Stress has become part of our daily personal and professional life. Stress is considered as a physiological response to a threat or an uncomfortable situation or any stimulation. Another associated terminology we come across regularly is anxiety. It is defined as the specific reaction to the stress. Stress and anxiety both were not considered as health conditions earlier. They were categorized as a behavioral or a characteristic feature of a person. Being a psychological condition, it is quite hard to define and determine stress conditions clinically. Modern science helped in defining and establishing the condition as a serious illness. Advanced research established the scientific facts through physiological, biochemical, neurological, and psychological analysis for stress response and anxiety. Seeking medical attention for stress and anxiety is now considered seriously. Chronic stress and anxiety can harm our health and may cause permanent damage. Chronic stress can often lead to serious health problems. On the other hand, acute stress may impact our daily lives, and disturb our general wellbeing.
Digest: Stress and Anxiety
Stress: Physiological response to an altering environment of stimulation.
Anxiety: Specific reaction to the stress
A general stress response is expressed by the increased heart rate, lung dilation, reduced digestion activity, and increased energy metabolism. Even though in modern science we consider stress or anxiety as a negative health condition, in certain circumstances these expressions act as a natural reaction, sometimes beneficial to the individual as well depending on the condition. For instance, in several species, the “Fight or flight” response is observed as a response to the environmental stimulus that ignites stress. Situationally, such responses are beneficial to save an animal, depending on the environmental condition. However, psychological verification is important to assess the condition, the stress and anxiety igniting factors, frequency, and episodes of expression, before considering the condition as a beyond normal one.
Digest: Stress response
Limited and controlled stress response is part of our natural defence mechanism.
Clinical precise detection is important to consider stress or anxiety as a harmful health condition.
Frequent ignition of stress response is harmful for health.
Clinical assessment of the stress or anxiety condition is crucial before the declaration of the patients’ condition. The modern clinical evaluation system applies several psychological, physiological, biochemical, and neurological evaluation systems and metrics to assess stress and anxiety. Some of such techniques are visual analogue scale [1], Perceived stress scale [2], Psychosocial Index [3]. Sensor-based assessment of blood volume photoplethysmographic (BVP) that is used on a finger or thumb and aids in determining the pulse rate using a LORETA z-score neurofeedback [4]. Similarly, several precisely designed clinical scales are used to measure the anxiety level. Some common scales used for anxiety assessment are Hamilton anxiety scale (HAM-A) [5], Zung Self‐Rating Depression Scale (SDS), Beck Depression Inventory (BDI), and Taylor Manifest Anxiety Scale (TMAS) [6]. Modern-day advanced bioelectronics also helped in designing advanced physiological sensors to measure and determine the anxiety and stress [7]. Wearable sensors that can detect such signals to distinguish between stressed and non-stressed situations are also being used [8].
Digest: Stress and Anxiety Assessment
Psychological, physiological, biocehmcial, clinical evaluation is important to declare the clinical condition.
Hamilton anxiety scale (HAM-A), Zung Self‐Rating Depression Scale (SDS), Beck Depression Inventory (BDI), and Taylor Manifest Anxiety Scale (TMAS) scales are used to assess stress and anxiety.
Wearable physiological sensor based gadgets are available to measure and monitor stress.
A systematic orderly neurological activation and suppression is observed as part of the stress response neurologically. Sensory environmental stimulations that are judged as stress-causing activate the hypothalamus that further activates the pituitary gland and the adrenal medulla. Hence, activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis [9] allows the secretion of adrenocorticotropic hormone (ACTH) followed by the release of an important corticosteroid, i. e., cortisol, from the adrenal medulla [10]. Cortisol (hydrocortisone) is pivotal in releasing deposited glucose from the liver the maintaining a constant energy source during an emergency [11]. The immune system is suppressed through a feedback mechanism for reduced energy utilization. However, the suppression or reduction of the intensity of the stress stimulation reverses the process towards stress relaxation and returns to the homeostatic condition [12–13].
Digest: Hormonal involvement
Chronic stress response involves hormonal imbalances.
Important hormones, cortisols, ACTH are involved.
Several drugs are available in the market that efficiently tackles stress conditions and provide some relief. These drugs are primarily targeted towards the molecular aspects of the stress ignition and response pathway. Different molecular targets are approached to either activate or suppress to manage the overexpression of the stress and anxiety. Several drugs are available in the market which is being used as anxiolytic, anti-stressor, and anti-depressant. Long term use of such medication is harmful. Several side-effects including ulcer development and gastrointestinal complications [14–15], mucosal damage [16], and other issues were noted long ago.
