Withania - A Useful Adjunct with SSRI's For Anxiety

 Posted: August 2020
Author: Phil Rasmussen |  M.Pharm., M.P.S., Dip. Herb. Med.; M.N.I.M.H.(UK),  F.N.Z.A.M.H. 

Withania is one of our most treasured herbs, particularly at present with raised stress levels and increased incidence of conditions such as insomnia and anxiety, as a result of the ongoing Covid-19 global pandemic. While predominantly considered an adaptogen rather than anxiolytic, several studies now support its applications for stress-associated anxiety conditions, including human clinical trials^(1,2). 

Anxiety disorders are the most prevalent mental health disorder affecting children and adults, but many more people are dealing with problematic anxiety symptoms without any formal diagnosis. Due to its often chronic nature, drug treatment regimens can often last for a long period of time, with a relatively high incidence of unwanted adverse effects⁽³⁾.

Patients often present to us when already taking pharmaceutical drugs prescribed for the management of such conditions, but with a desire to be less dependent on these, or to help reduce some of the adverse events associated with their use. The efficacy and safety of Withania as concomitant treatment with such drugs is therefore relevant, particularly as we (practitioners and our patients) continue to hear frequent statements about the unproven safety of combining herbs with drugs, in the popular media.

Selective serotonin reuptake inhibitors (SSRI’s), are commonly prescribed to treat anxiety disorders and symptoms these days, in addition to their application as antidepressant drugs. However, these don’t always produce a complete remission, and cause adverse events in some patients.

Researchers in Iran recently published results from a clinical trial involving 40 patients diagnosed with generalized anxiety disorder, who took Withania or a placebo alongside their ongoing treatment with SSRI’s⁽⁴⁾. Anxiety was rated at baseline, then after 2 and 6 weeks of concomitant treatment using the validated Hamilton anxiety rating scale. 

After two weeks of Withania treatment, anxiety scores improved significantly compared to the placebo group (p-0.04). This improvement continued further with a further four weeks of adjunctive Withania treatment (p=0.02). No difference was measured in the frequency of adverse events between the two treatment groups.

Clinical trials have previously found Withania to combine well with antipsychotic drugs^{(5, 6)}, producing not only a significant improvement in schizophrenia symptom scores and stress scores compared to placebo, but also a lesser need to be prescribed higher doses of or additional antipsychotic drugs.

Also published recently, was a systematic review which evaluated the clinical evidence base for Withania to help manage cognitive dysfunction⁽⁷⁾. While no surprise to us medical herbalists, this concluded that Withania improves performance on cognitive tasks, executive function, attention, and reaction time. Also that it is well tolerated, with good adherence and minimal side effects.

References:

1. Andrade C et al, Indian J Psychiatry 2000; 42(3):295-301.
2. Pratte MA et al, J Altern Complement Med 2014; 20(12):901-908.
3. Rasmussen PL, Why Herbs should be the first choice of treatments for anxiety. https://herbblurb.com/?s=anxiety
4. Fuladi S et al, Curr Clin Pharmacol. 2020 Apr 13. doi: 10.2174/1574884715666200413120413
5. Agnihotri AP et al, Indian J Pharmacol. 2013 Jul-Aug;45(4):417-8
6. Chengappa KNR et al, J Clin Psychiatry. 2018 Jul 10;79(5).
7. Ng QX et al, Phytother Res. 2020 Mar;34(3):583-590.