Ashwagandha May Alleviate Anxiety and Depression in Schizophrenic Individuals

Written by Angeline A. De Leon, Staff Writer. Study results suggest that Withania somnifera extract may treat a broad spectrum of symptoms in exacerbated schizophrenia.

Although schizophrenia is most saliently characterized by symptoms of hallucination and delusion, this mental illness is also commonly accompanied by disturbances in mood, with up to 80% of patients experiencing depression and almost 50% anxiety ^1,2. Treatment options for schizophrenia comorbid with symptoms of anxiety and depression include selective serotonin reuptake inhibitors (SSRIs) ³, however, clinical outcomes remain poor with standard treatment ⁴. Extracts of the herb Withania somnifera, also known as ashwagandha, have demonstrated potent anxiolytic ⁵, as well as anti-depressant effects ⁶, due to its anti-inflammatory, immunomodulating actions ^7,8. Such anti-oxidant agents help regulate stress response through inflammatory pathways ^9,10 and have, in fact, been studied as potential adjunctive treatments for schizophrenia and depressive and anxiety disorders ^11,12. In a 2019 study ¹³ published in the Annals of Clinical Psychiatry, researchers conducted the first exploratory investigation looking at the effects of ashwagandha supplementation on symptoms of anxiety and depression in patients with schizophrenia.

A total of 66 patients (aged 18-75 years) with recent exacerbations in positive symptoms of schizophrenia were enrolled in a randomized, double-blind, placebo-controlled trial. In addition to their ongoing psychotropic medications, subjects were randomized to receive either a standardized extract of Withania somnifera (WSE) or matching placebo, with the active group assigned to ingest 500 mg of ashwagandha daily for the first week, which was titrated up to 1000 mg daily for the second week, then maintained for 10 additional weeks. At baseline and at the end of Week 12, the Positive and Negative Syndrome Scale (PANSS) was administered to evaluate general symptoms of schizophrenia, as well as symptoms of depression (single-item depression score) and anxiety (anxiety-depression cluster sub-scores).

At the end of 12 weeks, mean improvement in single-item depression scores was significantly greater for WSE subjects, compared to placebo (0.71 +/- 0.97 vs. 0.06 +/- 0.93, p = 0.011). Likewise, mean improvement in anxiety-depression cluster scores for the WSE group was also significantly greater than that of the placebo group (2.86 +/- 2.56 vs. 1.19 +/- 2.32, p = 0.011). Finally, medium treatment effect sizes were observed in favor of WSE vs. placebo on single-item depression scores (Cohen’s d = 0.683, 95% Confidence Interval: 0.16 to 1.21) and anxiety-depression cluster scores (Cohen’s d = 0.686, 95% CI: 0.16 to 1.21).

Overall results suggest that supplementation with ashwagandha extract may offer therapeutic benefits for symptoms of mood disturbance commonly experienced by patients with schizophrenia. In line with previous research, treatment with WSE demonstrated significant anxiolytic and anti-depressant effects ^5,6, but for the first time, within the context of schizophrenia. While reductions in anxiety and depression were evident based on the PANSS, the absence of more sensitive and more specific diagnostic instruments to evaluate symptoms of anxiety and depression independently (rather than as a merged anxiety-depression cluster sub-score, for example) may be considered a prominent limitation of the current study. The exclusion of participants with negative symptoms of schizophrenia also limits the generalizability of study findings to this particular clinical population. Additional trials are needed to replicate results and to explore the potential transferability of findings to patients with schizoaffective disorder.

Source: Gannon JM, Brar J, Chengappa KNR. Effects of a standardized extract of Withania somnifera (Ashwagandha) on depression and anxiety symptoms in persons with schizophrenia participating in a randomized, placebo-controlled clinical trial. Ann Clin Psychiatry. 2019; 31(2): 123-129.

Posted January 21, 2020.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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