Ashwagandha And Its Growing Impact In Mental Health

By: Abhishek Rai, MD and Ankur Sarin, MD

Withania somnifera, known commonly as Ashwagandha, Indian ginseng, poison gooseberry or winter cherry is a plant in the solanaceae or nightshade family.  Ashwagandha is one of the central herbs in Ayurveda, the traditional medicine system native to India.  It's been used for thousands of years in Ayurvedic medicine to target everything from the negative effects of stress on the body, to strengthening the immune system.  Ashwagandha is also known as "winter cherry," and is thought of by herbalists as the Ayurvedic answer to ginseng and its rejuvenating properties.  In Sanskrit Ashwagandha means "the smell of a horse."  

Ashwagandha is native to the dry regions of India, northern Africa, and the Middle East, but today is also grown in more mild climates, including in the United States.  It's known as an "adaptogen," a class of medicinal herbs that works to normalize physiological function in various, sometimes unknown ways.  It's those unknowns that researchers are trying to figure out.  

Several mechanisms of action have been suggested in various studies of withania somnifera.  The withanolides are reported to show antioxidant properties including the prevention of lipid peroxidation. (1)  In a clinical study, following 12 weeks of treatment with ashwagandhathe circulating levels of inhibitory transmitters like glutamic acid decreased, this study points towards a potential clinical benefit in using ashwagandha to decrease the progression of neurocognitive disease. (2)

Ashwagandha in mental health

Studies have shown that Ashwagandha reduces anxiety levels and improves the quality of life of individuals, including significant reduction in stress and improved vitality, motivation and general health. (6)

Benzodiazepines are agonist at GABA receptor and are used to treat anxiety. (7)  Ashwagandha has GABA mimetic activity like benzodiazepines.  Ashwagandha has also exhibited an antidepressant effect in animal models of depression, comparable with that induced by imipramine, in two standard tests, the forced swim-induced 'behavioral despair' and 'learned helplessness' tests. (8)  Thus, Ashwagandha use in depression and anxiety disorders warrants further investigation.  

Various mood stabilizers and antipsychotic medication are used to treat patients with bipolar disorder. (9)  These medications are long term and can cause neurological, gastrointestinal, metabolic, thyroid, dermatological, nephrogenic, cognitive, sexual, hematological, hepatogenic, and teratogenic side effects. (10)  A placebo-controlled study was carried out at Pittsburgh's Western Psychiatric Institute and Clinic in persons with bipolar disorder who were euthymic, and taking stable treatment regimens for bipolar disorder.  A standardized extract of withania somnifera, called Sensoril, was dosed at 500 mg/day, added to existing bipolar treatment regimen and patients were followed for 8 weeks.  The withania somnifera group showed improvements of a moderate effect size in digit span backward, a measure of auditory verbal working memory.  Improvements in a measure of social cognition and in reaction time favored the withania somnifera group, and side effects were mild and similar to placebo. (11)  Mood stability was maintained.  However, this is a preliminary study, and needs to be replicated and the ideal dosage and duration of treatment need to be determined.  

Recent work has indicated that withania somnifera extract reversed deficits in spatial learning and working memory tasks in mouse models of Alzheimer's disease (12) probably by promoting hepatic clearance of B-amyloid.  Scopolamine-induced anticholinergic actions and down-regulation of BDNF (brain-derived neurotrophic factor) or GFAP (glial fibrillary acidic protein) were reversed by WSE. (13)  Ashwagandha has a wide array of action, thus it has a potential to work in various psychiatric disorders. 

There are a limited number of options to improve cognitive function in patients suffering from mental disorders.  Naturopathic medicine with other augmentation strategies like cognitive therapy helps improve cognition in people with psychiatric disorders. (14)  We need different strategies along with allopathic medicine for these patients.  

Preliminary studies have found various constituents of ashwagandha exhibit a variety of therapeutic effects with little or no associated toxicity.  These results are encouraging and indicate that ashwagandha should be studied more extensively to confirm these results and reveal other potential therapeutic effects.  Clinical trials using ashwagandha for a variety of conditions should also be conducted.  

