properties.[130] A few human clinical trials in adults with and without health conditions appear to reflect this possibility, too. Ashwagandha use (500–5,000 mg daily for 8–12 weeks) correlated with increases in antioxidants and decreases in oxidation markers such as malondialdehyde, along with improvements in exercise recovery, fertility, lung function, oxygen uptake, perceived stress signs and symptoms, and quality of life.[27][66][28] Several studies have also explored ashwagandha for treating arthritis (500–1,000 mg daily for 8–12 weeks), where anti-inflammatory capacity was the proposed mechanism of action, though this mechanism and effect still has yet to be confirmed.[131][132][133]

    Does ashwagandha affect physical fitness and body composition?

    Oral supplementation of ashwagandha in people with no health conditions appears to improve cardiorespiratory parameters during exercise, notably VO2 max.[134] Increases in power output in sedentary people with no health conditions who start resistance training (750–1,250mg daily for one month) and also those who undergo no training (600 mg daily for two months) have been published.[92][24] Ashwagandha (120–1,250 mg daily for 2–12 weeks) reportedly also improves VO2max, upper and lower body strength, lower body power, and recovery in both trained and untrained athletes.[6][26][15][25][134][27][5][24][6] Ashwagandha has also been shown to improve endurance performance by increasing levels of hemoglobin[6] (the protein in red blood cells responsible for transporting oxygen to the rest of the body) but more studies are needed to confirm this effect. Ashwagandha (600–1,250 mg daily for 1–2 months) in sedentary people with no health conditions may increase lean mass and decrease fat mass, but the results thus far have been mixed.[92][24]

    Does ashwagandha affect cardiometabolic health?

    Animal studies suggest ashwagandha may be cardioprotective against a variety of insults.[135][136][137] The exact mechanism responsible for this effect is still unconfirmed, as limited evidence indicates ashwagandha has no clear influence on blood pressure parameters in people with no health conditions.[134]

    In rodent studies, ashwagandha appears to improve the lipoprotein profile with a mild increase in HDL-C and more notable reductions in LDL-C and total cholesterol. The reduction in LDL cholesterol actually appears to be a per se mechanism of action rather than just fixing a metabolic abnormality, and occurs in normal rats as well as those with metabolic ailments.[130][138] A reduction in LDL cholesterol has been confirmed in people with no health conditions taking ashwagandha (750–1,250 mg for one month), though there was no indication of changes in triglycerides in these same individuals over the same period.[92] A mild reduction in triglycerides has been associated with oral ingestion of ashwagandha when taken by people with metabolic syndrome.[92][139]

    In rodent models of diabetes, ashwagandha reduced blood glucose when given at the standard oral doses, with a potency comparable to reference drugs such as glipizide.[140][141][138] Similarly, there appears to be a mild reduction in blood glucose when supplemented (1,200 mg daily for 30 days) by people with metabolic syndrome (insulin resistance).[139]

    What else has ashwagandha been studied for?

    Cancer therapy is a newer frontier for exploring ashwagandha as a potential therapy. Preclinical studies on withaferin A (an isolated constituent of ashwagandha) indicate it may inhibit or control cancer metastasis in animal and cell models.[142][143][144][145] In humans undergoing chemotherapy for breast cancer, ashwagandha as a whole herb supplement has demonstrated an increase in well-being and physical/emotional function, and a reduction in fatigue, insomnia, and pain.[73]

    What are ashwagandha’s main drawbacks?

    Ashwagandha appears to be safe, but more long-term research specifically designed to evaluate its safety is needed. Ashwagandha may cause mild drowsiness and sedation for some people.[35][36][10][37]

    Some case reports have suggested adverse effects such as rash or thyroid dysregulation may occur with ashwagandha use, but the same has not yet been observed by safety studies with larger samples.[38][39][35] Several case reports have also raised concerns regarding the rare occurrence of liver toxicity with ashwagandha use, but similarly, toxicity has not been observed in clinical safety trials. In the reports, liver toxicity was usually reported within 2–12 weeks of ashwagandha use, and liver function returned to normal in all but one case following medical support and ashwagandha discontinuation.[40][41][42][43][44][45] An in vitro study suggested that withanone (one type of withanolide in ashwagandha), may have toxic effects in the context of low levels of the cellular antioxidant glutathione (GSH), which is involved in drug detoxification.[46] However, this research is far from conclusive and the mechanisms underlying this possible adverse effect are unclear.

    How does ashwagandha work?

    Ashwagandha contains numerous bioactive compounds, namely alkaloids, flavonoids, glycosides, steroids, and steroidal lactones.[10] Within the steroidal lactones are withanolides, which are considered to be responsible for most of the plant’s benefits.

    A prevailing theory that is proposed to explain ashwagandha’s effects in humans involves the plant’s influence on the hypothalamic-pituitary-adrenal (HPA) axis as evidenced by its ability to affect cortisol levels.[47]

    Current evidence on the effects of ashwagandha in humans tends to implicate the HPA axis. A majority of the related studies focus on stress and stress-related conditions, which are frequently tied to cortisol, other neuroendocrine hormones, and neurotransmitters. Much research has been devoted to understanding the ability of ashwagandha to mitigate the effects of both healthy and detrimental stress, which, in turn, could affect other outcomes and or health states. Anxiety, depression, fertility, obesity, sleep, exercise recovery, immune health, and cognition are just a few examples. The HPA stress response may also explain some of the varied results seen in the body of evidence. This variance could be the result of ashwagandha affecting the HPA axis differently in different people. It may also be due to the complex relationship between stress and health conditions. If stress isn’t the precipitating factor for a negative health state, ashwagandha may not be an effective treatment for it either.

    The strongest evidence to date suggests ashwagandha has cortisol and corticosteroid lowering effects.[47][8][21][18][20][22][19][48][49][50] In studies where cortisol was lowered, other outcomes, such as anxiety, weight management, fertility, cognition, sleep, and/or quality of life, have also shown some improvement.[22][19][49][21][48][8][18][20]

    Does ashwagandha increase testosterone?
    Quick answer:

    There is a bit of evidence that shows Ashwagandha increases testosterone, but it is not convincing.

    What is Ashwagandha?

    Ashwagandha is a traditional Indian medicine (Ayurveda) that is known to be associated with male virility and vitality; a common supplement to recommend to men that are feeling past their prime and a traditional medicine with a surprisingly large amount of evidence overall. It does seem to have some anti-stress effects due to having the properties of an adaptogen.

    Among the adaptogens and traditional medicine, however, ashwagandha is one of the few associated with masculinity. Since anything that can be named a testosterone booster gets praise faster than it gets research, many people are wondering whether ashwagandha can increase testosterone or whether it is overhyped.

    What does it do?

