Unmasking Potential Withdrawal Effects of Ashwagandha: A Case Report and Review.

Ashwagandha (Withania somnifera) is a widely available herbal product often taken for stress-related concerns. While it is typically well-tolerated, individuals may occasionally experience side effects. Symptoms emerging after the discontinuation of ashwagandha have not been extensively documented. We report the case of a 20-year-old male who presented with tachycardia, insomnia, and symptoms of anxiety following abrupt discontinuation of ashwagandha extract (600 mg/day). His medical workup, including cardiac enzymes, electrocardiogram, complete blood count, liver function tests, and thyroid function tests, was unremarkable. His symptoms began shortly after cessation of ashwagandha, and no other clear medical or psychosocial stressors were identified. He was treated supportively with hydroxyzine for sleep and referred for outpatient psychiatric follow-up. This case may represent a withdrawal syndrome related to ashwagandha cessation, potentially mediated by its GABA-ergic activity. Although alternative explanations, such as recurrence of underlying anxiety, are possible, the timing and severity of symptoms after discontinuation suggest a withdrawal phenomenon. This case highlights the importance of assessing herbal supplement use in patients presenting with new-onset psychiatric or autonomic symptoms. Clinicians should be aware of the potential for withdrawal symptoms following ashwagandha cessation. A thorough history of supplement use should be included in the evaluation of patients presenting with anxiety, insomnia, or related complaints.