Some of the limitations which make it difficult to recommend ashwagandha as a treatment option are that, ashwagandha is constituted of various compounds like alkaloids (isopelletierine, anaferine, cuseohygrine, anahygrine, etc.) steroidal lactones (withanolides, withaferins) and sitoindosides and acylsterylglucosides. (15)  The pharmacodynamics and pharmacokinetics of these compounds are not fully known.  Also, the studies that have been carried out are of short durations involving small sample sizes thus making the findings from these studies inconclusive and premature.  



(1) S. Sumathi et al. Free radical scavenging activity of different parts of withania somnifera.

(2) Mehta AK et al.  Pharmacological effects of Withania somnifera root extract on GABA receptor complex. Indian J Med Res. 1991 Aug; 94:312-5. 

(3) Kulkarni RR et al. Treatment of osteoarthritis with an herb mineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol

(4) Ahmad, M.K. et al. "Withania Somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males" Fertility and Sterility 94 (3):989-996. doi:10.1016/j.fertnstert.2009.04.046.PMID 19501822. 

(5) Ashwinikumar A. Raut et al. Exploratory study to evaluate tolerability, safety, and activity of Ashwagandha (Withania Somnifera) in healthy volunteers.  ICMR Advanced Centre for Reverse Pharmacology in Traditional Medicine at MRC-KHS, Mumbia, India

(6) Indian medicine (Ashwagandha) on acute phase reactants in inflammation. Indian J Exp Biol

(7) Kulkarni et al GABA receptor medicated anticonvulsant action of Withinia Somnifera and its root extract.  Indian drugs 30, 305-315. 

(8) Narendra Singh et al. An overview on Ashwagandha: A Rasayana (Rejuvenator) of Ayurveda. Published online 2011 Jul 3. doi: 10.4314/ajtcam.v8i5S.9 PMID: PMC3252722

(9) Geddes JR, Miklowitz D. Treatment of bipolar disorder. Lancet. 2013 May 11; 381(9878):1672-82.

(10) Dols A, et al. The prevalence and management of side effects of lithium and anticonvulsants as mood stabilizers in bipolar disorder from a clinical perspective: a review. Int Clin Psychopharmacol. 2013 Nov; 28(6): 287-96.

(11) Chengappa KN et al. Randomized placebo-controlled adjunctive study of an extract of withani somnifera for cognitive dysfunction in bipolar disorder. J Clinical Psychiatry. 2013 Nov; 74(11): 1076-83. doi: 10.4088/JCP.13m08413. 

(12) Neha Seghal et al. Withania Somnifera reverses Alzheimer disease pathology by enhancing LDL receptor related protein in liver. 

(13) Arpita Konar et al. Protective role of Ashwagandha's leaf extracts and its components Withanone on Scopalamine induced changes in the brain and brain derived cells. 

(14) Pingali U, Pilli R, Fatima N.  Effect of standardized aqueous extract of Withania Somnifera on tests of cognitive and psychomotor performance in healthy human participants. Pharmacognosy Res. 2014;6(1):12-18. 

(15) Narender Singh et al. An overview on Ashwagandha: A Rasayana (Rejuvenator) of Ayurveda.  Afr J Tradit Complement Altern Med. 2011; 8(5 suppl):205-2. 




ISBD Task Force: Prospective Offspring Studies and Treatment Trials (POST)

Background:  A number of studies of offspring of bipolar parents have been conducted across the globe, and more large and small-scale studies are about to commence or are currently being planned.  Researchers involved in the existing prospective offspring studies and/or undertaking studies of potential psychological and pharmacological interventions for high-risk offspring agree that collaboration and dialogue between the research teams would be both timely and valuable.  As such the ISBD Prospective Offspring Studies and Treatment Trials (POST) Task Force has been initiated as a vehicle to offer peer support, increase dialogue between established studies to foster learning between existing and/or novice groups and to offer the prospect of longer-term collaborative ventures. 

