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Maca is a root vegetable native to Peru, Bolivia, Paraguay, and Argentina. It is used as a food and in traditional medicine. Maca has been used for anemia; chronic fatigue syndrome (CFS); and enhancing energy, stamina, athletic performance, and memory. It is also used for female hormone imbalance and menstrual irregularities, enhancing fertility, sexual dysfunction associated with antidepressant use, menopause symptoms, osteoporosis, depression, stomach cancer, leukemia, HIV/AIDS, tuberculosis, impotence, as an aphrodisiac, and as an immunostimulant.

Also known as: Ayak Chichira, Ayuk Willku, Ginseng Andin, Ginseng Péruvien, Maca Maca, Maca Péruvien, Maino, Maka, Peruvian Ginseng, Peruvian Maca

Diseases and Conditions

There is not enough scientific research to assign an effectiveness rating to maca for the following:

  • Anemia
  • Chronic fatigue syndrome (CFS)
  • Enhancing energy, stamina, athletic performance, and memory
  • Female hormone imbalance
  • Menstrual irregularities
  • Enhancing fertility
  • Sexual dysfunction associated with antidepressant use
  • Menopause symptoms
  • Osteoporosis
  • Depression
  • Stomach cancer
  • Leukemia
  • Tuberculosis
  • Impotence
  • As an aphrodisiac
  • As an immunostimulant


Maca is likely safe when used orally and appropriately in found amounts.

Medication Interactions

There are no known medication interactions for maca.

Supplement and Food Interactions

There are no known supplement, herb, or food interactions for maca.


The correct dosage of any supplement requires a comprehensive analysis of many factors including your age, sex, health conditions, DNA, andlifestyle.

  • Antidepressant-induced sexual dysfunction: 1.5 grams twice daily for 12 weeks has been used.
  • Male infertility: 1.5 grams to 3 grams daily for 4 months has been used.
  • Postmenopausal conditions: 3.3 grams daily in two divided doses for 6 weeks has been used.
  • Sexual desire: 1.5 to 3 grams daily in three divided doses for 12 weeks has been used.


Maca is used as a food.

5 Things That Happened When I Started Taking Ashwagandha Every Day

May 14, 2017 0 Comments 320 views

Author: Shannon Dyson / Source: mindbodygreen

When I was 15 years old I was diagnosed with lupus. By 18, I had figured out that diet was a major contributor to my condition and reworked my entire lifestyle around my diagnosis. Removing key foods like nightshades, dairy, and legumes really improved my achy joints, runs to the bathroom, and overall health—but sometimes there’s more to it than just nutrition. When I dug deeper and deeper into my healing process I noticed a few things about my health that my diet hadn’t been able to change, and most of them had everything to do with the medication I was taking.

When you’re on medication it’s very important to supplement your body with what those medicines might be depleting. Take oral contraceptives, for instance, and your body is being stripped of B vitamins. Being deficient in vitamin B12 can show up in symptoms such as fatigue, brain fog, dizziness, and anxiety—just to name a few.

Why I turned to ashwagandha.

Ashwagandha is an ayurvedic herb known for its extremely powerful, intelligent, and notoriously restorative benefits. It is an adaptogen that helps regulate the hormones in your body. An adaptogen is a natural substance that helps the body adapt and regulate to cope with the stresses of life, clear brain fog, and restore balance. Interestingly enough, ashwagandha is a part of the Solanaceae (or nightshade) family, which is normally not recommended for people with inflammation. But in such low doses, it does not seem to trigger my inflammatory response.

I turned to this herb because I’d been on prednisone and Plaquenil to control my illness for almost eight years. Prednisone is a corticosteroid that imitates the effect of the adrenal hormones that your body produces naturally. It’s not good to be on prednisone for an extended period of time since it can cause weak bones, weight fluctuations, bruising, mood changes, a weakened immune system, depression, and anxiety—again, just to name a few.

Here’s what happened when I started taking ashwagandha every day.

Prednisone also depletes calcium, vitamin D, vitamin C, selenium, magnesium, potassium, vitamin B6, and zinc, nutrients you need in order to be functional. While on one of my late-night Facebook scrolls I stumbled across a few articles on ashwagandha and figured I’d give it a try. Here’s what happened:


  • Always check with your doctor before you use a natural product. Some products may not mix well with other drugs or natural products.

  • This product may interfere with some lab tests. Be sure to talk with your doctor about this and all drugs you are taking, especially digoxin (Lanoxin).

  • Be sure to tell your doctor that you take this product if you are scheduled for surgery or tests.

  • Do not use this product if you are pregnant or plan to become pregnant soon. Use birth control you can trust while taking this product.

  • Do not use this product if you have stomach problems or ulcers.

  • Avoid beer, wine, and mixed drinks (alcohol) while taking this product. It may cause you to become sleepy or drowsy.

  • Take extra care if you are at a high risk for infection. This includes people who have had a transplant, are on chemo, or have an autoimmune disease.

  • This product may cause you to be sleepy. Take extra care driving and doing tasks that you need to be alert for while taking this product.

  • Take extra care if you are using drugs to help you relax or sleep. These are drugs like diazepam (Valium), lorazepam (Ativan), phenobarbital (Donnatal), or zolpidem (Ambien).

  • Take extra care and check with your doctor if you have:

    • Heart problems

    • Blood pressure problems

    • Blood sugar problems

    • Thyroid problems

    Keep hard candies, glucose tablets, liquid glucose, or juice on hand for low blood sugar, especially if you have blood sugar problems.



Table of Contents > Supplements > Melatonin

Overview Uses Available Forms How to Take It Precautions Possible Interactions Supporting Research

Melatonin is a hormone secreted by the pineal gland in the brain. It helps regulate other hormones and maintains the body’s circadian rhythm. The circadian rhythm is an internal 24-hour “clock” that plays a critical role in when we fall asleep and when we wake up. When it is dark, your body produces more melatonin. When it is light, the production of melatonin drops. Being exposed to bright lights in the evening, or too little light during the day, can disrupt the body’s normal melatonin cycles. For example, jet lag, shift work, and poor vision can disrupt melatonin cycles.

Melatonin also helps control the timing and release of female reproductive hormones. It helps determine when a woman starts to menstruate, the frequency and duration of menstrual cycles, and when a woman stops menstruating (menopause). Preliminary research suggests low levels of melatonin help identify women at risk of a pregnancy complication called pre-eclampsia.

Some researchers also believe that melatonin levels may be related to aging. For example, young children have the highest levels of nighttime melatonin. Researchers believe these levels drop as we age. Some people think lower levels of melatonin may explain why some older adults have sleep problems and tend to go to bed and wake up earlier than when they were younger. However, newer research calls this theory into question.

Melatonin has strong antioxidant effects. Preliminary evidence suggests that it may help strengthen the immune system.

If you are considering using melatonin supplements, talk to your doctor first.



Studies suggest that melatonin supplements may help people with disrupted circadian rhythms (such as people with jet lag or those who work the night shift), and those with low melatonin levels (such as some seniors and people with schizophrenia) to sleep better. A review of the scientific literature suggests that melatonin supplements may help prevent jet lag, particularly in people who cross 5 or more time zones.

A few clinical studies suggest that, when taken for short periods of time (days to weeks), melatonin is more effective than a placebo in reducing the time it takes to fall asleep, increasing the number of sleeping hours, and boosting daytime alertness. It is not clear how well melatonin works, however. Some studies suggest that it only reduces the amount of time to fall asleep by a few minutes.

