Ashwagandha

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Specifically for Bipolar Disorder

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Why it works for Bipolar Disorder:

There is suggestive but limited evidence that ashwagandha (Withania somnifera) can help stress, anxiety and some cognitive symptoms through anti-inflammatory, GABA/monoamine-modulating and neuroprotective effects — but high-quality evidence specifically proving it as a safe, effective treatment for bipolar disorder is scarce. There are small, preliminary trials (including a registered randomized trial of a standardized extract for cognition in people with bipolar disorder), but there are also case reports and reviews that raise safety concerns in people with mood disorders (mania, withdrawal-related symptoms, psychosis) and other risks (liver, thyroid, drug interactions). Because bipolar disorder is high-risk (mania, suicidality, need for mood stabilizers), you should not start, stop, or change psychiatric medicines based on ashwagandha without direct guidance from your treating psychiatrist.

Researchers propose several mechanisms that could explain beneficial effects on mood/cognition:

Adaptogen / HPA axis modulation: ashwagandha reduces stress hormone (cortisol) responses and improves physiologic stress resilience. ScienceDirect
GABAergic / anxiolytic effects: some bioactive withanolides and other constituents interact with GABA and other neurotransmitter systems, which may reduce anxiety and improve sleep. ResearchGate
Anti-inflammatory / neuroprotective effects: antioxidant and anti-inflammatory properties could protect neurons and improve cognitive function (relevant because inflammation and cognitive deficits are implicated in bipolar disorder). ScienceDirect

These mechanisms help explain why ashwagandha shows benefit in trials for stress, anxiety and some cognitive outcomes — but those mechanisms do not prove safety or efficacy for bipolar disorder specifically. ResearchGate

How to use for Bipolar Disorder:

There is no universal, guideline-endorsed “ashwagandha protocol” for bipolar disorder. What follows are doses/formulations commonly used in human trials for anxiety, stress and cognitive endpoints — these may be the starting place clinicians reference when considering experimental adjunctive use:

KSM-66 (aqueous root extract): common trial dose 300 mg twice daily (600 mg/day) for 6–8 weeks in stress/anxiety trials. ResearchGate
KSM-66 and other extracts: some studies used 240–600 mg/day (varies by extract standardization and trial). ResearchGate
Sensoril® (standardized extract): used in an 8-week randomized, double-blind trial protocol for cognitive enhancement in bipolar disorder (registered clinical trial — see registry entry for exact dosing for that study). The sensoril trial was a formal study specifically in people with bipolar disorder (cognition outcomes). ICHGCP+1

Practical notes if a clinician were to consider adjunctive use (NOT medical advice to start on your own):

Use a standardized product (Sensoril®, KSM-66, or clearly labeled root extract with stated withanolide content) so dosing is predictable. ResearchGate
Start low and monitor closely (many herbal protocols use “start low, go slow”), but in bipolar disorder even small changes may precipitate symptoms — so monitoring should be medical (psychiatrist). Frontiers
Duration in trials is commonly 6–12 weeks for mood/stress outcomes; any adjunctive plan for bipolar disorder must include defined monitoring for mood switching. ResearchGate

Scientific Evidence for Bipolar Disorder:

Direct / bipolar-specific:

Registered randomized, double-blind placebo-controlled trial (Sensoril®) for cognitive enhancement in persons with bipolar disorder (University of Pittsburgh) — registry entry shows this trial was planned to evaluate Sensoril® in bipolar I/II for cognition and anxiety/metabolic outcomes. This is a key direct clinical study in bipolar populations (check registry for status/results). ICHGCP

Indirect — human RCTs and systematic reviews supporting anxiolytic / stress / cognitive benefits (relevant but not proof for bipolar):

Systematic reviews / narrative reviews summarizing RCTs of ashwagandha for stress/anxiety, and trials showing reduced cortisol and improved self-reported stress and some cognitive measures. (Example reviews and summaries of human trials). ScienceDirect
Randomized placebo-controlled trials in non-bipolar populations showing benefit for stress/anxiety, with doses commonly 240–600 mg/day. These are the trials that underpin interest in psychiatric indications. See trial summaries in the reviews above. ResearchGate

Case reports / observational evidence raising safety signals in mood disorders:

Case reports and small series describe psychiatric adverse events potentially linked to ashwagandha: withdrawal syndromes, emergence of psychosis after long-term use and cessation, acute movement disorders (dystonia), and isolated reports of mood destabilization. These are safety-relevant for people with bipolar disorder. Cureus

Safety / adverse-event compilations:

Reactions Weekly / pharmacovigilance reports document rare cases of liver injury attributed to Withania somnifera in a few patients — important when combining with other meds or with preexisting liver disease. SpringerLink

Specific Warnings for Bipolar Disorder:

Risk of precipitating mania / hypomania or psychiatric destabilization.

Herbal medicines (including those with GABA/monoamine effects) have been linked in systematic reviews and case reports to episodes of mania or medication-induced bipolar disorder. Several reports and reviews highlight the possibility that even “natural” products can trigger mood switching. People with bipolar disorder are at special risk and should be cautious. Frontiers

Withdrawal-related psychiatric symptoms reported.