To ensure we do not duplicate the ongoing work of existing ISBD Task Forces, we have discussed our proposal with other ISBD Task Forces (i.e. Prodromes, Pediatric Bipolar, and Staging) and/or invited members who have also contributed to the work of those groups.  The convenors of POST comr from Europe, Canada, and Australia and also are members of other Task Forces, the initial membership of the Task Force has been deliberately kept quite small, with only a limited group of individuals who were identified because they are able to represent one or more of the following - (a) they are leading or are a key player in a group undertaking prospective follow-up studies or undertaking intervention studies with offspring; (b) they can represent work from a particular region of the world, profession, gender or age demographic; (c) they have current or prior involvement in closely related ISBD Task Forces; and/or (d) they have other expertise that was especially relevant to the initial objectives. 

Overall Objectives: It is important to highlight that one of the main aims of the POST Task Force is that it will focus on sharing ideas and information about research paradigms, and the optimum methods and strategies for offspring studies.  We believe the POST Task Force can therefore make a major contribution to support researchers and, if appropriate, share information on possible research strategies for planned projects.  Similarly, the POST Task Force will discuss potential methodologies for treatment intervention studies, especially as RCTs may not always be feasible or appropriate in certain populations or clinical settings. 

The main short-term objectives of POST Task Force are to undertake an evidence mapping exercise and to present a workshop on study design. 

The mapping exercise aims to put together a detailed picture of work and interest in this field.  In order to identify as many studies as possible we have designed an international web-based survey (see details below) to identify established/recently started/planned projects, both big and small.  We also hope to be able to use this data to present an overview of the methods and research paradigms being employed.  Our goal is to place this overview on the ISBD website and also to update it as and when applicable.  

The POST Task Force also aims to be an educational resource, and so internationally renowned experts have agreed to present a half-day workshop at a future ISBD meeting.  This will include advice on study design, shared experiences about how to conduct prospective offspring studies and findings from intervention studies and will compliment any clinical or research symposia on linked topics. 

In the medium to long-term, the POST Task Force aims to publich a large-scale, wide ranging review of the similarities and differences in methodologies and outcomes from prospective studies of offspring and of treatment intervention studies.  Finally, it is hoped that in the long-term, the POST Task Force will offer a useful first step in developing or expanding collaborative networks for sharing clinical knowledge and/or research data.  

Can you help?  If you are currently undertaking or are planning to undertake an offspring study, we would be keen to get some basic information from you about your project(s).  We want to make sure all those who are working or have plans in the field are represented in our evidence map, so we hope you can spare a few minutes to register your study and provide a few basic details via this link to the online survey:


Jan Scott, Newcastle University, UK

Anne Duffy, University of Calgary, Canada

Philip Mitchell, University of New South Wales, Australia

Willem Nolen, University of Groningen, The Netherlands

ISBD Regional Chapter Newsletter - North America

The ISBD would like to congratulate the following newly inducted ISBD Scholar.  



Eric Youngstrom, Ph.D, is a professor of Psychology and Psychiatry at the University of North Carolina at Chapel Hill and Associate Director of the Center of Excellence for Research and treatment of Bipolar Disorder.  He is the first recipient of the Early Career Award from the Division of Child and Adolescent Clinical Psychology, and has also been an American College of Neuropsychopharmacology Travel Fellow.  He has served as the Director of the Data Management and Statistical Analysis Unit and Research Methods Core of the Center for Research in Bipolar Disorder across the Life Cycle.  He earned his doctorate in clinical psychology at the Univeristy of Deleware, and he completed his predoctoral internship training at Western Psychiatric Institute and Clinic before joining the faculty at Case Western Reserve University.  Dr. Youngstrom is a licensed psychologist who specializes in the relationship of emotions and psychopathology, and the clinical assessment of children and families.  He teaches courses on assessment and therapy, developmental psychopathology, research design, and multivariate statistics, and has earned the Carl F. Wittke, Glennan Fellowship, and the Northeaastern Ohio Teaching Awards. He also actively investigates ways of improving the use of clinical assessment instruments for making better differential diagnoses, predictions about future functioning, or monitoring of treatment progress - particularly with regard to bipolar disorder across the lifespan.  Dr. Youngstrom has spoken on the topic of pediatric bipolar disorder at scientific meetings in Canada, Europe, South America, and Asia, as well as around the United States.  