    When it comes to the topic of testosterone, the first study to find an effect was one in male rats where an increase was seen.[51] When later tested in men suffering from some degree of infertility, improvements in sperm quality came alongside subtle boosts in testosterone around the range of 14-40%[52] or 10-22%[49].

    While a promising supplement for fertility, it should be stated that supplements that can provide antioxidant support to the testicles are at times associated with an increase in testosterone in infertile but not otherwise fertile men (Vitamin E and CoQ10, for example). Other profertility drugs, such as D-Aspartic acid, are commonly confused with testosterone boosting supplements when the benefits seen in infertile men are erroneously extrapolated.

    However, despite all that, at least one study has found a mild increase in testosterone in otherwise healthy men subject to weight training by 15%.[24] It is not likely that a 15% increase in testosterone will result in major changes in muscularity, but an earnest increase in testosterone in healthy young men by a dietary supplement is quite rare.

    While it is more likely a profertility agent, we cannot deny a possibility that ashwagandha could increase testosterone. However, evidence at this time is quite limited.

    Update History

    One new meta analysis added

    minor

    We added one additional meta-analysis to the database.

    Reviewed By

    Research Breakdown

    References

    1. ^Cooley K, Szczurko O, Perri D, Mills EJ, Bernhardt B, Zhou Q, Seely DNaturopathic care for anxiety: a randomized controlled trial ISRCTN78958974PLoS One.(2009 Aug 31)
    2. ^Ambiye VR, Langade D, Dongre S, Aptikar P, Kulkarni M, Dongre AClinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha (Withania somnifera) in Oligospermic Males: A Pilot StudyEvid Based Complement Alternat Med.(2013)
    3. ^Chengappa KN, Bowie CR, Schlicht PJ, Fleet D, Brar JS, Jindal RRandomized placebo-controlled adjunctive study of an extract of withania somnifera for cognitive dysfunction in bipolar disorderJ Clin Psychiatry.(2013 Nov)
    4. ^Tharakan A, Shukla H, Benny IR, Tharakan M, George L, Koshy SImmunomodulatory Effect of (Ashwagandha) Extract-A Randomized, Double-Blind, Placebo Controlled Trial with an Open Label Extension on Healthy Participants.J Clin Med.(2021-Aug-18)
    5. ^Kae Ling Cheah, Mohd Noor Norhayati, Lili Husniati Yaacob, Razlina Abdul RahmanEffect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysisPLoS One.(2021 Sep 24)
    6. ^Diego A Bonilla, Yurany Moreno, Camila Gho, Jorge L Petro, Adrián Odriozola-Martínez, Richard B KreiderEffects of Ashwagandha ( Withania somnifera) on Physical Performance: Systematic Review and Bayesian Meta-AnalysisJ Funct Morphol Kinesiol.(2021 Feb 11)
    7. ^Chauhan S, Srivastava MK, Pathak AKEffect of standardized root extract of ashwagandha () on well-being and sexual performance in adult males: A randomized controlled trial.Health Sci Rep.(2022-Jul)
    8. ^K Chandrasekhar, Jyoti Kapoor, Sridhar AnishettyA prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adultsIndian J Psychol Med.(2012 Jul)
    9. ^Deepa S Mandlik Ingawale, Ajay G NamdeoPharmacological evaluation of Ashwagandha highlighting its healthcare claims, safety, and toxicity aspectsJ Diet Suppl.(2021)
    10. ^Subhabrata Paul, Shreya Chakraborty, Uttpal Anand, Swarnali Dey, Samapika Nandy, Mimosa Ghorai, Suchismita Chatterjee Saha, Manoj Tukaram Patil, Ramesh Kandimalla, Jarosław Proćków, Abhijit DeyWithania somnifera (L.) Dunal (Ashwagandha): A comprehensive review on ethnopharmacology, pharmacotherapeutics, biomedicinal and toxicological aspectsBiomed Pharmacother.(2021 Nov)
    11. ^Camellia Akhgarjand, Farzaneh Asoudeh, Amir Bagheri, Zahra Kalantar, Zahra Vahabi, Sakineh Shab-Bidar, Hamid Rezvani, Kurosh DjafarianDoes Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trialsPhytother Res.(2022 Aug 25)
    12. ^Chen WY, Liu HC, Cheng YC, Li H, Huang CC, Ding YW, Huang MC, Chiu CC, Tu YK, Kuo PHEffect of Pharmacological and Neurostimulation Interventions for Cognitive Domains in Patients with Bipolar Disorder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.Clin Epidemiol.(2021)
    13. ^Zhang W, Yan Y, Wu Y, Yang H, Zhu P, Yan F, Zhao R, Tian P, Wang T, Fan Q, Su ZMedicinal herbs for the treatment of anxiety: A systematic review and network meta-analysis.Pharmacol Res.(2022-May)
    14. ^Çakici N, van Beveren NJM, Judge-Hundal G, Koola MM, Sommer IECAn update on the efficacy of anti-inflammatory agents for patients with schizophrenia: a meta-analysis.Psychol Med.(2019-Oct)
    15. ^Pérez-Gómez J, Villafaina S, Adsuar JC, Merellano-Navarro E, Collado-Mateo DEffects of Ashwagandha () on VO: A Systematic Review and Meta-Analysis.Nutrients.(2020-Apr-17)
    16. ^Pratte MA, Nanavati KB, Young V, Morley CPAn alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera)J Altern Complement Med.(2014 Dec)
    17. ^Sara Fuladi, Seyed Ahmad Emami, Amir Hooshang Mohammadpour, Asieh Karimani, Ali Akhondpour Manteghi, Amirhossein SahebkarAssessment of Withania Somnifera Root Extract Efficacy in Patients With Generalized Anxiety Disorder: A Randomized Double-Blind Placebo-Controlled TrialCurr Clin Pharmacol.(2020 Apr 13)
