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Adjunctive ashwagandha shows promise in schizophrenia
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Adjunctive treatment with a standardized extract of Withania somnifera, a medicinal herb known commonly as ashwagandha, provided benefits for patients with schizophrenia experiencing an exacerbation of symptoms and stress, according to study findings.
“A recent review concluded that of the 42 different add-on treatment strategies (added to anti-psychotic drugs) not one could be confidently recommended. Among [these] 42 add-on treatments, only one class of drugs showed some promise: non-steroidal anti-inflammatory drugs,” K. N. Roy Chengappa, MD, FRCPC, from the Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, told Healio Psychiatry.
“However, NSAID usage comes with clinical concerns, [such as] risk of bleeding, drug interactions, severe gastro-intestinal side effects, among others. So, NSAID alternatives that are effective but benign in terms of side-effects could fulfill a significant unmet treatment need,” he continued. “Standardized extracts of Withania somnifera may offer such an alternative. Extracts of ashwagandha have shown anti-inflammatory and immunomodulatory properties, as well as a desirable impact on glutamatergic, GABAergic [gamma-aminobutyric acid-ergic] and cholinergic systems in the brain, which are dysfunctional in schizophrenia.”
In this randomized, double-blind, placebo-controlled study, researchers examined whether adjunctive treatment with a standardized extract of W. somnifera improved psychopathology and stress in patients with schizophrenia or schizoaffective disorder.
Investigators assigned 66 patients with schizophrenia experiencing exacerbation of symptoms to adjunctive treatment with 1,000 mg W. somnifera extract or placebo for 12 weeks, along with antipsychotic medication. They compared patients’ change from baseline to end of treatment between groups on the Positive and Negative Syndrome Scale, as well as stress and inflammatory markers using the Perceived Stress Scale, S100 calcium-binding protein B (S100B) and C-reactive protein (CRP).
Beginning at 4 weeks and continuing to the end of treatment, the group treated with adjunctive W. somnifera achieved significantly greater reductions in negative, general and total symptom scores compared with patients treated with placebo.
Effect sizes favoring W. somnifera ranged from large for negative and total symptoms (Cohen d = 0.83) to medium for general symptoms (Cohen d = 0.76). Although positive symptom scores improved more in patients receiving W. somnifera compared with placebo, they did not reach statistical significance. Treatment with W. somnifera also resulted in a greater improvement in stress scores (Cohen d = 0.58) than treatment with placebo. CRP and S100B dropped more in these patients as well, but not significantly compared with placebo.
The authors reported that treatment adverse events were mild to moderate and transient. Furthermore, there were no remarkable changes in vital signs, body weight, clinical laboratory and ECG measures, suggesting good tolerability of W. somnifera.
“Clinicians should take note that this is an early but promising study, and that a highly standardized extract of ashwagandha was used for the clinical trial where the desirable bioactive constituents were concentrated, and contaminants and toxic substances were eliminated,” Chengappa said. – by Savannah Demko
Disclosures: Chengappa reports that the University of Pittsburgh is pursuing intellectual property protection for the technology discussed in this article. Please see the study for all other authors’ relevant financial disclosures.