Case reports describe severe anxiety, depressive symptoms and even psychosis temporally associated with cessation or withdrawal from long-term ashwagandha use. This raises concerns about dependence/withdrawal in susceptible individuals. If used adjunctively, stopping suddenly is not advisable without clinical oversight. Cureus

Possible interactions with psychiatric medications.

Ashwagandha may affect sedative load, thyroid function, blood sugar, and liver enzymes — this can interact with mood stabilizers, antipsychotics, antidepressants, and other medicines. Explicit interaction data are limited, so caution and clinician review are required. MedShun

Liver injury and other organ toxicities (rare).

Pharmacovigilance reports and case series document hepatocellular and cholestatic liver injury in some users. This is relevant when combining with other hepatically metabolized psychiatric drugs. Baseline and follow-up liver tests may be prudent if a clinician is supervising use. SpringerLink

Thyroid effects / potential to cause hyperthyroid-like symptoms in isolated reports.

Case reports suggest ashwagandha can affect thyroid hormone levels in some people; monitor if preexisting thyroid disease or on thyroid meds. In the Clinic with Camille

Quality and formulation variability.

Supplements are not regulated like prescription drugs; potency and contaminant risk vary. Use only well-characterized, standardized extracts from reputable manufacturers (and ideally products used in published trials: Sensoril®, KSM-66, etc.). ResearchGate

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General Information (All Ailments)

Note: You are viewing ailment-specific information above. This section shows the general remedy information for all conditions.

What It Is

Ashwagandha (Withania somnifera) is a medicinal herb traditionally used in Ayurvedic medicine for over 3,000 years. It is sometimes called Indian ginseng or winter cherry, though it’s botanically unrelated to true ginseng. The root and leaf extracts are the primary sources of its active compounds, known as withanolides — natural steroidal lactones thought to be responsible for many of its therapeutic effects.

Ashwagandha is classified as an adaptogen, meaning it helps the body manage stress and maintain physiological balance. It’s available in various forms: powders, capsules, tinctures, teas, and standardized extracts.

How It Works

Ashwagandha’s mechanisms of action are multifaceted and supported by both traditional use and modern research:

Stress Response Modulation

Regulates the hypothalamic-pituitary-adrenal (HPA) axis, which controls the body’s stress response.
Reduces cortisol levels (the main stress hormone), helping mitigate chronic stress, fatigue, and anxiety.

Neuroprotection and Brain Function

Promotes antioxidant activity in the brain, protecting nerve cells from oxidative stress.
May increase levels of acetylcholine and GABA, supporting better focus, memory, and relaxation.

Hormonal and Energy Support

In men, some studies show improved testosterone levels and sperm quality.
Enhances thyroid function in some individuals by stimulating T4 production.
Increases mitochondrial energy production, reducing fatigue and improving endurance.

Anti-inflammatory and Immunomodulatory Effects

Contains withaferin A, which has shown anti-inflammatory effects by inhibiting NF-κB (a key inflammation pathway).
Helps modulate immune activity, potentially balancing overactive or suppressed immune responses.

Why It’s Important

Ashwagandha has gained global attention for its broad spectrum of potential health benefits, including:

Stress and Anxiety Relief: Clinical trials suggest significant reductions in perceived stress and cortisol levels.
Improved Sleep: May promote deeper, more restorative sleep through GABA-mimetic activity.
Cognitive Enhancement: Enhances memory, focus, and information processing speed.
Physical Performance: Boosts muscle strength, VO₂ max, and recovery in athletes.
Hormonal Balance: Supports reproductive and thyroid health in both men and women.
Overall Vitality: Promotes resilience, energy, and mood stability — aligning with its Ayurvedic reputation for rejuvenation (rasayana).

Considerations

While generally well-tolerated, Ashwagandha is not suitable for everyone or in all contexts. Key considerations include:

Dosage

Common clinical dosages range from 300–600 mg/day of standardized extract (with 5% withanolides).
Effects often build over several weeks.

Safety and Side Effects

Mild: Gastrointestinal upset, drowsiness, or headache.
Rare: Allergic reactions or over-stimulation of thyroid hormone.
Avoid very high doses, as these may cause stomach irritation or diarrhea.

Interactions

May potentiate the effects of sedatives, thyroid medications, blood pressure drugs, or immunosuppressants.
Should not be combined with alcohol or other strong adaptogens without guidance.

Who Should Avoid It

Pregnant or breastfeeding women (due to possible uterine stimulation).
Individuals with hyperthyroidism or autoimmune disorders without medical supervision.
Those scheduled for surgery (may interfere with anesthesia or blood pressure).

Quality Matters

Choose extracts standardized to 5% withanolides and tested for contaminants like heavy metals or pesticides.
Reputable brands often use clinically studied extracts such as KSM-66 or Sensoril.

Helps with these conditions

Ashwagandha is most effective for general wellness support with emerging research . The effectiveness varies by condition based on clinical evidence and user experiences.

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Hypothyroidism 0% effective

OCD 0% effective

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Ashwagandha is an adaptogenic herb whose bioactive compounds (mainly withanolides) appear to modulate the stress response (HPA axis), lower cortisol,...

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