    18. ^Lopresti AL, Smith SJ, Malvi H, Kodgule RAn investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled studyMedicine (Baltimore).(2019 Sep)
    19. ^Kumarpillai Gopukumar, Shefali Thanawala, Venkateswarlu Somepalli, T S Sathyanaryana Rao, Vijaya Bhaskar Thamatam, Sanjaya ChauhanEfficacy and Safety of Ashwagandha Root Extract on Cognitive Functions in Healthy, Stressed Adults: A Randomized, Double-Blind, Placebo-Controlled StudyEvid Based Complement Alternat Med.(2021 Nov 30)
    20. ^Salve J, Pate S, Debnath K, Langade DAdaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical StudyCureus.(2019 Dec 25)
    21. ^Choudhary D, Bhattacharyya S, Joshi KBody Weight Management in Adults Under Chronic Stress Through Treatment With Ashwagandha Root Extract: A Double-Blind, Randomized, Placebo-Controlled TrialJ Evid Based Complementary Altern Med.(2017 Jan)
    22. ^A Remenapp, K Coyle, T Orange, T Lynch, D Hooper, S Hooper, K Conway, H A HausenblasEfficacy of Withania somnifera supplementation on adult's cognition and moodJ Ayurveda Integr Med.(2021 Nov 25)
    23. ^Braun C, Anderson CApplied Pathophysiology: A conceptual approach to the mechanisms of disease 3rd Edition(2017)
    24. ^Wankhede S, Langade D, Joshi K, Sinha SR, Bhattacharyya SExamining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trialJ Int Soc Sports Nutr.(2015 Nov 25)
    25. ^Ziegenfuss TN, Kedia AW, Sandrock JE, Raub BJ, Kerksick CM, Lopez HLEffects of an Aqueous Extract of Withania somnifera on Strength Training Adaptations and Recovery: The STAR TrialNutrients.(2018 Nov 20)
    26. ^Shenoy S, Chaskar U, Sandhu JS, Paadhi MMEffects of eight-week supplementation of Ashwagandha on cardiorespiratory endurance in elite Indian cyclistsJ Ayurveda Integr Med.(2012 Oct)
    27. ^Shashank Tiwari, Sandeep Kumar Gupta, Anklesh Kumar PathakA double-blind, randomized, placebo-controlled trial on the effect of Ashwagandha (Withania somnifera dunal.) root extract in improving cardiorespiratory endurance and recovery in healthy athletic adultsJ Ethnopharmacol.(2021 May 23)
    28. ^Singh P, Salman KA, Shameem M, Warsi MSas Add-On Therapy for COPD Patients: A Randomized, Placebo-Controlled, Double-Blind Study.Front Pharmacol.(2022)
    29. ^Bhat J, Damle A, Vaishnav PP, Albers R, Joshi M, Banerjee GIn vivo enhancement of natural killer cell activity through tea fortified with Ayurvedic herbsPhytother Res.(2010 Jan)
    30. ^Modi MB, Donga SB, Dei LClinical evaluation of Ashokarishta, Ashwagandha Churna and Praval Pishti in the management of menopausal syndrome.Ayu.(2012-Oct)
    31. ^Nasimi Doost Azgomi R, Nazemiyeh H, Sadeghi Bazargani H, Fazljou SMB, Nejatbakhsh F, Moini Jazani A, Ahmadi AsrBadr Y, Zomorrodi AComparative evaluation of the effects of Withania somnifera with pentoxifylline on the sperm parameters in idiopathic male infertility: A triple-blind randomised clinical trialAndrologia.(2018 Sep)
    32. ^Gopal S, Ajgaonkar A, Kanchi P, Kaundinya A, Thakare V, Chauhan S, Langade DEffect of an ashwagandha (Withania Somnifera) root extract on climacteric symptoms in women during perimenopause: A randomized, double-blind, placebo-controlled study.J Obstet Gynaecol Res.(2021-Dec)
    33. ^Mamidi P, Thakar ABEfficacy of Ashwagandha (Withania somnifera Dunal. Linn.) in the management of psychogenic erectile dysfunctionAyu.(2011 Jul)
    34. ^Ajgaonkar A, Jain M, Debnath KEfficacy and Safety of Ashwagandha (Withania somnifera) Root Extract for Improvement of Sexual Health in Healthy Women: A Prospective, Randomized, Placebo-Controlled Study.Cureus.(2022-Oct)
    35. ^Verma N, Gupta SK, Tiwari S, Mishra AKSafety of Ashwagandha Root Extract: A Randomized, Placebo-Controlled, study in Healthy Volunteers.Complement Ther Med.(2021-Mar)
    36. ^Tandon N, Yadav SSSafety and clinical effectiveness of Withania Somnifera (Linn.) Dunal root in human ailments.J Ethnopharmacol.(2020-Jun-12)
    37. ^Mishra LC, Singh BB, Dagenais SScientific basis for the therapeutic use of Withania somnifera (ashwagandha): a reviewAltern Med Rev.(2000 Aug)
    38. ^van der Hooft CS, Hoekstra A, Winter A, de Smet PA, Stricker BHThyrotoxicosis following the use of ashwagandha.Ned Tijdschr Geneeskd.(2005-Nov-19)
    39. ^Sehgal VN, Verma P, Bhattacharya SNFixed-drug eruption caused by ashwagandha (Withania somnifera): a widely used Ayurvedic drug.Skinmed.(2012)
    40. ^Lubarska M, Hałasiński P, Hryhorowicz S, Mahadea DS, Łykowska-Szuber L, Eder P, Dobrowolska A, Krela-Kaźmierczak ILiver Dangers of Herbal Products: A Case Report of Ashwagandha-Induced Liver Injury.Int J Environ Res Public Health.(2023-Feb-22)
    41. ^Tóth M, Benedek AE, Longerich T, Seitz HK-induced acute liver injury: A case report.Clin Case Rep.(2023-Mar)
    42. ^Suryawanshi G, Abdallah M, Thomson M, Desai N, Chauhan A, Lim NAshwagandha-Associated Acute Liver Failure Requiring Liver Transplantation.Am J Ther.(2023)
    43. ^Pusec CM, Wolsky R, Llerena C, Sura PA Case of Supplement-Induced Hepatitis.Cureus.(2022-Oct)
