The effect of Withania somnifera (Ashwagandha) on mental health symptoms in individuals with mental disorders: systematic review and meta-analysis.
Study Design
- Jenis Studi
- Meta-analysis
- Ukuran Sampel
- 713
- Durasi
- 8 weeks
- Intervensi
- The effect of Withania somnifera (Ashwagandha) on mental health symptoms in individuals with mental disorders: systematic review and meta-analysis. 600 mg/day (median)
- Pembanding
- Placebo
- Arah Efek
- Positive
- Risiko Bias
- Moderate
Abstract
BACKGROUND: Withania somnifera (WS) is considered an adaptogen agent with reported antistress, cognition facilitating and anti-inflammatory properties, which may be beneficial in the treatment of mental disorders. AIMS: This systematic review investigated the efficacy and tolerability of Withania somnifera for mental health symptoms in individuals with mental disorders. METHOD: The protocol of this review was registered with PROSPERO (CRD42023467959). PubMed, Scopus, PsycINFO, CINAHL, Embase and CENTRAL were searched for randomised controlled trials comparing Withania somnifera to any comparator, in people of any age, with any mental disorder. The meta-analyses were based on standardised mean differences (SMDs) and odds ratios with 95% confidence intervals, estimated through frequentist and Bayesian-hierarchical models with random-effects. RESULTS: Fourteen studies, corresponding to 360 people treated with Withania somnifera and 353 controls were included. Anxiety disorders were the predominant diagnostic category. Thirteen trials administered Withania somnifera orally (median dose 600 mg/day), one with Shirodhara therapy. The median follow-up time was 8 weeks. Although limited by the small number of studies, substantial between-study heterogeneity, and outlier effects, our investigation showed Withania somnifera effectiveness in improving anxiety (outlier-corrected SMD: -1.13 (95% CI: -1.65; -0.60), pooled SMD: -1.962 (95% CI: -2.66; -0.57)), depression (SMD: -1.28 (95% CI: -2.40; -0.16) and stress (SMD: -0.95 (95% CI: -1.46; -0.43) symptoms and sleep quality (SMD: -1.35 (95% CI: -1.79; -0.91). The effect size was confirmed using the Bayesian for anxiety but not for depression. No significant difference between Withania somnifera and the comparators was found for safety and tolerability. CONCLUSIONS: We found evidence supporting the effectiveness of Withania somnifera in treating anxiety symptoms. Future trials should replicate this finding in larger samples and further clarify a possible Withania somnifera role in depression and insomnia treatment.
Full Text
Figures
Fig. 1
PRISMA flow diagram for the systematic review and meta-analysis of Withania somnifera (ashwagandha) effects on mental health symptoms in individuals with mental disorders.
flowchart
Fig. 2
Forest plot of the overall effect of ashwagandha supplementation on anxiety symptoms across included randomized controlled trials.
forest_plot
Fig. 3
Forest plot showing the pooled effect of ashwagandha on stress or cortisol-related outcomes in individuals with mental health conditions.
forest_plot
Fig. 4
Meta-analysis results for the effect of ashwagandha supplementation on sleep quality measures in participants with mental disorders.
forest_plot
Fig. 5
Subgroup analysis examining the influence of ashwagandha dosage, treatment duration, or specific disorder type on mental health outcomes.
forest_plot
Fig. 6
Forest plot depicting the effect of ashwagandha on depression symptoms across the included studies.
forest_plot
Fig. 7
Sensitivity analysis or leave-one-out assessment evaluating the robustness of the meta-analytic findings on ashwagandha and mental health.
forest_plot
Fig. 8
Funnel plot or publication bias evaluation for the meta-analysis of ashwagandha effects on mental health symptoms.
chartTables
Table 1
| Author, year (trial ID) | Study design | Country | Setting | Diagnosis | Duration | % Female | Mean age (s.d.) or range | T | C | Concurrent treatment | Outcomes reported | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Andrade et al, 2000
| RCT | India | Out-patient clinic | Anxiety | 6 weeks | 20/19 | 38.5 | 41.3 (13.8) | WS 500 mg po daily | PBO (NR) | Any stable treatment | Anxiety |
| Chengappa et al, 2013
| RCT | USA | Out-patient clinic | Bipolar disorder I, II, or NOS | 8 weeks | 24/29 | 61.7 | 46.4 (10.3) | WS 500 mg po daily | PBO (inert filler) | Mood stabiliser | Depression, mania or anxiety |
| Chengappa et al, 2018
| RCT | USA | Out-patient clinic | SZ, schizo-affective disorder | 12 weeks | 33/33 | 48.5 | 46.3 (12.1) | WS 1000 mg po daily | PBO (inert filler) | AP | Depression, psychotic symptoms |
| Choudhary et al, 2017
| RCT | India | Out-patient clinic | Chronic stress | 8 weeks | 25/25 | 26.9 | 18-60 | WS 600 mg po daily | PBO (inert filler) | None | Stress |
| Cooley et al, 2009
| RCT | Canada | Out-patient clinic | Anxiety | 12 weeks | 36/39 | 63 | 51.7 (9.6) | WS 600 mg po daily + adult multi-vitamin | CBT + PBO (inert filler) | None | Anxiety |
| Fuladi et al, 2021
| RCT | Iran | NR | GAD | 6 weeks | 18/22 | 45 | 40.2 (8.8) | WS 1000 mg po daily | PBO (lactose) | SSRI | Anxiety |
| Fulzele et al, 2014
| RCT | India | NR | MDD | 6 weeks | 15/15 | NR | 20-65 | WS, Shirodhara oil (dose NR) | NA |
| Depression |
| Hosseini et al, 2019
| RCT | Iran | Out-patient clinic | ADHD | 6 weeks | 14/14 | 39.3 | 9.5 (1.6) | WS 10 mg po daily | PBO (NR) | Anti-ADHD treatment | Anxiety |
| Jahanbakhsh et al, 2016
| RCT | Iran | NR | OCD | 6 weeks | 15/15 | 90 | 33.1 (10.8) | WS 1000 mg po daily | PBO (lactose) | SSRI | OCD symptoms |
| Khyati et al, 2013
| RCT | India | NR | GAD | 8 weeks | 44/42 | NR | 16-60 | WS 12000 mg po daily | PBO (wheat flour) | NR | Anxiety |
| Langade et al, 2019
| RCT | India | Out-patient clinic | Insomnia | 10 weeks | 40/20 | 22.5 | 39.2 (5.4) | WS 600 mg po daily | PBO (starch) | NR | Anxiety, sleep quality |
| Langade et al, 2021
| RCT | India | Out-patient clinic | Insomnia | 8 weeks | 20/20 | NR | 37.3 (6.4) | WS 600 mg po daily | PBO (starch) | None | Anxiety, insomnia |
| Majeed et al, 2023
| RCT | India | NR | Depression or Anxiety | 12 weeks | 34/36 | 38.6 | 40.7 (11.3) | WS 500 mg po daily + 5 mg 95% piperine ( | PBO (cellulose) | NR | Depression, anxiety or sleep quality |
| Pandit et al, 2024
| RCT | India | Out-patient clinic | Chronic stress | 8 weeks | 22/24 | 28.6 | 35.1 (10.3) | WS 500 mg po daily | PBO (NR) | None | Depression, anxiety, sleep quality or stress |
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