Ashwagandha for Sleep and Stress: What the Research Shows
Ashwagandha is widely promoted for relaxation, stress management and better sleep—but these claims do not all have the same level of scientific support. This guide examines the human research on sleep and stress separately, including studied doses, limitations, safety considerations and what the evidence can—and cannot—tell us.
Ashwagandha, Stress & Sleep: What Are We Actually Studying?
Ashwagandha is often discussed as though stress relief, relaxation and better sleep were interchangeable outcomes. They are not. Researchers can measure changes in perceived stress, physiological stress markers, sleep quality, sleep duration and other outcomes separately. Understanding those distinctions is essential before interpreting the research.
Stress Response
Stress research may examine outcomes such as perceived stress, anxiety-related symptoms or physiological markers associated with the stress response. Improvement in one of these measures does not automatically demonstrate an improvement in sleep.
Sleep Outcomes
Sleep studies can examine different endpoints, including sleep quality, sleep onset, total sleep time, nighttime awakenings and daytime functioning. These outcomes should be evaluated directly rather than inferred from changes in stress.
Plausible Mechanisms
Researchers have proposed several biological pathways through which ashwagandha might influence stress or sleep. These mechanisms can help generate hypotheses, but a plausible mechanism is not the same as a proven benefit in humans.
Clinical Evidence
The most useful question is whether controlled human studies show meaningful changes in the outcome being investigated. Study size, duration, participant characteristics, extract, dose and outcome measurement all affect how confidently results can be interpreted.
The Evidence Chain: Where Claims Can Become Overstated
Stress improvement ≠ proven sleep improvement
Stress and sleep can influence one another, but they remain distinct research outcomes. A study showing lower perceived stress should not automatically be presented as evidence that ashwagandha improves sleep. Likewise, sleep-specific findings should be evaluated according to the actual sleep measures used in the study.
What should we look for in the research?
Did the study directly measure sleep, stress or both—and which specific outcomes changed?
Which ashwagandha extract, daily amount and treatment duration were actually studied?
Were participants healthy adults, people reporting stress, or individuals experiencing sleep difficulties?
Ashwagandha and Stress: What Human Studies Show
Several randomized controlled trials have investigated ashwagandha in adults reporting elevated or chronic stress. Taken together, the research provides some evidence of improvements in subjective stress measures and stress-related biomarkers such as cortisol—but the findings are not completely consistent, and the studies have used different extracts, doses and outcome measures.
Several trials report improvements on standardized stress questionnaires, although pooled analyses have not produced entirely consistent conclusions.
Reductions in cortisol have been reported in multiple trials, but cortisol is a biomarker—not a complete measure of how a person experiences stress.
Many published stress trials have lasted roughly six to eight weeks, although study duration and formulations vary.
What happens to perceived stress?
Perceived stress is commonly measured with questionnaires such as the Perceived Stress Scale (PSS) or related psychological scales. Several controlled trials have reported larger improvements in stress-related scores with ashwagandha than with placebo.
For example, randomized trials in stressed adults have studied standardized root extracts for approximately 60 days and reported improvements in some subjective stress or anxiety-related measures. However, individual trials have been relatively small, and not every psychological outcome has reached statistical significance.
What about cortisol?
Cortisol is involved in the body's stress-response system and is frequently measured in ashwagandha research. Several trials have reported reductions in serum, morning or salivary cortisol after supplementation.
This is biologically interesting, but cortisol should not be interpreted as a stand-alone score of stress. Cortisol varies with time of day, sampling conditions, individual physiology and other factors. A lower value also does not automatically establish that someone feels better, sleeps better or has improved health.
What do systematic reviews tell us?
Meta-analyses generally suggest a potentially favorable effect of ashwagandha on stress-related outcomes, but the strength of that conclusion depends on which trials, measures and analytical methods are included.
Importantly, recent pooled analyses have not been completely uniform: some report improvements in perceived stress, while another analysis found a significant reduction in cortisol without a statistically significant pooled improvement in perceived stress. This disagreement is one reason the evidence should be described as promising rather than definitive.
