Does Ashwagandha Help with Benzodiazepine Tapering and Withdrawal?

Does ashwagandha help during a benzodiazepine taper?

Ashwagandha may take some of the edge off poor sleep and anxiety for some people, but it is not a taper tool. It acts on the same gamma-aminobutyric acid (GABA) system that benzodiazepines act on, it can add to their sedation, and it has never been properly tested in people who are coming off these medications.

Most patients who ask about it took a benzodiazepine, or a z-drug such as zolpidem (Ambien), exactly as prescribed, and their nervous system adapted to the medication. That is physical dependence, and dependence is not addiction. It is a medical condition caused by the prescription, and wanting something gentle to get through a taper is a reasonable thing to want.

Ashwagandha, or Withania somnifera, is a shrub in the nightshade family whose root has been used in Ayurvedic medicine for centuries. It is sold as capsules, powders, gummies, and teas, usually under the word “adaptogen,” a loose term for an herb said to help the body handle stress. The species name, somnifera, means sleep-inducing.

So, what does the herb actually do, and where does it fit in a taper?

Why do people who are tapering ask about ashwagandha?

Sleep and anxiety are the two symptoms that wear patients down the most during a taper. Often, the anxiety is not the original anxiety coming back. It is a withdrawal symptom, produced by a nervous system that has lost part of its calming signal, and the insomnia that gets worse during a taper has the same source.

In Chapter III of the Ashton Manual (benzo.org.uk), Professor C. Heather Ashton wrote that the sleep benzodiazepines produce “is not a normal sleep.” She described the vivid dreams and frequent awakenings of withdrawal as a rebound of dreaming sleep, a normal reaction, and a sign that healing is beginning.

That is hard to believe at 3 am. Unfortunately, many patients have also learned to be wary of another prescription, because the last one came with an assurance that it was safe. An herb sold for calm and sleep looks like the gentler choice.

Ashwagandha is not inert. It acts on the GABA system.

Benzodiazepines work by boosting GABA, the brain’s main calming chemical, at a receptor called GABA-A. The opening chapter of the Ashton Manual explains that with long-term use those receptors become less responsive. That is why the dose has to come down slowly: each small step gives the receptors time to readjust.

Ashwagandha works on the same system. In laboratory work, extracts of the root act on GABA-A receptors, the same receptors a benzodiazepine uses, and that is a likely reason the herb makes people drowsy. How much of that effect a capsule delivers to a human brain has not been worked out.

“Natural” does not mean neutral. For a person in a taper, ashwagandha is a second substance acting on the very system the taper is trying to let settle, and what happens in the brain during withdrawal is sensitive enough without it.

Claims that ashwagandha restores GABA receptors, or protects the brain from benzodiazepines, have no human evidence behind them. Nothing sold in a bottle has been shown to speed that repair. Time and a slow taper do it.

How can a calming herb complicate a taper?

First, the sedation adds up. The Ashton Manual’s opening chapter notes that benzodiazepines have additive effects with other drugs that sedate, including alcohol, and a sedating herb behaves the same way. More drowsiness, slower reactions, and unsteadiness matter for driving, for work, and for anyone at risk of a fall.

Second, the herb can mask what the taper is doing. A taper is steered by how the patient feels after each small reduction, like lowering a thermostat one degree at a time and waiting to see whether the house stays comfortable. A sedating herb is a space heater plugged in down the hall. The house may feel fine, but nobody can tell what the thermostat is doing anymore, and the day the heater is unplugged, the cold arrives all at once.

So, a reduction that seemed easy may have been covered by the herb, and a bad week may be the reduction, the herb, or the herb being stopped. Patients in withdrawal also report reacting to supplements and medications they once tolerated. That is the reason to make one change at a time, and to tell the prescriber about each one.

Professor Ashton made a related point in Chapter II, advising against compensating for a lower benzodiazepine dose with more alcohol or non-prescription drugs. In Chapter III she added that most other sleeping pills and sedatives act in a similar way to benzodiazepines and should not be used as alternative sleep aids during withdrawal. She was writing about drugs that act in a similar way to benzodiazepines, and the Manual does not mention ashwagandha. Yet, the Maudsley Deprescribing Guidelines call GABA-affecting supplements such as valerian particularly unwise for that same reason.

What about the liver, and what is actually in the bottle?