Several human studies have measured the effects of melatonin supplements on sleep in healthy people. A wide range of doses has been used, often taken by mouth 30 to 60 minutes prior to sleep time. Results have been mixed. Some evidence suggests that melatonin may work best for people over 55 who have insomnia. One study of 334 people aged 55 and older found that sustained-release melatonin seemed to help people with primary insomnia fall asleep faster, sleep better, be more alert in the morning, and improve quality of life in people with primary insomnia.

Heart Disease

Several studies show melatonin has cardioprotective properties, including antioxidant and anti-inflammatory effects. Research also suggests that melatonin may help lower blood pressure levels and improve cholesterol profiles. More research is needed.


Melatonin supplements may improve sleep problems associated with menopause. Other studies suggest it may help restore quality of life and prevent bone loss among perimenopausal women. However, it does not appear to relieve other symptoms of menopause, such as hot flashes. Peri- or postmenopausal women who use melatonin supplements should do so only for a short period of time since long-term effects are not known.

Benzodiazepine Withdrawal

Some research suggests that melatonin may help elderly people with insomnia who are tapering off or stopping benzodiazepines such as diazepam (Valium), alprazolam (Xanax), or lorazepam (Ativan). Taking controlled-release melatonin improved sleep quality in those stopping benzodiazepine use. More research is needed. You should never combine melatonin with sedative medications unless you are under the strict supervision of a health care provider.

Breast Cancer

Several studies suggest that low melatonin levels may be associated with breast cancer risk. For example, women with breast cancer tend to have lower levels of melatonin than those without the disease. Laboratory experiments have found that low levels of melatonin stimulate the growth of certain types of breast cancer cells, while adding melatonin to these cells slows their growth. Preliminary evidence also suggests that melatonin may strengthen the effects of some chemotherapy drugs used to treat breast cancer. In a study that included a small number of women with breast cancer, melatonin (given 7 days before beginning chemotherapy) prevented the lowering of platelets in the blood. This is a common complication of chemotherapy that can lead to bleeding.

In another small study of women who were taking tamoxifen for breast cancer but seeing no improvement, adding melatonin caused tumors to modestly shrink in more than 28% of the women. Women with breast cancer should ask their doctors before taking melatonin.

Prostate Cancer

Studies show that men with prostate cancer have lower melatonin levels than men without the disease. In test tube studies, melatonin blocks the growth of prostate cancer cells. In one small-scale study, melatonin, combined with conventional medical treatment, improved survival rates in 9 out of 14 men with metastatic prostate cancer. Interestingly, since meditation may cause melatonin levels to rise it appears to be a valuable addition to the treatment of prostate cancer. More research is needed before doctors can make recommendations in this area. Men with prostate cancer should talk to their doctor before taking medication.

Attention Deficit Hyperactivity Disorder (ADHD) and Autism

Some evidence suggests that melatonin may help promote sleep in children with ADHD or autism, although it does not seem to improve the behavioral symptoms of ADHD or autism.

Fibromyalgia and Chronic Pain

A randomized, placebo-controlled study found that people with fibromyalgia experienced a significant reduction in their symptoms when they took a melatonin supplement either alone or in conjunction with fluoxetine (Prozac). Other studies suggest that melatonin may play a role in other painful conditions, such as migraines. People with chronic pain should speak to their physicians before using melatonin as it can interact with some medications.

Other Uses

  • Sunburn. Preliminary studies suggest that gels, lotions, or ointments containing melatonin may protect against sunburn and other skin damage. Studies examined using melatonin alone or combined with topical vitamin E prior to UV light exposure from the sun.
  • Irritable Bowel Syndrome (IBS). Preliminary research suggests that people with IBS who take melatonin reduce some symptoms, such as abdominal pain. Results are mixed as to whether melatonin may help improve other symptoms, such as bloating and frequency of bowel movements.
  • Epilepsy. Some studies suggest melatonin may reduce the frequency and duration of seizures in children with epilepsy, but other studies suggest melatonin may increase the frequency of seizures. DO NOT take melatonin for epilepsy, or give it to a child, without talking to your doctor first.
  • Sarcoidosis. Some researchers suggest that melatonin may be effective in the treatment of pulmonary sarcoidosis. Talk to your doctor.
  • Assisted Reproduction. Interestingly, preliminary studies suggest melatonin supplementation in the eggs of women with polycystic ovarian syndrome could improve egg maturation and pregnancy rates.
  • Other Uses. Preliminary evidence suggests that melatonin may play a role in pain modulation and digestive function. More research is needed.

Available Forms

Melatonin is available as tablets, capsules, cream, and lozenges that dissolve under the tongue.

How to Take It

There is currently no recommended dose for melatonin supplements. Different people will have different responses to its effects. Lower doses appear to work better in people who are especially sensitive. Higher doses may cause anxiety and irritability.

The best approach for any condition is to begin with very low doses of melatonin. Keep the dose close to the amount that our bodies normally produce (< 0.3 mg per day). You should only use the lowest amount possible to achieve the desired effect. Your doctor can help you determine the most appropriate dose for your situation, including how to increase the amount, if needed.


  • Always ask your child’s doctor before giving melatonin to a child. In fact, doses between 1 to 5 mg may cause seizures in this age group.


  • You should work with your doctor to find the safest and most effective dose for you. The right dose for you should produce restful sleep with no daytime irritability or fatigue.
  • Jet lag: 0.5 to 5 mg of melatonin 1 hour prior to bedtime at final destination has been used in several studies. Another approach that has been used is 1 to 5 mg 1 hour before bedtime for 2 days prior to departure and for 2 to 3 days upon arrival at final destination.


Because of the potential for side effects and interactions with medications, people should take dietary supplements only under the supervision of a knowledgeable health care provider.

Some people may have vivid dreams or nightmares when they take melatonin. Taking too much melatonin may disrupt circadian rhythms (your “body clock”).

Melatonin can cause drowsiness if taken during the day. If you are drowsy the morning after taking melatonin, try taking a lower dose.

Additional side effects include stomach cramps, dizziness, headache, irritability, decreased libido, breast enlargement in men (called gynecomastia), and reduced sperm count.

Pregnant or nursing women should not take melatonin because it could interfere with their fertility, or their pregnancy.

Melatonin is a hormone so patients with a history of hormonal-related issues should only use melatonin under the supervision of their physicians.

Some studies show that melatonin supplements worsened symptoms of depression. For this reason, people with depression should consult their doctor before using melatonin supplements.

Although many researchers believe that melatonin levels go down with age, newer evidence has brought this theory into question. People older than 65 should ask their doctor before taking melatonin supplements, so blood levels of this hormone can be monitored.

Possible Interactions

If you are taking prescription medications, you should not use melatonin without first discussing it with your health care provider. Below is a partial list of medications that may interact with melatonin.

Antidepressant medications. In an animal study, melatonin supplements reduced the antidepressant effects of desipramine and fluoxetine (Prozac). More research is needed to know if the same thing would happen in people. In addition, fluoxetine (a member of a class of drugs called selective serotonin reuptake inhibitors, or SSRIs) can cause low levels of melatonin in people.

Antipsychotic medications. A common side effect of antipsychotic medications used to treat schizophrenia is a condition called tardive dyskinesia, which causes involuntary movements. In a study of 22 people with schizophrenia and tardive dyskinesia caused by antipsychotic medications, those who took melatonin supplements had fewer symptoms compared to those who did not take the supplements.

Benzodiazepines. The combination of melatonin and triazolam (Halcion) improved sleep quality in one study. In addition, a few reports have suggested that melatonin supplements may help people stop using long-term benzodiazepine therapy. (Benzodiazepines are habit forming.)

Birth control pills. Birth control pills may increase the amount of melatonin your body makes. Taking additional melatonin could increase your levels of melatonin above the healthy range.