Examples of Doses Studied in Stress Research
Ashwagandha trials have not used one standardized dose or one interchangeable product. These examples describe study protocols—not a universal dosing recommendation.
| Study Example | Daily Amount | Duration | Key Point |
|---|---|---|---|
| Stressed healthy adults | 240 mg/day standardized extract | 60 days | Improvements were reported in selected psychological and cortisol outcomes. |
| Adults with chronic stress | 300 mg twice daily | 60 days | A high-concentration root extract was studied against placebo using stress scales and cortisol. |
| Chronic-stress trial | 300 mg twice daily | 8 weeks | Perceived stress and cortisol were among the measured outcomes. |
The Main Limitation: “Ashwagandha” Is Not One Intervention
Different trials use different root extracts, extraction processes, concentrations, withanolide specifications, doses and treatment durations. Study populations are also relatively small and often consist of adults who already report elevated stress. For these reasons, results from one formulation cannot automatically be transferred to every ashwagandha supplement—or to every population. Larger, independent and longer-duration trials would strengthen confidence in the findings.
Ashwagandha and Sleep: What Human Studies Show
Sleep-specific trials provide a more direct test of the claim that ashwagandha may influence sleep. Researchers have measured outcomes including sleep onset latency, total sleep time, sleep efficiency, wake after sleep onset and perceived sleep quality. The findings are encouraging, but the evidence base remains relatively small.
Promising Sleep Evidence—but Not Yet Definitive
Randomized trials have reported improvements in several objective and subjective sleep measures. A systematic review also found a small overall benefit, with larger effects appearing in adults with insomnia and in studies using longer interventions and higher studied doses. However, only a limited number of randomized trials were available, and formulations differed between studies.
How long it takes to fall asleep.
Estimated time actually spent asleep.
Percentage of time in bed spent sleeping.
Time awake after initially falling asleep.
Subjective perception of overall sleep.
What happened in adults with insomnia?
One randomized, double-blind, placebo-controlled trial enrolled 60 adults with insomnia and anxiety. Participants receiving ashwagandha took a standardized root extract at 300 mg twice daily for 10 weeks.
Sleep was assessed with actigraphy as well as subjective questionnaires. Compared with placebo, the ashwagandha group showed improvements in measures including sleep onset latency, sleep efficiency and sleep quality.
What about adults without insomnia?
Ashwagandha has also been studied in adults who were otherwise healthy but reported non-restorative sleep. This matters because results from insomnia populations cannot automatically be generalized to everyone who simply wants to sleep better.
In one randomized trial, 150 healthy adults with non-restorative sleep received 120 mg of a standardized extract once daily for six weeks. Actigraphy showed improvements in sleep efficiency, total sleep time, sleep latency and wake after sleep onset compared with placebo.
What Strengthens the Signal
- Randomized placebo-controlled trials exist.
- Some studies used objective actigraphy.
- Multiple sleep outcomes were evaluated.
- Findings are not limited only to perceived stress.
- Sleep-specific effects have been studied directly.
What Limits Confidence
- The total evidence base remains small.
- Individual trials have modest sample sizes.
- Different extracts and doses have been studied.
- Treatment durations are generally short.
- Results from insomnia populations may not apply equally to healthy sleepers.
What This Means in Practice
Human research provides a credible signal that certain standardized ashwagandha extracts may improve some sleep outcomes, particularly in people experiencing sleep difficulties. However, the current evidence does not show that every ashwagandha product will produce the same effect, nor does it establish ashwagandha as a replacement for evaluation or treatment of persistent insomnia. Product formulation, population, dose and duration all matter when interpreting the research.
How Might Ashwagandha Affect Stress and Sleep? Mechanisms vs. Proven Outcomes
Researchers have proposed several pathways that might help explain the stress- and sleep-related findings seen in some human trials. The most commonly discussed involve the stress-response system, physiological arousal and downstream effects on sleep. These explanations are useful—but they should not be mistaken for proof of a clinical benefit.
A supplement can influence a biological pathway without producing a meaningful improvement in how someone feels, functions or sleeps. Human outcomes must therefore be measured directly.
The HPA Axis and the Stress Response
One frequently discussed pathway is the hypothalamic-pituitary-adrenal (HPA) axis, a major component of the body's response to stress. Activation of this system contributes to the release of cortisol and helps the body adapt to physical and psychological demands.
Some ashwagandha trials have reported changes in cortisol alongside improvements in stress-related questionnaires. This has led researchers to investigate whether ashwagandha may influence aspects of stress-response regulation.
