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 AnxietyStress: 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 responseLimited 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 , Perceived stress scale , Psychosocial Index . 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 . 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) , Zung Self‐Rating Depression Scale (SDS), Beck Depression Inventory (BDI), and Taylor Manifest Anxiety Scale (TMAS) . Modern-day advanced bioelectronics also helped in designing advanced physiological sensors to measure and determine the anxiety and stress . Wearable sensors that can detect such signals to distinguish between stressed and non-stressed situations are also being used .
Digest: Stress and Anxiety AssessmentPsychological, 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  allows the secretion of adrenocorticotropic hormone (ACTH) followed by the release of an important corticosteroid, i. e., cortisol, from the adrenal medulla . Cortisol (hydrocortisone) is pivotal in releasing deposited glucose from the liver the maintaining a constant energy source during an emergency . 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 involvementChronic 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 , 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  and Indian Ayurvedic therapeutics [18–19] are well recognized and globally accepted as anti-stress therapeutics and supplements.
Digest: Long-term Effect of medicationMost 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 . 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 . It was proven that Ashwagandha can provide expected outcomes in managing stress and anxiety . 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: AshwagandhaAshwagandha 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 . Another similar study results containing self-reported stress reduction outcomes applying ecological momentary assessment (EMA) suggested a positive impact of Ashwagandha . 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 . 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 . 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 .
Digest: Modern scientific proofModern 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 .
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.
 Lesage FX, Berjot S, Deschamps F. Clinical stress assessment using a visual analogue scale. Occupational medicine. 2012 Dec 1;62(8):600-5.
 Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. Measuring stress: A guide for health and social scientists. 1994;10:1-2.
 Sonino N, Fava GA. A simple instrument for assessing stress in clinical practice. Postgraduate medical journal. 1998 Jul 1;74(873):408-10.
 Thompson M, Thompson L, Reid-Chung A. Combining LORETA z-score neurofeedback with heart rate variability training. InZ Score Neurofeedback 2015 Jan 1 (pp. 159-188). Academic Press.
 Bech P. Fifty years with the Hamilton scales for anxiety and depression. Psychotherapy and Psychosomatics. 2009;78(4):202-11.
 Meites K, Lovallo W, Pishkin V. A comparison of four scales for anxiety, depression, and neuroticism. Journal of Clinical Psychology. 1980 Apr;36(2):427-32.
 Sioni R, Chittaro L. Stress detection using physiological sensors. Computer. 2015 Oct 28;48(10):26-33.
 Sandulescu V, Andrews S, Ellis D, Bellotto N, Mozos OM. Stress detection using wearable physiological sensors. InInternational Work-Conference on the Interplay Between Natural and Artificial Computation 2015 Jun 1 (pp. 526-532). Springer, Cham.
 Herman JP. Neural pathways of stress integration: relevance to alcohol abuse. Alcohol research: current reviews. 2012;34(4):441.
 Saunders PR, Miceli P, Vallance BA, Wang L, Pinto S, Tougas G, Kamath M, Jacobson K. Noradrenergic and cholinergic neural pathways mediate stress-induced reactivation of colitis in the rat. Autonomic Neuroscience. 2006 Jan 30;124(1-2):56-68.
 Van de Kar LD, Blair ML. Forebrain pathways mediating stress-induced hormone secretion. Frontiers in neuroendocrinology. 1999 Jan 1;20(1):1-48.
 Stefano GB, Fricchione GL, Esch T. Relaxation: Molecular and physiological significance. Medical Science Monitor. 2006 Sep 1;12(9):HY21-31.
 Stefano GB, Stefano JM, Esch T. Anticipatory stress response: a significant commonality in stress, relaxation, pleasure and love responses. Medical Science Monitor. 2008 Jan 29;14(2):RA17-21.
 Szelenyi I, Thiemer K. Distention ulcer as a model for testing of drugs for ulcerogenic side effects. Archives of Toxicology. 1978 Mar 1;41(1):99-105.
 Rainsford K. Side-effects of anti-inflammatory/analgesic drugs: epidemiology and gastrointestinal tract. Trends in Pharmacological Sciences. 1984 Jan 1;5:156-9.
 Vorder WB, Peura DA. Stress-related mucosal damage: review of drug therapy. Journal of clinical gastroenterology. 1990;12:S35-40.
 Tong Y, Zou J, Ni LQ, Liang SH, Cao BY, Chen HJ. The effect of four kinds of traditional Chinese herbal compound on the experimental acute stress behaviors and the hypothalamus-pituitary-adrenal gland axis. Zhongguo Zhong yao za zhi= Zhongguo zhongyao zazhi= China journal of Chinese materia medica. 2005 Dec;30(23):1863-6.
 Gupta P, Siripurapu KB, Ahmad A, Palit G, Arora A, Maurya R. Anti-stress constituents of Evolvulus alsinoides: an ayurvedic crude drug. Chemical and Pharmaceutical Bulletin. 2007;55(5):771-5.
 Deole YS, Chavan SS, Ashok BK, Ravishankar B, Thakar AB, Chandola HM. Evaluation of anti-depressant and anxiolytic activity of Rasayana Ghana Tablet (A compound Ayurvedic formulation) in albino mice. Ayu. 2011 Jul;32(3):375.
 Singh N, Bhalla M, de Jager P, Gilca M. An overview on ashwagandha: A Rasayana (Rejuvenator) of Ayurveda. African Journal of Traditional, Complementary and Alternative Medicines. 2011;8(5S).
 Singh N, Nath R, Lata A, Singh SP, Kohli RP, Bhargava KP. Withania somnifera (ashwagandha), a rejuvenating herbal drug which enhances survival during stress (an adaptogen). International journal of Crude drug research. 1982 Jan 1;20(1):29-35.
 Bharti VK, Malik JK, Gupta RC. Ashwagandha: multiple health benefits. InNutraceuticals 2016 Jan 1 (pp. 717-733). Academic Press.
 Chai SC, Li I, Pacanowski C, Brewer B. Effects of Four-Week Supplementation of Ashwagandha and B-Vitamins on Mood and Stress Relief. Current Developments in Nutrition. 2020 Jun;4(Supplement_2):1195.
 Li I, Pacanowski C, Cao L, Chai SC. Evaluation of Self-Reported Stress Reduction from Ashwagandha and B Vitamin Supplementation Using Ecological Momentary Assessment (EMA). Current Developments in Nutrition. 2020 Jun;4(Supplement_2):1219.
 Langade D, Kanchi S, Salve J, Debnath K, Ambegaokar D. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled Study. Cureus. 2019 Sep;11(9).
 Salve J, Pate S, Debnath K, Langade D. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Cureus. 2019 Dec 25;11(12).
 Patel SB, Rao NJ, Hingorani LL. Safety assessment of Withania somnifera extract standardized for Withaferin A: acute and sub-acute toxicity study. Journal of Ayurveda and integrative medicine. 2016 Mar 1;7(1):30-37.