Blood pressure medications. Melatonin may make blood pressure medications like methoxamine (Vasoxyl) and clonidine (Catopres) less effective. In addition, medications in a class called calcium channel blockers may lower melatonin levels. Calcium channel blockers include:

Beta-blockers. Use of beta-blockers may lower melatonin levels in the body. Beta-blockers include:

Blood-thinning medications (anticoagulants). Melatonin may increase the risk of bleeding from anticoagulant medications such as warfarin (Coumadin).

Interleukin-2. In one study of 80 cancer patients, use of melatonin along with interleukin-2 led to more tumor regression and better survival rates than treatment with interleukin-2 alone.

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen (Advil, Motrin) may lower levels of melatonin in the blood.

Steroids and immunosuppressant medications. Melatonin may cause these medication to lose their effectiveness. DO NOT take melatonin with corticosteroids or other medications used to suppress the immune system.

Tamoxifen. Preliminary research suggests that the combination of tamoxifen (a chemotherapy drug) and melatonin may benefit some people with breast and other cancers. More research is needed to confirm these results.

Other. Caffeine, tobacco, and alcohol can all lower levels of melatonin in the body.

Supporting Research

Altun A, Ugur-Altun B. Melatonin: therapeutic and clinical utilization. Int J Clin Pract. 2007;61(5):835-45.

Arendt J. Melatonin, circadian rhythms and sleep. New Engl J Med. 2000;343(15):1114-6.

Attele AS, Xie JT, Yuan CS. Treatment of insomnia: an alternative approach.Altern Med Rev. 2000;5(3):249-59.

Barcelo E. Melatonin — estrogen interactions in breast cancer. J of Pineal Res. 2005;38:217-22.

Barcelo E. melatonin and mammary cancer: a short review. Endocrine-Related Cancer. 2003;10:153-9.

Bylesjo I, Forsgren L, Wetterberg L. Melatonin and epileptic seizures in patients with acute intermittent porphyria. Epileptic Disord. 2000;2(4):203-8.

Chang FY, Lu CL. Treatment of irritable bowel syndrome using complementary and alternative medicine. J Chin Med Assoc. 2009 Jun;72(6):294-300. Review.

Cos S, Sanchez-Barcelo EJ. Melatonin and mamary pathological growth. Frontiers Neuroendo. 2000;21:133-70.

Cos S, Sanchez-Barcelo EJ. Melatonin, experimental basis for a possible application in breast cancer prevention and treatment. Histo Histopath. 2000;15:637-47.

Dominguez-Rodriguez A. Melatonin in cardiovascular disease. Expert Opin Investig Drugs. 2012;21(11):1593-6.

Eck-Enriquez K, Kiefer TL, Spriggs LL, Hill SM. Pathways through which a regimen of melatonin and retinoic acid induces apoptosis in MCF-7 human breast cancer cells. Breast Cancer Res Treat. 2000;61(3):229-39.

Gordon N. The therapeutics of melatonin: a paediatric perspective. Brain Dev. 2000;22(4):213-7.

Herxheimer A, Petrie KJ. Melatonin for preventing and treating jet lag. Cocharane Database Syst Rev. 2001;1:CD001520.

Jacobson JS, Workman SB, Kronenberg F. Research on complementary/alternative medicine for patients with breast cancer: a review of the biomedical literature. J Clin Onc. 2000;18(3):668-83.

Kaneko S, Okumura K, Numaguchi Y, Matsui H, Murase K, Mokuno S, et al. Melatonin scavenges hydroxyl radical and protects isolated rat hearts from ischemic reperfusion injury. Life Sciences. 2000;67(2):101-12.

Kotlarczyk MP, Lassila HC, O’Neil CK, et al. Melatonin osteoporosis prevention study (MOPS): a randomized, double-blind, placebo-controlled study examining the effects of melatonin on bone health and quality of life in perimenopausal women. J Pineal Res. 2012;52(4):414-26.

Lanoix D, Guerin P, Vaillancourt C. Placental melatonin production and melatonin receptor expression are altered in preeclampsia: new insights into the role of this hormone in pregnancy. J Pineal Res. 2012;53(4):417-25.

Lewy AJ, Emens J, Jackman A, Yuhas K. Circadian uses of melatonin in humans. Chronobiol Int. 2006;23(1-2):403-12.

Low Dog T, Riley D, Carter T. Traditional and alternative therapies for breast cancer. Alt Ther. 2001;7(3):36-47.

Lusardi P, Piazza E, Fogari R. Cardiovascular effects of melatonin in hypertensive patients well controlled by nifedipine: a 24-hour study. Br J Clin Pharmacol. 2000;49(5):423-7.

Malhotra S, Sawhney G, Pandhi P. The therapeutic potential of melatonin: a review of the science. Medscape General Medicine. 2004;6(2).

Melmed: Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011.

Morceli G, Honorio-Franca AC, Fagundes DL, Calderon IM, Franca EL. Antioxidant effect of melatonin on the functional activity of colostral phagocytes in diabetic women. PLoS One. 2013;8(2):e56915.

Motta E, Czuczwar SJ, Ostrowska Z, et al. Circadian profile of salivary melatonin secretion and its concentration after epileptic seizure in patients with drug-resistant epilepsy–preliminary report. Pharmacol Rep. 2014;66(3):492-8.

Nagtagaal JE, Laurant MW, Kerkhof GA, Smits MG, van der Meer YG, Coenen AM. Effects of melatonin on the quality of life in patients with delayed sleep phase syndrome. J Psychosom Res. 2000;48(1):45-50.

Piccirillo JF. Melatonin. Prog Brain Res. 2007;166:331-3.

Pignone AM, Rosso AD, Fiori G, et al. Melatonin is a safe and effective treatment for chronic pulmonary and extrapulmonary sarcoidosis. J Pineal Res. 2006 Sep;41(2):95-100.

Reiter RJ. Melatonin: clinical relevance. Best Pract Res Clin Endocrinol Metab. 2003;17(2):273-85.

Reiter RJ, Tan DX, Korkmanz A, Rosales-Corral SA. Melatonin and stable circadian rhythms optimize maternal, placental and fetal physiology. Hum Reprod Update. 2014;20(2):293-307.

Rossignol DA, Frye RE. Melatonin in autism spectrum disorders. Curr Clin Pharmacol. 2014;9(4):326-34.

Schernhammer E, Hankinson S. Urinary melatonin levels and breast cancer risk. J Nat Canc Instit. 2005;97(14):1084-7.

Serfaty MA, Osborne D, Buszewicz MJ, Blizard R, Raven PW. A randomized double-blind placebo-controlled trial of treatment as usual plus exogenous slow-release melatonin (6 mg) or placebo for sleep disturbance and depressed mood. Int Clin Psychopharmacol. 2010;25(3):132-42.

Simko F, Pechanova O. Potential roles of melatonin and chronotherapy among the new trends in hypertension treatment. J Pineal Res. 2009 Sep;47(2):127-33. Epub 2009 Jun 29. Review.

Smits MG, Nagtegaal EE, van der Heijden J, Coenen AM, Kerkhof GA. Melatonin for chronic sleep onset insomnia in children: a randomized placebo-controlled trial. J Child Neurol. 2001;16(2):86-92.

Stewart LS. Endogenous melatonin and epileptogenesis: facts and hypothesis. Int J Neurosci. 2001;107(1-2):77-85.

van Wijingaarden E, Savitz DA, Kleckner RC, Cai J, Loomis D. Exposure to electromagnetic fields and suicide among electric utility workers: a nested case-control study. West J Med. 2000;173;94-100.

Vural EM, van Munster BC, de Rooij SE. Optimal dosages for melatonin supplementation therapy in older adults: a systematic review of current literature. Drugs Aging. 2014:31(6):441-51.