However, describing this as “balancing cortisol” or “resetting the HPA axis” goes beyond what the available clinical evidence can establish. Cortisol is dynamic, follows a daily rhythm and responds to many physiological and environmental factors.
How Could Stress Biology Connect to Sleep?
One hypothesis is that changes in stress-related arousal could indirectly influence sleep. The important word is could: each step requires evidence, and the entire chain cannot be assumed from a change in one biomarker.
Psychological and physiological stress can increase arousal and make it harder for some people to disengage at night.
If an intervention modifies aspects of stress response, nighttime arousal might also change.
Reduced arousal could theoretically influence sleep onset or perceived sleep quality.
Trials must directly demonstrate changes in latency, efficiency, duration, awakenings or sleep quality.
Three Different Levels of Evidence
Mechanistic Hypothesis
Laboratory, biological or physiological observations suggest a pathway through which ashwagandha might influence stress or sleep. This helps explain what researchers should test—it does not establish that the outcome occurs in people.
Biomarker Change
Human studies may show changes in a measurable marker such as cortisol. This strengthens biological context, but a biomarker is not automatically equivalent to reduced perceived stress, better sleep or improved health.
Clinical Outcome
Randomized human trials directly measure outcomes such as perceived stress, sleep onset latency, sleep efficiency or sleep quality. These findings provide more relevant evidence for evaluating real-world claims.
What the Research Can Support
- Stress and sleep involve interconnected physiological systems.
- Some human ashwagandha trials report changes in cortisol and perceived stress.
- Separate randomized trials have directly measured sleep outcomes.
- These findings provide plausible biological and clinical signals worth further study.
What Has Not Been Established
- That lowering cortisol automatically improves sleep.
- That ashwagandha “resets” or permanently normalizes the HPA axis.
- That one proposed mechanism explains every observed sleep effect.
- That all ashwagandha extracts, doses or products have equivalent biological effects.
Mechanisms Help Explain Evidence—They Do Not Replace It
The most defensible interpretation is that ashwagandha has plausible biological pathways that may contribute to the stress- and sleep-related effects observed in some human studies. The clinical relevance of those pathways, however, depends on actual human outcomes. That is why changes in perceived stress, cortisol and sleep measures should remain separate pieces of evidence rather than being collapsed into a single claim.
Dosage, Extracts, Timing & How to Read the Label
There is no single research-backed dose that applies to every ashwagandha product. Human studies have used different standardized extracts, daily amounts, dosing schedules and intervention periods. Comparing products therefore requires more than simply comparing the number of milligrams on the label.
A 120 mg dose of one concentrated standardized extract should not automatically be treated as weaker, stronger or equivalent to 300 mg or 600 mg of another extract. Extract composition, plant part, concentration and standardization can differ substantially.
120 mg/day
Once daily • 6 weeksA standardized extract at this amount was studied in healthy adults reporting non-restorative sleep. This protocol belongs to that specific extract and should not be converted directly into an equivalent amount of another formulation.
240 mg/day
Daily • 60 daysA standardized ashwagandha extract at 240 mg per day has been investigated in stressed adults. The amount describes the intervention used in that trial—not a universal dose recommendation.
600 mg/day
300 mg twice dailySeveral trials have used 300 mg twice daily of particular root extracts, including research involving stress and insomnia. Again, the formulation matters alongside the total daily amount.
Why 120 mg Does Not Necessarily Equal “Less” Than 600 mg
Supplement labels can make dose comparisons look simple, but clinical research is formulation-specific. A more useful comparison considers several characteristics together:
How to Read an Ashwagandha Label
When comparing a commercial supplement with a clinical study, look beyond the front-label dose. These details can determine whether the comparison is meaningful.
Plant Part
Check whether the product identifies root, leaf, root-and-leaf material or another preparation. Research on one preparation should not automatically be transferred to another.
Extract vs. Powder
A concentrated extract is not directly comparable gram-for-gram with ordinary powdered plant material. The preparation used in the clinical trial matters.
Standardization
Some products state a standardized concentration of characteristic constituents such as withanolides. Even then, percentage alone does not establish clinical equivalence between extracts.
Serving Size
Determine whether the listed amount refers to one capsule, multiple capsules or the complete daily serving. “300 mg per capsule” and “300 mg per daily serving” are not necessarily the same regimen.