    44. ^Ireland PJ, Hardy T, Burt AD, Donnelly MCDrug-induced hepatocellular injury due to herbal supplement ashwagandha.J R Coll Physicians Edinb.(2021-Dec)
    45. ^Björnsson HK, Björnsson ES, Avula B, Khan IA, Jonasson JG, Ghabril M, Hayashi PH, Navarro VAshwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network.Liver Int.(2020-Apr)
    46. ^Siddiqui S, Ahmed N, Goswami M, Chakrabarty A, Chowdhury GDNA damage by Withanone as a potential cause of liver toxicity observed for herbal products of (Ashwagandha).Curr Res Toxicol.(2021)
    47. ^Adrian L Lopresti, Stephen J Smith, Peter D DrummondModulation of the hypothalamic-pituitary-adrenal (HPA) axis by plants and phytonutrients: a systematic review of human trialsNutr Neurosci.(2021 Mar 2)
    48. ^Adrian L Lopresti, Peter D Drummond, Stephen J SmithA Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight MalesAm J Mens Health.(Mar-Apr 2019)
    49. ^Abbas Ali Mahdi, Kamla Kant Shukla, Mohammad Kaleem Ahmad, Singh Rajender, Satya Narain Shankhwar, Vishwajeet Singh, Deepansh DalelaWithania somnifera Improves Semen Quality in Stress-Related Male FertilityEvid Based Complement Alternat Med.(2009 Sep 29)
    50. ^Kalani A, Bahtiyar G, Sacerdote AAshwagandha root in the treatment of non-classical adrenal hyperplasia.BMJ Case Rep.(2012-Sep-17)
    51. ^Zahra Kiasalari, Mohsen Khalili, Mahbobeh AghaeiEffect of withania somnifera on levels of sex hormones in the diabetic male ratsInternational Journal of Reproductive Biomed.(2009)
    52. ^Ahmad MK, Mahdi AA, Shukla KK, Islam N, Rajender S, Madhukar D, Shankhwar SN, Ahmad SWithania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile malesFertil Steril.(2010 Aug)
    53. ^Widodo N, Priyandoko D, Shah N, Wadhwa R, Kaul SCSelective killing of cancer cells by Ashwagandha leaf extract and its component Withanone involves ROS signaling.PLoS One.(2010-Oct-21)
    54. ^Widodo N, Takagi Y, Shrestha BG, Ishii T, Kaul SC, Wadhwa RSelective killing of cancer cells by leaf extract of Ashwagandha: components, activity and pathway analyses.Cancer Lett.(2008-Apr-08)
    55. ^Dhuley JNAdaptogenic and cardioprotective action of ashwagandha in rats and frogs.J Ethnopharmacol.(2000-Apr)
    56. ^Baliga MS, Meera S, Vaishnav LK, Rao S, Palatty PLRasayana drugs from the Ayurvedic system of medicine as possible radioprotective agents in cancer treatment.Integr Cancer Ther.(2013-Nov)
    57. ^Kulkarni SK, Dhir AWithania somnifera: an Indian ginseng.Prog Neuropsychopharmacol Biol Psychiatry.(2008-Jul-01)
    58. ^Deocaris CC, Widodo N, Wadhwa R, Kaul SCMerger of ayurveda and tissue culture-based functional genomics: inspirations from systems biology.J Transl Med.(2008-Mar-18)
    59. ^Modak M, Dixit P, Londhe J, Ghaskadbi S, Devasagayam TPIndian herbs and herbal drugs used for the treatment of diabetes.J Clin Biochem Nutr.(2007-May)
    60. ^Monograph. Withania somnifera.Altern Med Rev.(2004 Jun)
    61. ^Bhattacharya SK, Muruganandam AVAdaptogenic activity of Withania somnifera: an experimental study using a rat model of chronic stressPharmacol Biochem Behav.(2003 Jun)
    62. ^Kour K, Pandey A, Suri KA, Satti NK, Gupta KK, Bani SRestoration of stress-induced altered T cell function and corresponding cytokines patterns by Withanolide A.Int Immunopharmacol.(2009-Sep)
    63. ^Khan B, Ahmad SF, Bani S, Kaul A, Suri KA, Satti NK, Athar M, Qazi GNAugmentation and proliferation of T lymphocytes and Th-1 cytokines by Withania somnifera in stressed mice.Int Immunopharmacol.(2006-Sep)
    64. ^Ramin Nasimi Doost Azgomi, Afshar Zomorrodi, Hossein Nazemyieh, Seyed Mohammad Bagher Fazljou, Homayoun Sadeghi Bazargani, Fatemeh Nejatbakhsh, Arezoo Moini Jazani, Yadollah Ahmadi AsrBadrEffects of Withania somnifera on Reproductive System: A Systematic Review of the Available EvidenceBiomed Res Int.(2018 Jan 24)
    65. ^Gupta A, Mahdi AA, Shukla KK, Ahmad MK, Bansal N, Sankhwar P, Sankhwar SNEfficacy of Withania somnifera on seminal plasma metabolites of infertile males: a proton NMR study at 800 MHzJ Ethnopharmacol.(2013 Aug 26)
    66. ^Kamla Kant Shukla, Abbas Ali Mahdi, Vivek Mishra, Singh Rajender, Satya Narain Sankhwar, Devender Patel, Mukul DasWithania somnifera improves semen quality by combating oxidative stress and cell death and improving essential metal concentrationsReprod Biomed Online.(2011 May)
    67. ^Adam Shepherd, Oliver Brunckhorst, Kamran Ahmed, Qihe XuBotanicals in health and disease of the testis and male fertility: A scoping reviewPhytomedicine.(2022 Nov)
    68. ^Gould DThe biology of ageing: the special senses.Geriatr Nurs Home Care.(1987-Feb)
    69. ^Russo SJ, Murrough JW, Han MH, Charney DS, Nestler EJNeurobiology of resilience.Nat Neurosci.(2012-Nov)
    70. ^Faye C, Mcgowan JC, Denny CA, David DJNeurobiological Mechanisms of Stress Resilience and Implications for the Aged Population.Curr Neuropharmacol.(2018-Mar-05)
    71. ^Cathomas F, Murrough JW, Nestler EJ, Han MH, Russo SJNeurobiology of Resilience: Interface Between Mind and Body.Biol Psychiatry.(2019-Sep-15)
    72. ^Leschik J, Lutz B, Gentile AStress-Related Dysfunction of Adult Hippocampal Neurogenesis-An Attempt for Understanding Resilience?Int J Mol Sci.(2021-Jul-08)