Wilhelmsen M, Amirian I, Reiter RJ, Rosenburg J, Gogenur I. Analgesic effects of melatonin: a review of current evidence from experimental and clinical studies. Pineal Res. 51(3):270-7.

Review Date: 2/3/2016
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

According to the Centers for Medicare & Medicaid Services, approximately 1 in 10 adults in the United States is affected by depression.1 This overwhelming number of people affected are often treated with antidepressant medications. In fact, antidepressants are the prescription medications most frequently used by US adults between the ages of 20 and 59 years.1

According to the Centers for Disease Control and Prevention, antidepressant use increased nearly 65% over the course of 15 years.2 Between 2011 and 2014, 12.7% of people aged 12 years and older reported antidepressant medication use in the last month vs 7.7% from 1999 to 2002. Of people treated within the last month, a quarter of them have been using antidepressants for more than 10 years. Moreover, use increases with age, ranging from 3.4% among people aged 12 to 19 years to 19.1% among people aged 60 years and older. 2

Antidepressants are the third most frequently mentioned medications during physician office visits, with a significant proportion written by primary care physicians.3 Moreover, a significant proportion of antidepressants are not being prescribed for the approved indications (eg, depression and anxiety), but are being used off-label.4

Selective serotonin reuptake inhibitors (SSRIs) constitute the most widely used antidepressants.”5 However, they are associated with significant toxicity. According to the 2016 annual report of the National Poison Date System, SSRIs were number 10 of the top 25 substance categories associated with reported fatalities.6

In particular, SSRIs raise serotonin levels in the body, and when combined with other serotonergic agents, they can lead to a potentially fatal condition called serotonin syndrome (SS). The actual incidence of SS and associated morbidity is likely underestimated, as SS is frequently underdiagnosed and underreported and can easily be overlooked, especially when mild.7 It has been suggested that more than 85% of physicians are not familiar with the existence of SS or which drugs or drug combinations may cause it.8

“In my experience, the majority of prescribers have absolutely no idea that even exists, let alone what causes it and what to do about it,” according to Irene Campbell-Taylor, MB ChB, PhD, a clinical neuroscientist based in Nova Scotia, Canada, with a private practice focusing primarily on geriatrics.

“It is alarming because SSRIs are among the most frequently prescribed antidepressants, and patients are not usually warned about other serotonergic agents that can interact with SSRIs and induce serotonin syndrome, a condition that can be lethal,” she told Psychiatry Advisor.

Serotonin: Too Much of a Good Thing?

SS is caused by drugs that either affect serotonin metabolism or act as direct serotonin receptor agonists, or both, and takes place in the setting of excess stimulation of central and peripheral serotonin receptors.9

Decarboxylation and hydroxylation of tryptophan are responsible for producing serotonin (5-hydroxytryptamine ). After this process, 5-HT is stored in vesicles and released into the synaptic cleft when it is stimulated. Monoamine oxidase-A is responsible for metabolizing 5-HT.9

Serotonin can bind to at least 7 different families of 5-HT receptors, and no single receptor is responsible for the development of SS. However, evidence suggests that the 5HT-2A receptors are most implicated in the condition.9

Serotonin plays an essential and far-reaching role in multiple systems and acts both peripherally and centrally. Peripheral serotonin is produced primarily in gastrointestinal tract and is responsible for stimulating vasoconstriction, uterine contraction, bronchoconstriction, gastrointestinal motility, and platelet aggregation.9

Central serotonin, which is present in the midline raphe nuclei of the brainstem, functions to inhibit excitatory transmission. It also plays an important role in modulating wakefulness, attention, mood, affective and sexual behaviors, appetite, thermoregulation, motor tone, migraine, emesis, nociception, and aggression.9

Drugs that can cause SS do so by inhibiting serotonin reuptake, increasing serotonin synthesis, decreasing serotonin metabolism, increasing serotonin release, or activating serotonergic receptors.9 The inhibition of cytochrome P450 enzymes by SSRIs can result in the accumulation of certain serotonergic drugs that are usually metabolized by these enzymes, leading to an “exacerbation loop in which the SSRI inhibits the metabolism of a certain drug, which in turn increases serotonergic activity.”9 Drugs that increase serotonin concentrations and their mechanisms of action are listed in Table 1. Additional drugs with serotonergic effects that can potentiate other serotonergic agents and cause SS are listed in Table 2.

From Subtle to Serious

“Serotonin syndrome tends to be underrecognized by physicians because you have to be careful and on the lookout, since its presentation can be subtle,” Peter R. Chai, MD, MMS, from the Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, told Psychiatry Advisor.

The onset of SS can occur within hours of an exposure to a serotonergic agent, but can be delayed for as much as 24 hours.10

“It is important to note that serotonin syndrome can progress from mild to florid and serious very quickly, especially in the setting of the combination of an SSRI or and a drug of abuse, such as cocaine,” warned Dr Chai, who is also an assistant professor at Harvard Medical School in Boston.

Dr Campbell-Taylor recounted the case of a patient who was being treated with an SSRI and took over-the-counter melatonin for insomnia.

“He woke up during the night with headache, dizziness, and his ‘face on fire,’ which is typically a sign of elevated blood pressure,” she reported.

“The fact that it wasn’t lethal is likely because he took a relatively small dose of melatonin and his symptoms abated without requiring hospitalization,” she added.

Diagnosis of Serotonin Syndrome

Autonomic, cognitive, and neuromuscular derangements are common in SS, together with signs such as fever, agitation, and clonus. However, the condition varies considerably from patient to patient. Moreover, many of these manifestations are nonspecific, making the syndrome challenging to diagnose.10

It is essential to take a careful patient history, finding out what medications (prescription and over-the-counter) and dietary supplements the patient might have been using, for how long, and whether the dose was recently increased. It is also important to ascertain when the signs and symptoms began, relative to the exposure, and whether they were they rapid in onset.10

Dr Chai emphasized that it is important as well to find out whether the patient recently stopped taking a serotonergic agent and began taking another one, as many of these drugs have long half-lives and may still be in the system when a new drug is initiated.

There is no laboratory test that confirms SS and serum serotonin levels do not necessarily correlate with clinical findings. Instead, laboratory and other tests are used to rule out other diagnoses.11

Classical symptoms of SS are listed in Table 3. The Hunter Serotonin Toxicity Criteria for diagnosing serotonin syndrome has become the standard algorithm to diagnose SS and is listed in Table 4. Differential diagnoses of SS are included in Table 5.

Treating Serotonin Syndrome

“Clinicians should be aware that serotonin syndrome is treatable once you recognize the hallmark features, and that the prognosis is generally favorable,” Dr Chai said.

First-line management involves discontinuation of the offending serotonergic agents and provision of supportive care, with the intensity of treatment depending on the severity of the syndrome.11 Mild cases typically resolve in 24 to 72 hours with conservative therapy, and patients do not necessarily require hospital admission.11 In contrast, patients with moderate to severe cases involving hypertonicity, hyperthermia, autonomic instability, or progressive cognitive changes require hospitalization.11 Management of mild, moderate, and severe cases are listed in Table 6.

Prevention: The Role of Psychiatrists

Dr Campbell-Taylor and Dr Chai both emphasized the critical role that psychiatrists can plan in preventing SS.

Be vigilant about what you are prescribing.

Physicians and other prescribers should modify their prescription practices to avoid or at least minimize coprescription of drugs that have a high probability of inducing SS.11

“Do not combine 2 serotonergic agents, such as an SSRI and SNRI, in treatment, and be vigilant during initiation of the medication or when increasing the dose, especially in patients naive to these drugs,” Dr Chai warned.

A computerized ordering system and medical software can ascertain whether there are potential interactions when multidrug regimens are required.11 Physicians who do not have access to this system should verify potential interactions with a pharmacist.