Other Ingredients
Combination products may contain magnesium, melatonin, herbs or other compounds. Results from an ashwagandha-only trial cannot establish which ingredient is responsible for an effect from a multi-ingredient product.
Quality Information
Look for transparent ingredient identification, manufacturing information and credible independent quality testing where available. Label accuracy and product quality matter when interpreting supplements.
Morning, Evening or Split Doses?
Clinical trials have not used one universal timing strategy. Some protocols used once-daily dosing, while others divided the daily amount into two doses.
This means the current evidence does not justify a universal claim that ashwagandha must be taken immediately before bed to influence sleep. Study protocol and formulation should be considered before drawing conclusions about timing.
Duration Matters Too
Sleep and stress trials generally evaluate repeated use over several weeks, rather than treating ashwagandha simply as an immediate, single-dose sleep aid.
Published protocols discussed in this guide include approximately six, eight and ten weeks, as well as 60-day interventions. These durations describe the research—not a guarantee that benefits will appear after a particular number of days.
Three Comparisons to Avoid
A larger milligram number does not by itself establish greater potency, effectiveness or clinical relevance.
Standardization is useful information, but two extracts with similar headline percentages may still differ in composition and manufacturing.
A dose used in a clinical trial describes the research protocol. It does not automatically establish the right amount for an individual.
Read the Study and the Label Together
The most useful question is not simply “How many milligrams of ashwagandha?” but rather: Which extract was studied, at what amount, how often, for how long, in which population and for which outcome? Matching those details prevents results from one formulation from being generalized to products that may be substantially different.
Safety, Side Effects, Interactions & Who Should Be Careful
Ashwagandha is often described as a natural supplement, but natural does not mean risk-free. Short-term studies generally report relatively mild side effects in many participants, but important safety concerns include medication interactions, thyroid effects and rare reports of liver injury.
People who take prescription medications, have underlying medical conditions, are pregnant or breastfeeding, or are preparing for surgery should not assume that ashwagandha is appropriate simply because it is available without a prescription.
More Commonly Reported Side Effects
Short-term use is often tolerated in clinical studies, but gastrointestinal and sedating effects can occur. Individual responses vary.
Gastrointestinal discomfort can occur in some people.
Loose stools or diarrhea have been reported with use.
Nausea may occur, particularly in people who are sensitive to supplements.
Some people may experience sleepiness or sedation.
Important Situations Requiring Extra Caution
These concerns do not mean that every person will experience a problem. They identify situations in which self-directed supplementation deserves greater caution or professional review.
Drowsiness & Sedating Medications
Ashwagandha may cause drowsiness in some people. Combining it with medications or other substances that cause sedation could potentially increase sleepiness or impair alertness.
Extra caution is appropriate when driving, operating machinery or combining multiple products marketed for sleep or relaxation.
Thyroid Function & Thyroid Medication
Human research and case reports raise the possibility that ashwagandha can influence thyroid hormone levels in some people.
People with thyroid disorders or those taking thyroid hormone medication should discuss ashwagandha with a qualified healthcare professional rather than using it as an unsupervised thyroid intervention.
Autoimmune Conditions & Immunosuppressants
Ashwagandha may affect immune activity. That creates a potential concern for people with autoimmune conditions or those taking medications intended to suppress immune function.
In these situations, professional guidance is especially important before starting supplementation.
Blood Sugar & Blood Pressure
Ashwagandha may interact with medications used to manage blood glucose or blood pressure. Combining effects could potentially alter treatment response.
People using these medications should avoid changing their prescribed treatment based on supplement claims and should discuss potential interactions with their healthcare professional.
Liver Injury Has Been Reported
Cases of liver injury associated with ashwagandha-containing products have been reported. These events appear to be uncommon, but they are clinically important and mean that ashwagandha should not be described as completely free of serious adverse effects.
People with existing liver disease should seek medical guidance before using ashwagandha. Anyone who develops symptoms suggestive of liver injury while taking a supplement should stop using the product and seek prompt medical evaluation.
Potential Medication Interactions
Interaction data for supplements are often less complete than for prescription drugs. The following categories are therefore reasons for caution—not a complete list of every possible interaction.
Sedatives
Additive drowsiness or sedation may be a concern when combined with medicines or other substances that reduce alertness.
Thyroid Medication
Possible effects on thyroid hormones make unsupervised combination with thyroid treatment inappropriate.