    73. ^Biswal BM, Sulaiman SA, Ismail HC, Zakaria H, Musa KIEffect of Withania somnifera (Ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patientsIntegr Cancer Ther.(2013 Jul)
    74. ^Bhatnagar M, Sharma D, Salvi MNeuroprotective effects of Withania somnifera dunal.: A possible mechanismNeurochem Res.(2009 Nov)
    75. ^Bredt DS, Glatt CE, Hwang PM, Fotuhi M, Dawson TM, Snyder SHNitric oxide synthase protein and mRNA are discretely localized in neuronal populations of the mammalian CNS together with NADPH diaphorase.Neuron.(1991-Oct)
    76. ^Dawson TM, Bredt DS, Fotuhi M, Hwang PM, Snyder SHNitric oxide synthase and neuronal NADPH diaphorase are identical in brain and peripheral tissues.Proc Natl Acad Sci U S A.(1991-Sep-01)
    77. ^Speers AB, Cabey KA, Soumyanath A, Wright KMEffects of (Ashwagandha) on Stress and the Stress- Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia.Curr Neuropharmacol.(2021)
    78. ^Han SK, Abraham IM, Herbison AEEffect of GABA on GnRH neurons switches from depolarization to hyperpolarization at puberty in the female mouse.Endocrinology.(2002-Apr)
    79. ^DeFazio RA, Heger S, Ojeda SR, Moenter SMActivation of A-type gamma-aminobutyric acid receptors excites gonadotropin-releasing hormone neurons.Mol Endocrinol.(2002-Dec)
    80. ^Kulkarni SK, Akula KK, Dhir AEffect of Withania somnifera Dunal root extract against pentylenetetrazol seizure threshold in mice: possible involvement of GABAergic system.Indian J Exp Biol.(2008-Jun)
    81. ^Bhattarai JP, Ah Park S, Han SKThe methanolic extract of Withania somnifera ACTS on GABAA receptors in gonadotropin releasing hormone (GnRH) neurons in mice.Phytother Res.(2010-Aug)
    82. ^Mehta AK, Binkley P, Gandhi SS, Ticku MKPharmacological effects of Withania somnifera root extract on GABAA receptor complex.Indian J Med Res.(1991-Aug)
    83. ^A Kumar, H KaloniaEffect of Withania somnifera on Sleep-Wake Cycle in Sleep-Disturbed Rats: Possible GABAergic MechanismIndian J Pharm Sci.(2008 Nov)
    84. ^Kumar A, Kalonia HProtective effect of Withania somnifera Dunal on the behavioral and biochemical alterations in sleep-disturbed mice (Grid over water suspended method).Indian J Exp Biol.(2007-Jun)
    85. ^Migita D'Cruz, Chittaranjan AndradePotential clinical applications of Ashwagandha ( Withania somnifera) in medicine and neuropsychiatryExpert Rev Clin Pharmacol.(2022 Sep)
    86. ^Deepak Langade, Vaishali Thakare, Subodh Kanchi, Sunil KelganeClinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: A double-blind, randomized, parallel-group, placebo-controlled studyJ Ethnopharmacol.(2020 Aug 17)
    87. ^Abhijit Deshpande, Nushafreen Irani, Ratna Balkrishnan, Irin Rosanna BennyA randomized, double blind, placebo controlled study to evaluate the effects of ashwagandha (Withania somnifera) extract on sleep quality in healthy adultsSleep Med.(2020 Mar 21)
    88. ^O'Connor J, Lindsay K, Baker C, Kirby J, Hutchins A, Harris MThe Impact of Ashwagandha on Stress, Sleep Quality, and Food Cravings in College Students: Quantitative Analysis of a Double-Blind Randomized Control Trial.J Med Food.(2022-Dec)
    89. ^Sunil B Kelgane, Jaysing Salve, Prasanthi Sampara, Khokan DebnathEfficacy and Tolerability of Ashwagandha Root Extract in the Elderly for Improvement of General Well-being and Sleep: A Prospective, Randomized, Double-blind, Placebo-controlled StudyCureus.(2020 Feb 23)
    90. ^Manjunath Nandi Krishnamurthy, Shirley TellesAssessing depression following two ancient Indian interventions: effects of yoga and ayurveda on older adults in a residential homeJ Gerontol Nurs.(2007 Feb)
    91. ^Manjunath NK, Telles SInfluence of Yoga and Ayurveda on self-rated sleep in a geriatric population.Indian J Med Res.(2005-May)
    92. ^Raut AA, Rege NN, Tadvi FM, Solanki PV, Kene KR, Shirolkar SG, Pandey SN, Vaidya RA, Vaidya ABExploratory study to evaluate tolerability, safety, and activity of Ashwagandha (Withania somnifera) in healthy volunteersJ Ayurveda Integr Med.(2012 Jul)
    93. ^Gupta GL, Rana ACProtective effect of Withania somnifera dunal root extract against protracted social isolation induced behavior in rats.Indian J Physiol Pharmacol.(2007)
    94. ^Bhattacharya SK, Bhattacharya A, Sairam K, Ghosal SAnxiolytic-antidepressant activity of Withania somnifera glycowithanolides: an experimental studyPhytomedicine.(2000 Dec)
    95. ^Singh B, Saxena AK, Chandan BK, Gupta DK, Bhutani KK, Anand KKAdaptogenic activity of a novel, withanolide-free aqueous fraction from the roots of Withania somnifera Dun.Phytother Res.(2001-Jun)
    96. ^Singh B, Chandan BK, Gupta DKAdaptogenic activity of a novel withanolide-free aqueous fraction from the roots of Withania somnifera Dun. (Part II).Phytother Res.(2003-May)
    97. ^Kaur P, Mathur S, Sharma M, Tiwari M, Srivastava KK, Chandra RA biologically active constituent of withania somnifera (ashwagandha) with antistress activity.Indian J Clin Biochem.(2001-Jul)
    98. ^Gupta GL, Rana ACEffect of Withania somnifera Dunal in ethanol-induced anxiolysis and withdrawal anxiety in rats.Indian J Exp Biol.(2008-Jun)