Make sure you know what other agents your patient may be taking.

It is critical to inquire about every item that your patient uses, including all prescription mediations, over-the-counter remedies, dietary supplements, and drugs of abuse, Dr Campbell-Taylor emphasized.

“This requires thorough inquiring because many people don’t think to mention items taken for nonpsychiatric causes, such as cold remedies, antibiotics, or herbal supplements that the patient may regard as ‘natural’ and therefore perfectly safe,” she said.

Educate patients about serotonin syndrome

“Many drugs include instructions or warnings, such as not to take them in combination with alcohol or not to drive or use heavy equipment while being treated, but SSRIs do not carry those warnings, although there are warnings about suicidality,” Dr Campbell-Taylor pointed out. It therefore is incumbent on prescribers to inform patients about the risk for serotonin syndrome.

“I suggest that prescribers provide list of all products that patients should avoid while taking SSRIs, SNRIs, or other serotonergic agents,” she advised. “Patients should be told that if they have a cold or allergy or have difficulty sleeping, they should consult the prescriber before self-treating with an over-the-counter drug or herbal supplement.”

Part of education is educating patients and families about the risk for overdose and its associated symptoms, Dr Chai added.

Consider nonpharmacologic approaches for treatment of mood disorders

“The implications of this widespread SSRI use are staggering,” Dr Campbell-Taylor said. “It is incumbent on all medical professionals to educate themselves and their patients and avoid prescribing these drugs whenever possible.”

Evidence-based psychotherapies, such as cognitive behavioral therapy, are increasingly being regarded as potential first-line approaches to patients with mood disorders, and their use should be increased, together with other nonpharmacologic interventions, she advised.

1. Centers for Medicare and Medicaid Services (CMS). Antidepressant medications: use in adults. Accessed: February 12, 2019.

2. Centers for Disease Control and Prevention (CDC). Antidepressant use among persons aged 12 and over: United States, 2011–2014. Accessed: February 15, 2019.

3. Yuet WC, Derasari D, Sivoravong J, Mason D, Jann M. Selective serotonin reuptake inhibitor use and risk of gastrointestinal and intracranial bleeding. J Am Osteopath Assoc. 2019 Feb 1;119(2):102-111.

5. Medco Health Solutions. America’s state of mind. Accessed: February 12, 2019.

8. Brown CH. Drug-induced serotonin syndrome. US Pharm. November 17, 2010. Accessed: February 15, 2019.

9. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013 Winter;13(4):533-40.

10. Bartlett D. Drug-induced serotonin syndrome. Crit Care Nurse. 2017 Feb;37(1):49-54.

12. Patel et al. Dietary supplement-drug interaction-induced serotonin syndrome progressing to acute compartment syndrome. Am J Case Rep. 2017;18:926-930. Published 2017 Aug 25. doi:10.12659/AJCR.904375.

15. Erland LA, Saxena PK. Melatonin natural health products and supplements: presence of serotonin and significant variability of melatonin content. J Clin Sleep Med. 2017;13(2):275-281.

16. Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003 Sep;96(9):635-42.

Table 1

Mechanisms of Serotonin Syndrome9

Mechanism Category Drugs
Inhibition of serotonin uptake Amphetamines/weight loss drugs Phentermine
Antidepressants Bupropion, nefazodone, trazodone
Antiemetics Granisetron, ondansetron
Antihistamines Chrlopheniramine
Opiates Levomethorphan, levorphanol, meperidine, methadone, pentazocine, pethidine, tapentadol, tramadol
Drugs of abuse Cocaine, MDMA
OTC cold remedies Dextromethorphan
SNRIs Desvenlafaxine, duloxetine, venlafaxine
SSRIs Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
Tricyclic antidepressants Amitriptyline, amoxapine, clomipramine, desipramine, doxepine, imipramine, maprotiline, nortriptyline, protriptyline, trimipraline
Inhibition of serotonin metabolism Anxiolytics Buspirone
Monoamine oxidase inhibitor Furazolidone, isocarboxazid, linezolid, methylene blue, phenelzine, selegiline, Syrian rue, tranylcypromine
Triptans Almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
Increasing serotonin synthesis Amphetamines/weight loss drugs Phentermine
Dietary supplements L-tryptophan
Drugs of abuse Cocaine
Increasing serotonin release Antidepressants Mirtazapine
Amphetamines/weight loss drugs Phentermine
Opiates Meperidine, oxycodone, tramadol
Drugs of abuse MDMA
OTC cold remedies Dextromethorphan
Parkinson disease treatment/amino acid L-dopa
Activating serotonin receptors Anxiolytics Buspirone
Antidepressants Mirtazapine, trazodone
Antimigraines Dihydroergotamine, triptans
Opiates Fentanyl, meperidine
Drugs of abuse LSD
Mood stabilizers Lithium
Prokinetic agents Metoclopramide
Inhibition of various CYP450 microsomal oxidases CYP2D6 inhibitors Fluoxetine, sertraline9, 12
CYP2D6 substrates Dextromethorphan, oxycodone, phentermine, risperidone, tramadol
CYP3A4 inhibitors Ciprofloxacin, ritonavir
CYP3A4 substrates Methadone, oxycodone, venlafaxine
CYP2C19 inhibitors Fluconazole
CYP2C19 substrates Citalopram

Table 2

Additional Drugs/Supplements Associated With Serotonin Syndrome

Drug/Supplement Examples
Antimigraine medications11 Carbamazepine, valproic acid
Proton pump inhibitors13 Lansoprazole, omeprazole, pantoprazole
Angiotensin-converting enzyme inhibitors13 Benazepril, lisinopril, enalapril, captopril
Cardioselective β-adrenergic blocking drugs13 Atenolol, metoprolol, bisoprolol, esmolol
Digitalis glycoside13 Digoxin
Nonprescription product sold online as a weight-loss agent13 Sibutramine
Antibiotic13 Linezolid
Factor Xa inhibitor oral anticoagulant13 Rivaroxaban
Antiviral medications13 Ritonavir, acyclovir
Herbal/dietary supplements S-adenosyl-L-methionine14, curcumin13, ginseng13, nutmeg13, turmeric13, melatonin15 , St. John’s wort14

Table 3

Signs and Symptoms of Serotonin Syndrome10

  • Agitation
  • Akathisia
  • Ataxia
  • Clonus
  • Confusion
  • Diaphoresis
  • Diarrhea
  • Disseminated intravascular coagulation
  • Fever
  • Hyperreflexia
  • Hypertension
  • Hypomania
  • Increased bowel sounds
  • Muscular rigidity
  • Multiorgan failure
  • Mydriasis
  • Rhabdomyolysis
  • Shivering
  • Seizures
  • Tachycardia
  • Tremor

Table 4

Hunter Serotonin Toxicity Criteria: Decision Rules16

Symptom Presence of Serotonin Syndrome
Spontaneous clonus Yes
If the above is not present but there is…
Inducible clonus + agitation
Inducible clonus + diaphoresis
If the above are not present but there is…
Ocular clonus + agitation
Ocular clonus + diaphoresis
If the above are not present but there is…
Tremor + hyperflexia
If the above are not present but there is…
Hypertonic + temperature >38°C + ocular clonus
Hypertonic + temperature >38°C + inducible clonus
If none the above are present No

Table 5

Differential Diagnosis of Serotonin Syndrome11

  • Anticholinergic syndrome (primary)
  • Malignant hyperthermia (primary)
  • Neuroleptic malignant syndrome (primary)
  • Tetanus
  • Overdose of sympathomimetic drugs
  • Meningitis
  • Encephalitis
  • Thyroid storm
  • Heat stroke
  • Delirium tremens
  • Sepsis