Immunosuppressants
Potential immune effects may conflict with medications designed to suppress immune activity.
Diabetes Medication
Potential effects on blood glucose warrant caution in people taking glucose-lowering medications.
Blood Pressure Medication
People using antihypertensive treatment should discuss supplementation with their healthcare professional.
Multiple Supplements
Combining ashwagandha with several sleep, stress or relaxation products can make side effects and interactions harder to predict.
Avoid or Seek Medical Guidance First
- Pregnancy or breastfeeding
- Existing liver disease or previous unexplained liver injury
- Thyroid disease or thyroid medication use
- Autoimmune conditions
- Use of immunosuppressive medication
- Upcoming surgery or medical procedure
Discuss Use With a Healthcare Professional
- If you take prescription medications regularly
- If you use medication for diabetes or high blood pressure
- If you take sedating or sleep medications
- If you use several supplements at the same time
- If sleep problems are persistent or worsening
- If you have a chronic medical condition
Surgery & Medical Procedures
Because ashwagandha may have sedating effects and may interact with medications or physiological systems relevant to medical care, people preparing for surgery should tell their healthcare team about supplement use. A clinician can advise whether and when a supplement should be discontinued before a procedure.
Stop Use and Seek Medical Advice if Concerning Symptoms Develop
Serious adverse reactions appear uncommon, but symptoms that could indicate a significant reaction should not be ignored.
Safety Evidence Has Limits Too
Most clinical trials of ashwagandha have been relatively short, so short-term tolerability should not be interpreted as proof of long-term safety. Product composition can also vary. People taking medications or managing medical conditions should review supplement use with a qualified healthcare professional, particularly when ashwagandha is being considered for persistent sleep or stress-related symptoms.
Ashwagandha for Sleep and Stress: FAQ
These answers summarize the main evidence discussed in this guide, including what human studies suggest, where the research remains limited, and which safety considerations matter most.
Does ashwagandha help with sleep?
Possibly. Randomized human trials and a systematic review suggest that certain standardized ashwagandha extracts may improve some sleep outcomes. The overall evidence base is still relatively small, however, and results cannot automatically be generalized to every ashwagandha supplement.
Does ashwagandha reduce stress?
Several randomized trials have reported improvements in selected stress-related questionnaires and changes in cortisol compared with placebo. However, studies differ in extract, dose, duration and outcome measures, so the evidence should be interpreted as promising rather than proof that every product will reduce stress.
How much ashwagandha was used in sleep studies?
Sleep trials have used different formulations and amounts. Examples include 120 mg once daily for six weeks with one standardized extract and 300 mg twice daily for 10 weeks with another root extract. These are research protocols, not universal dosing recommendations, because different extracts are not necessarily equivalent milligram for milligram.
Should ashwagandha be taken at night for sleep?
Research does not establish one universally optimal time of day. Clinical trials have used different dosing schedules, including once-daily and divided doses. Therefore, the evidence does not support a general rule that ashwagandha must be taken immediately before bed to influence sleep.
Is ashwagandha a sedative?
Ashwagandha is not simply equivalent to a conventional sleep medication, but drowsiness can occur and sedative effects are a safety consideration. Combining it with sedating medications or multiple sleep products may increase concerns about excessive sleepiness or reduced alertness.
Is ashwagandha safe to take every day?
Short-term use appears to be tolerated by many adults, but long-term safety is not well established. Clinical studies are generally limited in duration, and rare cases of liver injury have been reported. Daily use should therefore not be assumed to be risk-free, especially for people with medical conditions or those taking medications.
Who should avoid or be cautious with ashwagandha?
Particular caution is appropriate during pregnancy or breastfeeding, before surgery, and in people with thyroid disorders, autoimmune conditions or liver disease. Potential interactions also exist with medications including sedatives, thyroid hormone, immunosuppressants and medicines used for diabetes or blood pressure. Professional guidance is appropriate in these situations.
Can ashwagandha replace treatment for insomnia or chronic stress?
No. Supplement research does not establish ashwagandha as a replacement for appropriate evaluation or treatment of persistent insomnia, significant anxiety, chronic stress-related symptoms or another underlying condition. Ongoing or worsening symptoms deserve professional assessment rather than relying only on a supplement.