Liver injury has been reported in people taking ashwagandha, usually within the first weeks to months of use. Most recovered within a few months of stopping the product, but a small number of severe cases have been reported. These reports appear to be uncommon. Yet, they are real.

The warning signs are yellowing of the skin or eyes, dark urine, itching, nausea, pain in the upper right abdomen, and unusual fatigue. Several of those, including nausea, itching, and fatigue, are also things patients feel during benzodiazepine withdrawal. A person who develops them while taking ashwagandha should stop the product and get medical care promptly, and should not assume it is the taper.

Ashwagandha is also a supplement, not a medication. In the United States, a supplement does not have to be shown to be safe or effective before it is sold, and the strength and the part of the plant used can differ from brand to brand. It may also raise thyroid hormone levels, which matters for anyone taking thyroid medication.

How strong is the evidence that ashwagandha helps?

It is thin. While ashwagandha has centuries of traditional use behind it, the human testing is small and short, lasting weeks to a few months, mostly in adults with everyday stress or trouble sleeping, and it points to a modest benefit at best. There is no good evidence from people who are tapering a benzodiazepine, and a taper often lasts longer than the herb has ever been tested.

Sellers often say that it lowers cortisol, the stress hormone. Whether that means anything for a person in benzodiazepine withdrawal is unknown.

The Ashton Manual is plain about supplements in general. In Chapter III, Professor Ashton wrote that there is “no general need for dietary supplements or extra vitamins or minerals,” and that all of these can be harmful in excess.

What is left is what patients report, and it varies. Some patients say ashwagandha helps them settle at night. Others notice nothing, feel groggy the next day, get an upset stomach, or feel worse, and nobody can predict the response from the label.

The decision belongs in the taper conversation.

None of this makes ashwagandha forbidden. Dr. Mark Leeds, an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida, does not work from a list of banned supplements or a list of approved ones. Supplement decisions during a taper are made per patient, with a physician who understands the pharmacology and can assess how that person responds.

When the United States Food and Drug Administration (FDA) updated the benzodiazepine boxed warning in 2020, its advice to patients included always telling their health care professionals about every prescription medicine, over-the-counter medicine, and other substance they take. An herb that acts on GABA receptors qualifies. The useful details are the product, how long it has been taken, why, and whether it was started or stopped near a dose reduction.

That conversation should run the way informed consent is supposed to run. Risks come first, then the alternatives, including taking nothing, then a plan for how the herb would be stopped. The patient keeps the right to decline.

Stacking is where the unknowns multiply. Valerian, passionflower, kava, and similar herbs also act on or near the GABA system, and each one added to ashwagandha makes the taper harder to read. The article on which supplements help with benzodiazepine withdrawal covers the rest of the shelf.

Questions patients ask about ashwagandha and benzodiazepines.

Can ashwagandha replace a benzodiazepine?

No. It cannot stand in for alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), or diazepam (Valium), and nothing shows that it prevents withdrawal. Swapping the medication for the herb amounts to stopping abruptly, and the FDA’s 2020 update warns that stopping abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, which can be life-threatening. Call emergency services for a seizure or any other medical emergency.

Is it safe to take ashwagandha with Xanax, Klonopin, or Ativan?

There is no single answer. Both are sedating and both act on the GABA system, so the drowsiness can add up, especially with alcohol, a sedating antihistamine, or a sleep medication on top. It is a question for the prescriber and the pharmacist before the first capsule.

What if someone is already taking ashwagandha when the taper begins?

Then the prescriber should know before the first reduction. The answer is not automatically to stop it. That is decided per patient, and what helps is keeping any change to the herb apart from the dose reductions, so that the effect of one can be told from the effect of the other.

A slow taper does the work that no herb can.

What relieves withdrawal is time and a gradual taper, directed by the patient and adapted to the person. The reductions are small, and they get smaller as the dose gets lower, the hyperbolic pattern described in the Maudsley Deprescribing Guidelines. The Ashton Manual, in Chapter II, describes steps of up to one tenth of the dose, with the patient as the best judge of the pace.

That takes months, sometimes longer. Fortunately, most of what patients hope an herb will do, a slow enough taper does better.

Dr. Leeds’ practice focuses on medically supervised benzodiazepine and z-drug tapering for patients in Florida, with the pace set by the patient. Every supplement a patient takes is part of that conversation, and none of them takes the place of the taper. Anyone in Florida who is looking for a slow, supervised taper can contact the office.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.