Table 6

Managing Serotonin Syndrome Based on Severity9

Category Symptoms Management
Mild Mild hypertension
1. Discontinue the offending agent/agents·
2. Support (ie, stabilize vital signs, initiate cooling measures)
3. For mild agitation, fever, hypertension, tachycardia: benzodiazepines (diazepam)
4. Observe for ≥6 hours
Moderate All the above plus·
Temperature of ≥40°C
Hyperactive bowel sounds
Ocular clonus
Pressured speech
All the above plus·
1. For severe agitation/hypothermia: 5-HT antagonist (cyproheptadine)
2. Admission to hospital for cardiac monitoring/observation
Severe All the above plus·
Temperature of ≥41.1°C
Dramatic swings in pulse rate, blood pressure
Muscle rigidity
All the above plus·
1. For severe hypertension/tachycardia: esmolol or nitroprusside
2. Sedation and paralysis with a nondepolarizing agent and intubation/ventilation
3. Admission to intensive care unit

Melatonin can help you fall asleep faster, but while doctors don’t recommend long-term use for anyone, women who are on birth control pills should take extra precautions before getting in the habit of reaching for a supplement whenever insomnia strikes.

Savita Ginde, MD, vice president of medical affairs at Stride Community Health Center and former chief medical officer of Planned Parenthood of the Rocky Mountains, explained that melatonin is naturally produced in the pineal gland, the same gland that regulates female hormone levels. “While there are no definitive studies, “one can propose that taking or adding external melatonin could impact natural cycles, whether it’s natural sleep cycles or natural hormonal cycles, such as those that impact ovulation and menstrual cycles and thus affect fertility,” Dr. Ginde told POPSUGAR.

Then there’s the matter of where and how the body metabolizes melatonin. Heather Bartos, MD, a board-certified ob-gyn, told POPSUGAR that melatonin is metabolized in the liver along with a number of other medications, including birth control pills. “By asking the liver to do double duty, it can lower the effectiveness of the birth control pill,” she explained. Dr. Bartos added that certain antibiotics, medications, and supplements can also interfere with the metabolization of birth control, including St. John’s wort, an over-the-counter supplement that’s commonly used to treat depression.


It’s also important to note that melatonin may interfere with certain types of birth control pills — such as progestin-only pills or combination pills — more than others, though there hasn’t been enough research conducted to determine exactly how and to what extent that’s the case. For this reason, Dr. Bartos recommends erring on the side of caution if you regularly take melatonin. “I would switch to a LARC (long-active reversible contraceptive) such as an IUD,” she said.

If you’re taking melatonin more than “every so often,” both Dr. Bartos and Dr. Ginde recommend talking to your doctor to ensure that you’re protected from unwanted pregnancy and that your sleep issues are being adequately treated. “If sleep is an issue, don’t self-diagnose,” Dr. Ginde said. “Talk with your physician about solutions, and if melatonin is part of that plan, you and your doctor can review if and how a particular dose will impact your specific type of birth control.”

Image Source: POPSUGAR Photography / Mark Popovich

7 things you can do to avoid drug interactions

4. Be suspicious of supplements

Some of the most serious drug interactions involve prescription medications and supplements. Not only are supplements less likely than FDA-approved medications to be listed in the databases of drug interactions, but health care providers also may not know what supplements people are taking. Since there isn’t much evidence that supplements have health benefits, it’s best to avoid them unless your doctor prescribes them.

5. Go easy on grapefruit juice

While it’s true that grapefruit juice affects the metabolism of several drugs, it usually takes about a quart of the juice to make a difference. If you love the juice, ask your pharmacist if any of the drugs you take are affected by it. If they are, you should still be able to enjoy half a grapefruit or an 8-ounce glass of juice daily as long as you wait a few hours after taking the medication.

6. Limit alcohol

It isn’t a good idea for women to have more than a drink a day in general, and it can be even worse to drink while you’re taking drugs. Alcohol increases drowsiness—an intended effect of sleeping pills and a side effect of many antihistamines, antidepressants, and anti-anxiety medications. It can also irritate the lining of the esophagus and stomach—a special concern if you’re taking aspirin, other nonsteroidal anti-inflammatory drugs, or an oral bisphosphonate for low bone density.

7. Talk to your pharmacist

When you pick up a prescription, you may find as many as three different sheets or leaflets with your medication, each detailing the conditions the drug is approved to treat, how to take the drug, and the drug’s possible side effects. If your first reaction is “too much information!” your next step should be to ask the pharmacist to summarize how to take the drug and what to expect.

Pharmacists have an extensive knowledge of how drugs work, their side effects, and the medications, supplements, and foods they interact with. In fact, you may want to bring all your prescription and nonprescription drugs, as well as any supplements you take, to the pharmacy when you pick up a new prescription. If the pharmacist identifies any possible interactions among your medications, he or she may be able to suggest a schedule for taking them that will minimize the likelihood of interactions.

Your pharmacist may also be willing to talk to your health care team about adjusting a medication dose or finding an alternative that will work better. Some health plans have medication therapy management (MTM), or programs that allow an annual in-depth consultation with a pharmacist. Check yours to see if you qualify for MTM services.

For up-to-date information

The repository of information about the medications we take is continually growing. Although any printed list of potential drug-drug, drug-supplement, or drug-food interactions is soon out of date, the consumer website developed by the Institute for Safe Medication Practices ( has a wealth of current information on prescription and nonprescription drugs and supplements, including potential interactions and safety alerts from the FDA.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Ashwagandha dangers: Are you taking Ashwagandha? Learn the truth about adrenal fatigue and the benefits of taking ashwagandha.

Some of our patients have admittedly tried various herbal remedies that they believe will enhance their recoveries. This month I want to look at Ashwagandha dangers in particular. Ashwagandha, also known as winter cherry, is a powerful herb in Ayurvedic medicine. The herb grows in India, the Middle East, and northern Africa, and is in the same family as the tomato. Due to its increasing popularity in the west, is now also being grown in North America.

Folks take it to alleviate stress, fatigue, low energy, and to improve problems with concentration. This popular herb is being touted as a fantastic immune booster and super food. Ashwagandha is often called “Indian ginseng” because it is so energizing, but botanically speaking, ginseng and Ashwagandha are completely unrelated. But this big superfood claim is a hoax. Ashwagandha can do a lot of damage to folks with abnormal methylation issues.

Ashwagandha contains many useful medicinal properties, and although the leaves and fruit are nutrient-rich, the root is most commonly used in Western herbal remedies.

Ashwagandha proponents claim this herb can be used to alleviate many symptoms of stress, to improve learning, reduce anxiety, stabilize brain-cell degeneration, lower cholesterol, and reduce inflammation. Does this sound too good to be true? In some cases it may be, especially if you are taking this without consulting a physician, as there are many health conditions that can be worsened if a patient is taking Ashwagandha.

I’ve discovered that most patients are confused about the reason for adrenal fatigue.

Ashwagandha is often touted as a wonderful remedy for adrenal fatigue. In our world we often see that adrenal fatigue is often secondary to copper toxicity and systemic oxidative stress.

If your hormones are present but are not activated then they are not doing their job even though they are present.

Hormone production needs a feedback mechanism. Hormone levels are not an indication of hormone ACTIVITY. This is why we look at the methylation cycle. If this is not in balance, methylation disorders could hinder optimal functionality of hormones and feedback mechanisms that drive hormone production.

The adrenal glands are endocrine glands that produce various hormones including adrenaline, aldosterone, and cortisol. Our sex hormones, glucocorticoids, and epinephrine levels are controlled by the adrenals. Rarely do we see an overmethylated patient with adrenal fatigue.