    99. ^Andrade C, Aswath A, Chaturvedi SK, Srinivasa M, Raguram RA double-blind, placebo-controlled evaluation of the anxiolytic efficacy ff an ethanolic extract of withania somniferaIndian J Psychiatry.(2000 Jul)
    100. ^Sarris J, Ravindran A, Yatham LN, Marx W, Rucklidge JJ, McIntyre RS, Akhondzadeh S, Benedetti F, Caneo C, Cramer H, Cribb L, de Manincor M, Dean O, Deslandes AC, Freeman MP, Gangadhar B, Harvey BH, Kasper S, Lake J, Lopresti A, Lu L, Metri NJ, Mischoulon D, Ng CH, Nishi D, Rahimi R, Seedat S, Sinclair J, Su KP, Zhang ZJ, Berk MClinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce.World J Biol Psychiatry.(2022-Jul)
    101. ^Shah PC, Trivedi NA, Bhatt JD, Hemavathi KGEffect of Withania somnifera on forced swimming test induced immobility in mice and its interaction with various drugs.Indian J Physiol Pharmacol.(2006)
    102. ^Ahmed ME, Javed H, Khan MM, Vaibhav K, Ahmad A, Khan A, Tabassum R, Islam F, Safhi MM, Islam FAttenuation of oxidative damage-associated cognitive decline by Withania somnifera in rat model of streptozotocin-induced cognitive impairment.Protoplasma.(2013-Oct)
    103. ^Bhanu P S Kaurav, Manish M Wanjari, Amol Chandekar, Nagendra Singh Chauhan, Neeraj UpmanyuInfluence of Withania somnifera on obsessive compulsive disorder in miceAsian Pac J Trop Med.(2012 May)
    104. ^Daphna JoelCurrent animal models of obsessive compulsive disorder: a critical reviewProg Neuropsychopharmacol Biol Psychiatry.(2006 May)
    105. ^Kalpana Velmurugan, Jawed Alam, Joe M McCord, Subbiah PugazhenthiSynergistic induction of heme oxygenase-1 by the components of the antioxidant supplement ProtandimFree Radic Biol Med.(2009 Feb 1)
    106. ^Pattipati S Naidu, Amanpreet Singh, Shrinivas K KulkarniEffect of Withania somnifera root extract on reserpine-induced orofacial dyskinesia and cognitive dysfunctionPhytother Res.(2006 Feb)
    107. ^Pattipati S Naidu, Amanpreet Singh, Shrinivas K KulkarniEffect of Withania somnifera root extract on haloperidol-induced orofacial dyskinesia: possible mechanisms of actionJ Med Food.(2003 Summer)
    108. ^Kasture S, Vinci S, Ibba F, Puddu A, Marongiu M, Murali B, Pisanu A, Lecca D, Zernig G, Acquas EWithania somnifera prevents morphine withdrawal-induced decrease in spine density in nucleus accumbens shell of rats: a confocal laser scanning microscopy study.Neurotox Res.(2009-Nov)
    109. ^Spiga S, Puddu MC, Pisano M, Diana MMorphine withdrawal-induced morphological changes in the nucleus accumbens.Eur J Neurosci.(2005-Nov)
    110. ^Priyandoko D, Ishii T, Kaul SC, Wadhwa RAshwagandha leaf derived withanone protects normal human cells against the toxicity of methoxyacetic acid, a major industrial metabolitePLoS One.(2011 May 4)
    111. ^Baitharu I, Jain V, Deep SN, Hota KB, Hota SK, Prasad D, Ilavazhagan GWithania somnifera root extract ameliorates hypobaric hypoxia induced memory impairment in rats.J Ethnopharmacol.(2013-Jan-30)
    112. ^Tohda C, Joyashiki ESominone enhances neurite outgrowth and spatial memory mediated by the neurotrophic factor receptor, RET.Br J Pharmacol.(2009-Aug)
    113. ^Konar A, Shah N, Singh R, Saxena N, Kaul SC, Wadhwa R, Thakur MKProtective role of Ashwagandha leaf extract and its component withanone on scopolamine-induced changes in the brain and brain-derived cells.PLoS One.(2011)
    114. ^Durbec P, Marcos-Gutierrez CV, Kilkenny C, Grigoriou M, Wartiowaara K, Suvanto P, Smith D, Ponder B, Costantini F, Saarma MGDNF signalling through the Ret receptor tyrosine kinase.Nature.(1996-Jun-27)
    115. ^Trupp M, Arenas E, Fainzilber M, Nilsson AS, Sieber BA, Grigoriou M, Kilkenny C, Salazar-Grueso E, Pachnis V, Arumäe UFunctional receptor for GDNF encoded by the c-ret proto-oncogene.Nature.(1996-Jun-27)
    116. ^Tohda C, Kuboyama T, Komatsu KSearch for natural products related to regeneration of the neuronal network.Neurosignals.(2005)
    117. ^Kuboyama T, Tohda C, Zhao J, Nakamura N, Hattori M, Komatsu KAxon- or dendrite-predominant outgrowth induced by constituents from Ashwagandha.Neuroreport.(2002-Oct-07)
    118. ^Kuboyama T, Tohda C, Komatsu KNeuritic regeneration and synaptic reconstruction induced by withanolide A.Br J Pharmacol.(2005-Apr)
    119. ^Jana CK, Hoecker J, Woods TM, Jessen HJ, Neuburger M, Gademann KSynthesis of withanolide A, biological evaluation of its neuritogenic properties, and studies on secretase inhibition.Angew Chem Int Ed Engl.(2011-Aug-29)
    120. ^Kuboyama T, Tohda C, Komatsu KWithanoside IV and its active metabolite, sominone, attenuate Abeta(25-35)-induced neurodegeneration.Eur J Neurosci.(2006-Mar)
    121. ^Dante Xing, Choongsung Yoo, Drew Gonzalez, Victoria Jenkins, Kay Nottingham, Broderick Dickerson, Megan Leonard, Joungbo Ko, Mark Faries, Wesley Kephart, Martin Purpura, Ralf Jäger, Ryan Sowinski, Christopher J Rasmussen, Richard B KreiderEffects of Acute Ashwagandha Ingestion on Cognitive FunctionInt J Environ Res Public Health.(2022 Sep 20)
    122. ^Wilfried Dimpfel, Leonie Schombert, Ingrid K Keplinger-Dimpfel, Alexander PanossianEffects of an Adaptogenic Extract on Electrical Activity of the Brain in Elderly Subjects with Mild Cognitive Impairment: A Randomized, Double-Blind, Placebo-Controlled, Two-Armed Cross-Over StudyPharmaceuticals (Basel).(2020 Mar 14)