There is an ongoing search for a natural solution in the form of a supplement for decades. Herbal extracts are preferred for being natural and mild most of the time. Chinese herbal drugs [17] and Indian Ayurvedic therapeutics [18–19] are well recognized and globally accepted as anti-stress therapeutics and supplements.
Digest: Long-term Effect of medication
Most modern medicines are used as an excitator or a inhibitor to the physiological components involved in stress and anxiety response.
Long –term use of allopathic medicines may display harmful side effects
Ayurveda has an extensively useful resource, medication, and information on managing stress conditions, and anxiety that are precisely documented in ancient scriptures. The use of traditional “Rasayana” including Ashwagandha or Withania somnifera was recommended in Ayurveda [20]. Ashwagandha, a perennial shrub, is also known as Indian ginseng, winter cherry, and belongs to the nightshade family or Solanaceae family. Traditionally, the root extract is recommended for medication and supplement purposes. Modern scientific research also supported the quality of Ashwagandha as a marvelous adaptogen [21]. It was proven that Ashwagandha can provide expected outcomes in managing stress and anxiety [22]. Besides traditional reputation, being an adaptogen, having a somniferous property, and not having any serious side-effect, made Ashwagandha an obvious choice to treat anxiety and stress. Consumption of the capsule or powder is generally advised with milk or water. The herb is generally abundant in the drylands of India and the African region. It is also found in other Asia Pacific countries.
Digest: Ashwagandha
Ashwagandha is time tested, proven and extensively used in Ayurveda.
Can be used as supplement instead of medicine.
Less or no side-effects.
Having beneficial adaptogeic, “Rasayana”, somniferous properties.
Consumption can provide other health benefits simultaneously.
Ashwagandha has become a prominent herb due to its enormous beneficial impact on human health. The great beneficial impact of Ashwagandha root extract is reported on stress, anxiety, and depression and in improving general wellbeing. Recent clinical trials provided several acceptable and hopeful evidence in this direction. Regular supplementation of the herb extract with vitamin B was found to be effective for mood improvement and stress reduction in women [23]. Another similar study results containing self-reported stress reduction outcomes applying ecological momentary assessment (EMA) suggested a positive impact of Ashwagandha [24]. A double-blind trial conducted recently suggested that probably Ashwagandha is having an impact on the HPA axis and the herb extract modulates the signal cascade towards stress reduction. Another double-blind, placebo-controlled study done on patients having insomnia provided remarkable outcomes with Ashwagandha root extract [25]. The 10-week long study implemented modern actigraphy tools to understand and evaluate sleep onset latency (SOL), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), total time in bed (sleep log), mental alertness on rising, sleep quality, Pittsburgh Sleep Quality Index (PSQI), and Hamilton Anxiety Rating Scale (HAM-A) scales for the insomnia patients and the controls. Significant improvement in sleep quality and reduction in anxiety was observed in the patients, moreover, consumption of Ashwagandha was reported to help in improving the general wellbeing and quality of life [26]. A recent report suggested excellent adaptogenic and anxiolytic impacts of Ashwagandha root-extract in healthy humans. The report suggested the reduction in Perceived Stress Scale scores, serum cortisol levels in the group consuming Ashwagandha root-extract compared to the placebo group participants. Improvement of sleep quality was also observed in this study for the participants receiving Ashwagandha [27].
Digest: Modern scientific proof
Modern science rediscovered the efficacy and safety of Ashwagandha with state-of-the-art clinical investigations.
Ashwagandha was found efficacious in managing stress and anxiety.
Varying dosages are recommended while consuming Ashwagandha either as a supplement or part of a polyherbal mixture to reduce stress. Studies attempted to explore the impact of varying dosages of Ashwagandha extract have reported dosage up to 600 mg/day (Salve et al., 2019). The commercially available reputed brands of Ashwagandha root-extract recommends 600 mg/day [25-26], preferably 300 mg extract should be taken twice a day. Acute and subacute toxicity analysis in mouse models suggested that upto 2000 mg/kg/day for 28 days dosage was tolerable for mouse and was not having any toxic effect on the animals [27].
Stress and anxiety have become part of daily life. Modern life has become complex due to the increase in activities, communications, and lack of quality time for self, family, and dear ones. The rat race is on at every level of society. However, healthy competition, progress, is welcome as such activities will bring our desired future. On the contrary, a balanced, relieved, and stress-free life is desirable. Often, we try to seek solace in different ways, sometimes being irrational. Progress of human society and evolving stress was recognized in ancient times, hence, Ayurveda provided some amicable and acceptable solutions in the form of Ayurvedic massage, adaptogens, and polyherbal formulations. Embracing the time tested nature’s gift such as Ashwagandha may provide us the actual solution and flourish human life.
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