Proponents of Ashwagandha don’t often understand the connection between elevated copper levels and adrenal fatigue. If you go to another practitioner you may get hormone therapy, glandulars (such as desiccated glandular supplements), and/or herbal remedies that may be problematic. Taking desiccated glandular supplements does not help the adrenal gland; they may not be doing what you think they should be doing, especially if you have a methylation disorder. The body does not work that way. The liver is a very powerful detoxification organ. The organ is functional because it has viability and a blood supply. Some of these adrenal support protocols may be carrying copper and can be detrimental to the methylation cycle.

What is causing the adrenal fatigue in the first place? That’s what excess copper does. It causes an increase in norepinephrine that puts stress on the adrenals. No outside agent will support the adrenals when they are being affected by an outside agent. We still have to put out that fire.

Our protocol for oxidative stress works at the root biochemical cause for adrenal fatigue. Patients on our Advanced Nutrient Therapy do not need to take Ashwagandha and risk the side effects.

Ashwagandha Dangers for Pregnancy and Breastfeeding

Plain and simple, please do not use Ashwagandha during pregnancy. There is evidence that it could cause miscarriages. We don’t know enough about the effects of using this herb during breastfeeding. It may be unsafe. If you are trying to become pregnant or if you have had previous miscarriages in your life, Ashwagandha is not for you. Just because it is natural it doesn’t make it beneficial.

Ashwagandha Dangers for Diabetes

Ashwagandha may lower blood sugar levels. If patients are taking a medication to lower blood glucose it could make their levels go dangerously low. And if their levels go too low and blood sugars bottom out, they can pass out. The consequences of low blood glucose can be just as dangerous as high blood sugar.

Ashwagandha Dangers for Blood Pressure

If you have high blood pressure levels or low blood pressure levels you can also lose consciousness and pass out from Ashwagandha.

Ashwagandha Dangers for GI Tract

Ashwagandha can irritate the GI tract. You have to be careful if you have an ulcer.

Ashwagandha Dangers for Autoimmune disorders

Ashwagandha can increase the symptoms of autoimmune disorders because it stimulates the immune system.

Ashwagandha Dangers for Thyroid

Ashwagandha may increase thyroid levels. If you take thyroid medicine you should not take ashwagandha. If your thyroid testing is irregular, please consult your physician.

Ashwagandha Dangers for Surgery

Ashwagandha can slow down the central nervous system. Patients going on anesthesia need to consult their physician if they are on Ashwagandha. They should stop taking Ashwagandha at least 2 weeks before surgery. Your central nervous system is responsible for breathing. If anything happens during surgery you can suffer respiratory arrest and die.


12 Proven Health Benefits of Ashwagandha

Ashwagandha is an ancient medicinal herb.

It’s classified as an adaptogen, meaning that it can help your body manage stress.

Ashwagandha also provides numerous other benefits for your body and brain.

For example, it can boost brain function, lower blood sugar and cortisol levels, and help fight symptoms of anxiety and depression.

Here are 12 benefits of ashwagandha that are supported by science.

1. Is an ancient medicinal herb

Ashwagandha is one of the most important herbs in Ayurveda, a form of alternative medicine based on Indian principles of natural healing.

It has been used for over 3,000 years to relieve stress, increase energy levels, and improve concentration (1).

“Ashwagandha” is Sanskrit for “smell of the horse,” which refers to both its unique smell and ability to increase strength.

Its botanical name is Withania somnifera, and it’s also known by several other names, including Indian ginseng and winter cherry.

The ashwagandha plant is a small shrub with yellow flowers that’s native to India and North Africa. Extracts or powder from the plant’s root or leaves are used to treat a variety of conditions.

Many of its health benefits are attributed to its high concentration of withanolides, which have been shown to fight inflammation and tumor growth (1).

Summary Ashwagandha is a prominent herb in Indian Ayurvedic medicine and has become a popular supplement due to its health benefits.

2. Can reduce blood sugar levels

In several studies, ashwagandha has been shown to lower blood sugar levels.

One test-tube study found that it increased insulin secretion and improved insulin sensitivity in muscle cells (2).

Also, several human studies have suggested that it can reduce blood sugar levels in both healthy people and those with diabetes (3, 4, 5, 6).

Additionally, in a 4-week study in people with schizophrenia, those treated with ashwagandha had an average reduction in fasting blood sugar levels of 13.5 mg/dL, compared with 4.5 mg/dL in those who received a placebo (5).

What’s more, in a small study in 6 people with type 2 diabetes, supplementing with ashwagandha for 30 days lowered fasting blood sugar levels. However, the study didn’t include a control group, making the results questionable (6).

Summary Limited evidence suggests that ashwagandha reduces blood sugar levels through its effects on insulin secretion and sensitivity.

3. Might have anticancer properties

Animal and test-tube studies have found that withaferin — a compound in ashwagandha — helps induce apoptosis, which is the programmed death of cancer cells (7).

It also impedes the growth of new cancer cells in several ways (7).

First, withaferin is believed to promote the formation of reactive oxygen species (ROS) inside cancer cells, disrupting their function. Second, it may cause cancer cells to become less resistant to apoptosis (8).

In one study, mice with ovarian tumors treated with withaferin alone or in combination with an anti-cancer drug showed a 70–80% reduction in tumor growth. The treatment also prevented the spread of cancer to other organs (13).

Although no evidence suggests that ashwagandha exerts similar effects in humans, the current research is encouraging.

Summary Animal and test-tube studies have shown that withaferin, a bioactive compound in ashwagandha, promotes the death of tumor cells and may be effective against several types of cancer.

4. Can reduce cortisol levels

Cortisol is known as a stress hormone given that your adrenal glands release it in response to stress, as well as when your blood sugar levels get too low.

Unfortunately, in some cases, cortisol levels may become chronically elevated, which can lead to high blood sugar levels and increased fat storage in the abdomen.

Studies have shown that ashwagandha may help reduce cortisol levels (3, 14, 15).

In one study in chronically stressed adults, those who supplemented with ashwagandha had significantly greater reductions in cortisol, compared with the control group. Those taking the highest dose experienced a 30% reduction, on average (3).

Summary Ashwagandha supplements may help lower cortisol levels in chronically stressed individuals.

5. May help reduce stress and anxiety

Ashwagandha is perhaps best known for its ability to reduce stress.

Researchers have reported that it blocked the stress pathway in the brains of rats by regulating chemical signaling in the nervous system (16).

Also, several controlled human studies have shown that it can reduce symptoms in people with stress and anxiety disorders (14, 17, 18).

In a 60-day study in 64 people with chronic stress, those in the group that supplemented with ashwagandha reported a 69% reduction in anxiety and insomnia, on average, compared with 11% in the placebo group (14).

In another 6-week study, 88% of people who took ashwagandha reported a reduction in anxiety, compared with 50% of those who took a placebo (18).

Summary Ashwagandha has been shown to reduce stress and anxiety in both animal and human studies.

6. May reduce symptoms of depression

Although it hasn’t been thoroughly studied, a few studies suggest ashwagandha may help alleviate depression (14, 18).

In one controlled 60-day study in 64 stressed adults, those who took 600 mg of high-concentration ashwagandha extract per day reported a 79% reduction in severe depression, while the placebo group reported a 10% increase (14).

However, only one of the participants in this study had a history of depression. For this reason, the relevance of the results is unclear.

Summary The limited research available suggests that ashwagandha may help reduce depression.

7. Can boost testosterone and increase fertility in men

Ashwagandha supplements may have powerful effects on testosterone levels and reproductive health (15, 19, 20, 21).

In one study in 75 infertile men, the group treated with ashwagandha showed increased sperm count and motility.

What’s more, the treatment led to a significant increase in testosterone levels (21).