Scientific & Institutional References
Evidence was evaluated by separating biological plausibility from measured human outcomes. The sources below include randomized controlled trials, systematic reviews and authoritative institutional safety resources.
Ashwagandha Biology & Mechanisms
-
National Center for Complementary and Integrative
Health (NCCIH).
Ashwagandha: Usefulness and Safety.
Overview of Withania somnifera, preparations,
evidence and safety.
NCCIH — Ashwagandha -
Lopresti AL, Smith SJ, Malvi H, Kodgule R.
An investigation into the stress-relieving and
pharmacological actions of an ashwagandha
(Withania somnifera) extract: a randomized,
double-blind, placebo-controlled study.
Medicine (Baltimore). 2019.
PubMed — PMID 31517876
Stress Evidence
-
Chandrasekhar K, Kapoor J, Anishetty S.
A prospective, randomized double-blind,
placebo-controlled study of safety and efficacy
of a high-concentration full-spectrum extract of
ashwagandha root in reducing stress and anxiety
in adults.
Indian J Psychol Med. 2012.
PubMed — PMID 23439798 -
Lopresti AL, Smith SJ, Malvi H, Kodgule R.
An investigation into the stress-relieving and
pharmacological actions of an ashwagandha extract.
Randomized, double-blind, placebo-controlled,
60-day trial in stressed adults.
PubMed — PMID 31517876
Sleep Evidence
-
Cheah KL, Norhayati MN, Husniati Yaacob L,
Abdul Rahman R.
Effect of Ashwagandha (Withania somnifera)
extract on sleep: A systematic review and
meta-analysis.
PLoS One. 2021.
Five randomized controlled trials involving
400 participants.
PubMed — PMID 34559859 -
Langade D, Kanchi S, Salve J, Debnath K,
Ambegaokar D.
Efficacy and Safety of Ashwagandha Root Extract
in Insomnia and Anxiety: A Double-blind,
Randomized, Placebo-controlled Study.
Cureus. 2019.
PubMed — PMID 31728244 -
Langade D, Thakare V, Kanchi S, Kelgane S.
Clinical evaluation of the pharmacological impact
of ashwagandha root extract on sleep in healthy
volunteers and insomnia patients.
J Ethnopharmacol. 2021.
PubMed — PMID 32818573 -
Deshpande A, Irani N, Balkrishnan R, Benny IR.
A randomized, double blind, placebo controlled
study to evaluate the effects of ashwagandha
extract on sleep quality in healthy adults.
Sleep Med. 2020.
PubMed — PMID 32540634
Dosage & Extracts
-
Deshpande A, et al.
Standardized ashwagandha extract,
120 mg once daily for six weeks,
studied in healthy adults reporting
non-restorative sleep.
PubMed — PMID 32540634 -
Langade D, et al.
Ashwagandha root extract,
300 mg twice daily for 10 weeks,
studied in adults with insomnia and anxiety.
PubMed — PMID 31728244 -
Lopresti AL, et al.
Standardized extract,
240 mg once daily for 60 days,
investigated in stressed healthy adults.
PubMed — PMID 31517876 -
Chandrasekhar K, et al.
High-concentration full-spectrum root extract,
300 mg twice daily for 60 days,
investigated in adults with chronic stress.
PubMed — PMID 23439798
Safety, Liver & Interactions
-
National Center for Complementary and Integrative
Health (NCCIH).
Ashwagandha: Usefulness and Safety.
Includes information on short-term safety,
pregnancy, breastfeeding, surgery, thyroid and
autoimmune conditions, and potential medication
interactions.
NCCIH — Safety Information -
National Institute of Diabetes and Digestive and
Kidney Diseases.
Ashwagandha — LiverTox.
Clinical and Research Information on Drug-Induced
Liver Injury. National Library of Medicine.
NCBI Bookshelf — LiverTox: Ashwagandha -
National Center for Complementary and Integrative
Health (NCCIH).
How Medications and Supplements Can Interact.
General guidance on supplement-drug interactions,
including sedative considerations for ashwagandha.
NCCIH — Medication & Supplement Interactions
Ashwagandha studies have used different extracts, concentrations, doses, populations and treatment durations. Results from one formulation should not automatically be applied to another product. The evidence discussed on this page is educational and does not establish ashwagandha as a treatment for insomnia, anxiety or another medical condition.