    123. ^Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KEDiurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis.Psychoneuroendocrinology.(2017-Sep)
    124. ^Devpura G, Tomar BS, Nathiya D, Sharma A, Bhandari D, Haldar S, Balkrishna A, Varshney ARandomized placebo-controlled pilot clinical trial on the efficacy of ayurvedic treatment regime on COVID-19 positive patients.Phytomedicine.(2021-Apr)
    125. ^Jeremy Mikolai, Andrew Erlandsen, Andrew Murison, Kimberly A Brown, William L Gregory, Padma Raman-Caplan, Heather L ZwickeyIn vivo effects of Ashwagandha (Withania somnifera) extract on the activation of lymphocytesJ Altern Complement Med.(2009 Apr)
    126. ^Vyas P, Chandola HM, Ghanchi F, Ranthem SClinical evaluation of Rasayana compound as an adjuvant in the management of tuberculosis with anti-Koch's treatment.Ayu.(2012-Jan)
    127. ^Debnath PK, Chattopadhyay J, Mitra A, Adhikari A, Alam MS, Bandopadhyay SK, Hazra JAdjunct therapy of Ayurvedic medicine with anti tubercular drugs on the therapeutic management of pulmonary tuberculosis.J Ayurveda Integr Med.(2012-Jul)
    128. ^Deepa Chitre, Satej Nadkarni, Namdev Jagtap, Rahul Tulle, Amol Gitte, Prashant Rahate, Sunetra Chaskar, Debendranath DeyPhase III randomized clinical trial of BV-4051, an Ayurvedic polyherbal formulation in moderate SARS-CoV-2 infections and its impact on inflammatory biomarkersPhytother Res.(2023 Apr)
    129. ^Arvind Chopra, Narayanam Srikanth, Bhushan Patwardhan, AYUSH CCRAS Research GroupWithania somnifera as a safer option to hydroxychloroquine in the chemoprophylaxis of COVID-19: Results of interim analysisComplement Ther Med.(2021 Nov)
    130. ^Nishant P Visavadiya, A V R L NarasimhacharyaHypocholesteremic and antioxidant effects of Withania somnifera (Dunal) in hypercholesteremic ratsPhytomedicine.(2007 Feb)
    131. ^Satyajyoti Kanjilal, Ashok Kumar Gupta, Ranjana Saksena Patnaik, Amitabha DeyAnalysis of Clinical Trial Registry of India for Evidence of Anti-Arthritic Properties of Withania somnifera (Ashwagandha)Altern Ther Health Med.(2021 Nov)
    132. ^Chopra A, Lavin P, Patwardhan B, Chitre DA 32-week randomized, placebo-controlled clinical evaluation of RA-11, an Ayurvedic drug, on osteoarthritis of the knees.J Clin Rheumatol.(2004-Oct)
    133. ^Khanna D, Sethi G, Ahn KS, Pandey MK, Kunnumakkara AB, Sung B, Aggarwal A, Aggarwal BBNatural products as a gold mine for arthritis treatment.Curr Opin Pharmacol.(2007-Jun)
    134. ^Sandhu JS, Shah B, Shenoy S, Chauhan S, Lavekar GS, Padhi MMEffects of Withania somnifera (Ashwagandha) and Terminalia arjuna (Arjuna) on physical performance and cardiorespiratory endurance in healthy young adultsInt J Ayurveda Res.(2010 Jul)
    135. ^Gupta SK, Mohanty I, Talwar KK, Dinda A, Joshi S, Bansal P, Saxena A, Arya DSCardioprotection from ischemia and reperfusion injury by Withania somnifera: a hemodynamic, biochemical and histopathological assessment.Mol Cell Biochem.(2004-May)
    136. ^Mohanty IR, Arya DS, Gupta SKWithania somnifera provides cardioprotection and attenuates ischemia-reperfusion induced apoptosisClin Nutr.(2008 Aug)
    137. ^A Hamza, A Amin, S DaoudThe protective effect of a purified extract of Withania somnifera against doxorubicin-induced cardiac toxicity in ratsCell Biol Toxicol.(2008 Jan)
    138. ^Datta A, Bagchi C, Das S, Mitra A, Pati AD, Tripathi SKAntidiabetic and antihyperlipidemic activity of hydroalcoholic extract of Withania coagulans Dunal dried fruit in experimental rat models.J Ayurveda Integr Med.(2013-Apr)
    139. ^Agnihotri AP, Sontakke SD, Thawani VR, Saoji A, Goswami VSEffects of Withania somnifera in patients of schizophrenia: A randomized, double blind, placebo controlled pilot trial studyIndian J Pharmacol.(2013 Jul)
    140. ^Anwer T, Sharma M, Pillai KK, Khan GProtective effect of Withania somnifera against oxidative stress and pancreatic beta-cell damage in type 2 diabetic rats.Acta Pol Pharm.(2012)
    141. ^Udayakumar R, Kasthurirengan S, Mariashibu TS, Rajesh M, Anbazhagan VR, Kim SC, Ganapathi A, Choi CWHypoglycaemic and hypolipidaemic effects of Withania somnifera root and leaf extracts on alloxan-induced diabetic rats.Int J Mol Sci.(2009-May-20)
    142. ^Yang Z, Garcia A, Xu S, Powell DR, Vertino PM, Singh S, Marcus AIWithania somnifera root extract inhibits mammary cancer metastasis and epithelial to mesenchymal transition.PLoS One.(2013)
    143. ^Bargagna-Mohan P, Hamza A, Kim YE, Khuan Abby Ho Y, Mor-Vaknin N, Wendschlag N, Liu J, Evans RM, Markovitz DM, Zhan CG, Kim KB, Mohan RThe tumor inhibitor and antiangiogenic agent withaferin A targets the intermediate filament protein vimentin.Chem Biol.(2007-Jun)
    144. ^Grin B, Mahammad S, Wedig T, Cleland MM, Tsai L, Herrmann H, Goldman RDWithaferin a alters intermediate filament organization, cell shape and behavior.PLoS One.(2012)
    145. ^Dae Hyung Lee, In-Hye Lim, Eon-Gi Sung, Joo-Young Kim, In-Hwan Song, Yoon Ki Park, Tae-Jin LeeWithaferin A inhibits matrix metalloproteinase-9 activity by suppressing the Akt signaling pathwayOncol Rep.(2013 Aug)