Dr. Youngstrom has published more than 100 peer reviewed publications on the topics of clinical assessment and emotion, and he has served as an ad hoc reviewer on more than thirty prominent psychology and psychiatry journals as well as being on the editorial boards of the Journal of the American Academy of Child and Adolescent Psychiatry, the Journal of Clinical Child and Adolescent Psychology, the Journal of Child and Adolescent Psychopharmacology, and Psychological Assessment.  Dr. Youngstrom is the principal investigator on a five year grant from the National Institute of Mental Health (R01 MH066647) and co-investigator of a second, multi-site R01, both designed to improve the assessment of bipolar disorder in diverse community samples.  He has received grants from the NIMH, the Ohio Department of Mental Health, Cuyahoga County, and the Schubert Center for Child Development, and has been principal or co-investigator on more than $14 million in funded projects.  





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Neuroprogression and Staging in Bipolar Disorder

By Flavio Kapczinski, Eduard Vieta, Pedro Magalhaes & Michael Berk

A staging system is a heuristic tool intended to add prognostic significance to clinical diagnoses.  If able to use valid staging models, the clinician is armed with information capable of aiding in selection of specific strategies for treatment.  An already firmly established strategy in clinical medicine, from fields as disparate as oncology and rheumatology, neurology and nephrology, prognostic staging has been gaining traction in psychiatry in the past 10 years. 

There is now consistent evidence that, at least for a significant portion of people with bipolar disorder, clinical course and outcome are not as benign as initially described.  The evidence thus far points to relevant differences between early and late stages of bipolar disorders in clinical course of illness, neurobiology and systemic pathology.  These all suggest staging is a viable addition to clinical care in bipolar disorder. 

This book provides a comprehensive and scholarly discussion on the current state of the evidence regarding staging systems in bipolar disorder.  Edited by the leading researchers in the field, the book counts on the expertise of prominent authors to cover a breadth of topics of interest for clinicians and researchers alike. 

Among the topics systematically covered are (1) the history and theoretical basis for staging, (2) comparisons between different proposals, (3) neurobiological underpinnings, including neuroimaging, biological markers, (4) the current evidence-base, (5) limitations and future directions and (6) clinical implications and recommendations for practice. 

As a first attempt to discuss comprehensively staging and neuroprogression, we see this volume as novel work by expert clinician researchers for those treating people with bipolar disorder and working with clinical and basic investigation in the field.  The book is intended to provide a solid, in depth outline of the basis and utility of staging models and thus influence research and practice in the field of bipolar disorder. 

To purchase a copy:


ISBD Regional Chapter Newsletter - Middle East

The ISBD would like to congratulate the following newly inducted ISBD Scholar.  


Mohammad Alsuwaidan News

Mohammad Alsuwaidan, MD, MPH, FRCPC completed his residency in psychiatry at the University of Toronto (UofT) in 2010 and went on to complete two fellowships at UofT including in Mood & Anxiety Disorders and in Medical Education.  He also completed a Masters of Public Health at Johns Hopkins University in 2012 and then joined the department of psychiatry at UofT as an assistant professor.  Dr. Alsuwaidan has many accomplishments and awards from his time at UofT. 

In 2013 Dr. Alsuwaidan moved to his native country of Kuwait where there is less than 1 national psychiatrist for every 300,000 individuals (compared to about 1 for every 7,000 in Toronto).  He established the country's first specialized program in mood disorders within months of arriving and it has been a beacon of excellence in clinical care, research, advocacy and education.  More information is available about the program here.  







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