The researchers also reported that the group who took the herb had increased antioxidant levels in their blood.

In another study, men who received ashwagandha for stress experienced higher antioxidant levels and better sperm quality. After 3 months of treatment, 14% of the men’s partners had become pregnant (15).

Summary Ashwagandha helps increase testosterone levels and significantly boosts sperm quality and fertility in men.

8. May increase muscle mass and strength

Research has shown that ashwagandha may improve body composition and increase strength (4, 20, 22).

In a study to determine a safe and effective dosage for ashwagandha, healthy men who took 750–1,250 mg of pulverized ashwagandha root per day gained muscle strength after 30 days (4).

In another study, those who took ashwagandha had significantly greater gains in muscle strength and size. It also more than doubled their reductions in body fat percentage, compared with the placebo group (20).

Summary Ashwagandha has been shown to increase muscle mass, reduce body fat, and increase strength in men.

9. May reduce inflammation

Several animal studies have shown that ashwagandha helps decrease inflammation (23, 24, 25).

Studies in humans have found that it increases the activity of natural killer cells, which are immune cells that fight infection and help you stay healthy (26, 27).

It has also been shown to decrease markers of inflammation, such as C-reactive protein (CRP). This marker is linked to an increased risk of heart disease.

In one controlled study, the group who took 250 mg of standardized ashwagandha extract daily had a 36% decrease in CRP, on average, compared with a 6% decrease in the placebo group (3).

Summary Ashwagandha has been shown to increase natural killer cell activity and decrease markers of inflammation.

10. May lower cholesterol and triglycerides

In addition to its anti-inflammatory effects, ashwagandha may help improve heart health by reducing cholesterol and triglyceride levels.

Animal studies have found that it significantly decreases levels of these blood fats.

One study in rats found that it lowered total cholesterol and triglyceride levels by 53% and nearly 45%, respectively (28).

While controlled human studies have reported less dramatic results, they have observed some impressive improvements in these markers (3, 4, 5, 6).

In a 60-day study in chronically stressed adults, the group taking the highest dosage of standardized ashwagandha extract experienced a 17% decrease in LDL (bad) cholesterol and an 11% decrease in triglycerides, on average (3).

Summary Ashwagandha may help reduce the risk of heart disease by decreasing cholesterol and triglyceride levels.

11. May improve brain function, including memory

Test-tube and animal studies suggest that ashwagandha may mitigate memory and brain function problems caused by injury or disease (29, 30, 31, 32).

Research has shown that it promotes antioxidant activity that protects nerve cells from harmful free radicals.

In one study, rats with epilepsy that were treated with ashwagandha had nearly a complete reversal of spatial memory impairment. This was likely caused by a reduction in oxidative stress (32).

Although ashwagandha has traditionally been used to boost memory in Ayurvedic medicine, only a small amount of human research has been conducted in this area.

In one controlled study, healthy men who took 500 mg of standardized extract daily reported significant improvements in their reaction time and task performance, compared with men who received a placebo (33).

Another 8-week study in 50 adults showed that taking 300 mg of ashwagandha root extract twice daily significantly improved general memory, task performance, and attention (34).

Summary Ashwagandha supplements may improve brain function, memory, reaction time, and the ability to perform tasks.

12. Is safe for most people and widely available

Ashwagandha is a safe supplement for most people, although its long-term effects are unknown.

However, certain individuals should not take it, including pregnant and breastfeeding women.

People with autoimmune diseases should also avoid ashwagandha unless authorized by a healthcare provider. This includes people with conditions like rheumatoid arthritis, lupus, Hashimoto’s thyroiditis, and type 1 diabetes.

Additionally, those on medication for thyroid disease should be careful when taking ashwagandha, as it may increase thyroid hormone levels in some people.

It may also decrease blood sugar and blood pressure levels, so medication dosages may need to be adjusted if you take it.

The recommended dosage of ashwagandha depends on the type of supplement. Extracts are more effective than crude ashwagandha root or leaf powder. Remember to follow instructions on labels.

Standardized root extract is commonly taken in 450–500-mg capsules once or twice daily.

It’s offered by several supplement manufacturers and available from various retailers, including health food stores and vitamin shops.

There’s also a great selection of high-quality supplements available online.

Summary Although ashwagandha is safe for most people, certain individuals shouldn’t use it unless authorized to do so by their healthcare provider. Standardized root extract is commonly taken in 450–500-mg capsules once or twice per day.

The bottom line

Ashwagandha is an ancient medicinal herb with multiple health benefits.

It can reduce anxiety and stress, help fight depression, boost fertility and testosterone in men, and even boost brain function.

Supplementing with ashwagandha may be an easy and effective way to improve your health and quality of life.

Where is it found?

The plant is native to Asia and Africa, but is also cultivated in Israel.

Parts of the plant used:

The root, leaves, fruit, and seeds

How is it used?

The leaves possess a narcotic action and the seeds are used to coagulate milk (Kapoor, 1990). The fruit decocted in water is used externally for eye diseases and the leaves are applied to wounds and skin infections. A paste made from the fresh leaves and roots is applied externally to boils, swelling, and rheumatism (Quattrocchi, 2012). Currently, Ashwagandha is available in commerce in pill or capsule form, alone or in combination with other herbs.

What is it used for?

Ashwagandha has been used in India’s Ayurvedic, Siddha, and Unani-Tibb systems of medicine for thousands of years, mainly as an adaptogen (helps to adapt to stressful situations), as well as to increase libido in both men an d women, improve sperm quality, stimulate growth in children, and to calm the nerves. The plant has also been used for the treatment of debility, emaciation, impotence, and premature ageing. Research undertaken to elucidate its pharmacological actions has shown that the plant possesses antitumor and adaptogenic actions similar to those found in Korean ginseng (Panax ginseng-Araliaceae). For this reason, Ashwagandha is also known in commerce as “Indian ginseng”, although the two species are botanically unrelated (Villaescusa-Castillo and Martín-Lopez, 2016; Khare, 2016, 2007; Bone and Mills, 2013).
Modern research has found that the root extracts have GABA- like activity. Villaescusa-Castillo and Martín-Lopez (2016) mention a study undertaken with rats, aimed at determining Ashwagandha’s usefulness as an anxiolytic (to decrease anxiety), as well as an antidepressant, showed that the root’s bioactive compounds possess am anxiolytic effect comparable to lorazepam. With regard to its antidepressant effects, the same study demonstrated that Ashwagandha can have antidepressant effects similar to those shown by imipramine. This research could justify using products made form Ashwagandha root as mood stabilizers, as well as for the treatment of depression and anxiety.
Ashwagandha root may also improve learning and memory (Bone and Mills, 2013). Although more research is needed to ascertain its clinical effects in humans, its active ingredients may have a role in the treatment of certain cancers, microbial infection, immune-modulation, and neurodegenerative disorders (Dar et al., 2015).
The bioactive phtyochemicals contained in the plant include withanolide A, withanolide D, withaferin A and the withaniamides. All of these play an important part in its pharmacological actions and properties (Dar et al., 2015; Sangwan et al., 2014; Khare, 2016, 2009).
Ashwagandha is a medicinal plant that was found to have anticancer properties more than forty years ago, after the isolation of a crystalline steroidal compound (withaferin A) from the leaves of this shrubby species. Additionally, the root and leaf extracts of the plant have been shown to offer protection against chemically-induced cancers in mice, as well as to retard the growth of xenografted tumors in athymic mice. The anticancer effect of Ashwagandha is usually attributed to steroidal lactone compounds known collectively as withanolides. Within this group of phytochemicals, Withaferin A seems to be the most active against cancer among structurally different withanolides that have been isolated from the leaves or roots (Vyas and Singh, 2014).

Maca root interactions with medications

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