Skip to content
Deals

Ashwagandha and perceived stress: grade B

Moderate evidence. Direction: Benefit.

B ModerateShort-term onlySubjective outcome only

Educational guidance, not medical advice

Why this grade

Rubric condition met: Meta-analysis with high heterogeneity (I2 = 83.1%, low certainty); A not met because one meta-analysis found no significant effect on the Perceived Stress Scale

Three meta-analyses report lower stress scores than placebo, but the largest rates certainty low with high heterogeneity, and a fourth (6 trials on the Perceived Stress Scale) found no significant effect even though cortisol fell. Trials ran about 60 days. Key trials used extracts funded or supplied by their makers: of the six supporting studies, two ([5][6]) are confirmed industry-linked and none of the four meta-analyses is, so the industry-funded modifier does not apply (policy 3.3).

How we grade evidence

Studies this grade rests on

EffectMixedNo effectSize shows participants (n)20102015202020252030Meta-analysisRCTAkhgarjand 2022, 2022: meta-analysis, n = 1,002, result not recordedArumugam 2024, 2024: meta-analysis, n = 558, result not recordedAlbalawi 2025, 2025: meta-analysis, n = 488, result not recordedChandrasekhar 2012, 2012: RCT, n = 64, result not recordedLopresti 2019, 2019: RCT, n = 60, result not recordedAlsanie 2026, 2026: meta-analysis, n not recorded, result not recorded
each study this grade rests on, by publication year and design. Solid: effect versus the comparator; half-filled: mixed; hollow: no effect; dashed: result not recorded yet. Larger marks had more participants.
Show the numbers
StudyYearDesignParticipantsResult
Chandrasekhar 20122012RCT64result not recorded
Lopresti 20192019RCT60result not recorded
Akhgarjand 20222022meta-analysis1002result not recorded
Arumugam 20242024meta-analysis558result not recorded
Albalawi 20252025meta-analysis488result not recorded
Alsanie 20262026meta-analysisnot recordedresult not recorded

An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study.

Lopresti AL, Smith SJ, Malvi H. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study Medicine (Baltimore), 2019. PMID 31517876

Result not recorded
Design
Randomized, double-blind, placebo-controlled trial, 60 days
Sample
n = 60
Population
Stressed, healthy adults
Funding
Arjuna Natural Ltd (full text; Crossref funder)

A 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 adults.

Chandrasekhar K, Kapoor J, Anishetty S. A 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 adults Indian J Psychol Med, 2012. PMID 23439798

Result not recorded
Design
Randomized, double-blind, placebo-controlled trial, 60 days
Sample
n = 64
Population
Adults with a history of chronic stress
Funding
Source of Support: Nil (paper); extract provided by its manufacturer, Ixoreal Biomed

Effects of ashwagandha (Withania somnifera) on mental health in adults: A systematic review and dose-response meta-analysis of randomized controlled trials.

Alsanie SA, Alhodieb FS, Askarpour M. Effects of ashwagandha (Withania somnifera) on mental health in adults: A systematic review and dose-response meta-analysis of randomized controlled trials Complement Ther Med, 2026. PMID 41644067

Result not recorded
Design
Systematic review and dose-response meta-analysis of 22 RCTs
Population
Adults
Funding
Qassim University

Dual impact of Ashwagandha: Significant cortisol reduction but no effects on perceived stress - A systematic review and meta-analysis.

Albalawi AA. Dual impact of Ashwagandha: Significant cortisol reduction but no effects on perceived stress - A systematic review and meta-analysis Nutr Health, 2025. PMID 40746175

Result not recorded
Design
Systematic review and meta-analysis of RCTs (7 on cortisol, 6 on perceived stress)
Sample
n = 488
Population
Adults in RCTs of at least 2 weeks at 250 mg/day or more
Funding
not stated

Effects of Ashwagandha (Withania Somnifera) on stress and anxiety: A systematic review and meta-analysis.

Arumugam V, Vijayakumar V, Balakrishnan A. Effects of Ashwagandha (Withania Somnifera) on stress and anxiety: A systematic review and meta-analysis Explore (NY), 2024. PMID 39348746

Result not recorded
Design
Systematic review and meta-analysis of 9 RCTs
Sample
n = 558
Population
Adults with stress or anxiety (described as patients)
Funding
not stated

Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials.

Akhgarjand C, Asoudeh F, Bagheri A. Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials Phytother Res, 2022. PMID 36017529

Result not recorded
Design
Systematic review and dose-response meta-analysis of 12 RCTs
Sample
n = 1,002
Population
Adults aged 25-48 years in RCTs of stress and anxiety
Funding
not stated

Search and history

Search (): ashwagandha[ti] AND (stress[tiab] OR anxiety[tiab] OR cortisol[tiab]) AND (meta-analysis[pt] OR systematic review[pt])

  • Graded B (proposed): Proposed in the monograph draft
  • B to B (approved): Editor sign-off November 13, 2026: grade matches the editor-approved final page