    Examine Database References

    1. High-density lipoprotein (HDL) - Agnihotri AP, Sontakke SD, Thawani VR, Saoji A, Goswami VSEffects of Withania somnifera in patients of schizophrenia: A randomized, double blind, placebo controlled pilot trial studyIndian J Pharmacol.(2013 Jul)
    2. Schizophrenia symptoms - Chengappa KNR, Brar JS, Gannon JM, Schlicht PJAdjunctive Use of a Standardized Extract of Withania somnifera (Ashwagandha) to Treat Symptom Exacerbation in Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled StudyJ Clin Psychiatry.(2018 Jul 10)
    3. Testosterone - Wankhede S, Langade D, Joshi K, Sinha SR, Bhattacharyya SExamining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trialJ Int Soc Sports Nutr.(2015 Nov 25)
    4. White Blood Cell Count - Raut AA, Rege NN, Tadvi FM, Solanki PV, Kene KR, Shirolkar SG, Pandey SN, Vaidya RA, Vaidya ABExploratory study to evaluate tolerability, safety, and activity of Ashwagandha (Withania somnifera) in healthy volunteersJ Ayurveda Integr Med.(2012 Jul)
    5. Oxygen Uptake - Sandhu JS, Shah B, Shenoy S, Chauhan S, Lavekar GS, Padhi MMEffects of Withania somnifera (Ashwagandha) and Terminalia arjuna (Arjuna) on physical performance and cardiorespiratory endurance in healthy young adultsInt J Ayurveda Res.(2010 Jul)
    6. Oxidative Stress Biomarkers - Kuchewar VV, Borkar MA, Nisargandha MAEvaluation of antioxidant potential of Rasayana drugs in healthy human volunteersAyu.(2014 Jan)
    7. Red Blood Cell Count - Ziegenfuss TN, Kedia AW, Sandrock JE, Raub BJ, Kerksick CM, Lopez HLEffects of an Aqueous Extract of Withania somnifera on Strength Training Adaptations and Recovery: The STAR TrialNutrients.(2018 Nov 20)
    8. Oxygen Uptake - Shenoy S, Chaskar U, Sandhu JS, Paadhi MMEffects of eight-week supplementation of Ashwagandha on cardiorespiratory endurance in elite Indian cyclistsJ Ayurveda Integr Med.(2012 Oct)
    9. vLDL-C - Auddy, B, et alA Standardized Withania Somnifera Extract Significantly Reduces Stress-Related Parameters in Chronically Stressed Humans: A Double-Blind, Randomized, Placebo-Controlled StudyJ Am Nut Assn.()
    10. Heart Rate - Choudhary D, Bhattacharyya S, Joshi KBody Weight Management in Adults Under Chronic Stress Through Treatment With Ashwagandha Root Extract: A Double-Blind, Randomized, Placebo-Controlled TrialJ Evid Based Complementary Altern Med.(2017 Jan)
    11. Stress Signs and Symptoms - Camellia Akhgarjand, Farzaneh Asoudeh, Amir Bagheri, Zahra Kalantar, Zahra Vahabi, Sakineh Shab-Bidar, Hamid Rezvani, Kurosh DjafarianDoes Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trialsPhytother Res.(2022 Aug 25)
    12. Testosterone - Gupta A, Mahdi AA, Shukla KK, Ahmad MK, Bansal N, Sankhwar P, Sankhwar SNEfficacy of Withania somnifera on seminal plasma metabolites of infertile males: a proton NMR study at 800 MHzJ Ethnopharmacol.(2013 Aug 26)
    13. Testosterone - Abbas Ali Mahdi, Kamla Kant Shukla, Mohammad Kaleem Ahmad, Singh Rajender, Satya Narain Shankhwar, Vishwajeet Singh, Deepansh DalelaWithania somnifera Improves Semen Quality in Stress-Related Male FertilityEvid Based Complement Alternat Med.(2009 Sep 29)
    14. Testosterone - Ahmad MK, Mahdi AA, Shukla KK, Islam N, Rajender S, Madhukar D, Shankhwar SN, Ahmad SWithania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile malesFertil Steril.(2010 Aug)
    15. Testosterone - Ambiye VR, Langade D, Dongre S, Aptikar P, Kulkarni M, Dongre AClinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha (Withania somnifera) in Oligospermic Males: A Pilot StudyEvid Based Complement Alternat Med.(2013)
    16. Sperm Quality - Nasimi Doost Azgomi R, Nazemiyeh H, Sadeghi Bazargani H, Fazljou SMB, Nejatbakhsh F, Moini Jazani A, Ahmadi AsrBadr Y, Zomorrodi AComparative evaluation of the effects of Withania somnifera with pentoxifylline on the sperm parameters in idiopathic male infertility: A triple-blind randomised clinical trialAndrologia.(2018 Sep)
    17. Anxiety Symptoms - Andrade C, Aswath A, Chaturvedi SK, Srinivasa M, Raguram RA double-blind, placebo-controlled evaluation of the anxiolytic efficacy ff an ethanolic extract of withania somniferaIndian J Psychiatry.(2000 Jul)
    18. Anxiety Symptoms - Langade D, Kanchi S, Salve J, Debnath K, Ambegaokar DEfficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled StudyCureus.(2019 Sep 28)
    19. Anxiety Symptoms - K Chandrasekhar, Jyoti Kapoor, Sridhar AnishettyA prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adultsIndian J Psychol Med.(2012 Jul)
    20. Anxiety Symptoms - Cooley K, Szczurko O, Perri D, Mills EJ, Bernhardt B, Zhou Q, Seely DNaturopathic care for anxiety: a randomized controlled trial ISRCTN78958974PLoS One.(2009 Aug 31)
    21. Anxiety Symptoms - Salve J, Pate S, Debnath K, Langade DAdaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical StudyCureus.(2019 Dec 25)
    22. Bipolar Disorder Symptoms - Chengappa KN, Bowie CR, Schlicht PJ, Fleet D, Brar JS, Jindal RRandomized placebo-controlled adjunctive study of an extract of withania somnifera for cognitive dysfunction in bipolar disorderJ Clin Psychiatry.(2013 Nov)
    23. Working Memory - Choudhary D, Bhattacharyya S, Bose SEfficacy and Safety of Ashwagandha (Withania somnifera (L.) Dunal) Root Extract in Improving Memory and Cognitive FunctionsJ Diet Suppl.(2017 Nov 2)
    24. Reaction Time - Pingali U, Pilli R, Fatima NEffect of standardized aqueous extract of Withania somnifera on tests of cognitive and psychomotor performance in healthy human participantsPharmacognosy Res.(2014 Jan)
    25. Subjective Well-Being - Sud Khyati S, Thaker Anup BA RANDOMIZED DOUBLE BLIND PLACEBO CONTROLLED STUDY OF ASHWAGANDHA ON GENERALIZED ANXIETY DISORDERInternational Ayurvedic Medical Journal .()
    26. Fatigue Symptoms - Adrian L Lopresti, Peter D Drummond, Stephen J SmithA Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight MalesAm J Mens Health.(Mar-Apr 2019)
    27. Erections - Mamidi P, Thakar ABEfficacy of Ashwagandha (Withania somnifera Dunal. Linn.) in the management of psychogenic erectile dysfunctionAyu.(2011 Jul)
    28. Thyroid-Stimulating Hormone - Sharma AK, Basu I, Singh SEfficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled TrialJ Altern Complement Med.(2018 Mar)
    29. Cortisol - Lopresti AL, Smith SJ, Malvi H, Kodgule RAn investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled studyMedicine (Baltimore).(2019 Sep)
    30. Natural Killer Cell Activity - Jeremy Mikolai, Andrew Erlandsen, Andrew Murison, Kimberly A Brown, William L Gregory, Padma Raman-Caplan, Heather L ZwickeyIn vivo effects of Ashwagandha (Withania somnifera) extract on the activation of lymphocytesJ Altern Complement Med.(2009 Apr)
    31. OCD Symptoms - Jahanbakhsh SP, Manteghi AA, Emami SA, Mahyari S, Gholampour B, Mohammadpour AH, Sahebkar AEvaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trialComplement Ther Med.(2016 Aug)
    32. Sexual Function - Dongre S, Langade D, Bhattacharyya SEfficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot StudyBiomed Res Int.(2015)
    33. Pain - Ramakanth GS, Uday Kumar C, Kishan PV, Usharani PA randomized, double blind placebo controlled study of efficacy and tolerability of Withaina somnifera extracts in knee joint painJ Ayurveda Integr Med.(2016 Jul - Sep)
    34. Blood glucose - B Andallu, B RadhikaHypoglycemic, diuretic and hypocholesterolemic effect of winter cherry (Withania somnifera, Dunal) rootIndian J Exp Biol.(2000 Jun)
    35. Quality of Life - Choudhary B, Shetty A, Langade DGEfficacy of Ashwagandha (Withania somnifera [L.] Dunal) in improving cardiorespiratory endurance in healthy athletic adultsAyu.(2015 Jan-Mar)
    36. Insomnia Signs and Symptoms - Biswal BM, Sulaiman SA, Ismail HC, Zakaria H, Musa KIEffect of Withania somnifera (Ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patientsIntegr Cancer Ther.(2013 Jul)