E0 ConsensusModerate confidencePEM not requiredReview-NarrativePeer-reviewedMachine draft
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Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity.
Panossian, Alexander, Wikman, Georg · Current clinical pharmacology · 2009 · DOI
Quick Summary
This review examined whether herbal supplements called adaptogens can help with fatigue and ME/CFS. Researchers found that some adaptogens—particularly Rhodiola rosea—showed promise in clinical studies for improving attention, thinking, and mental energy in people with fatigue and chronic fatigue syndrome. The review suggests these herbs may work by helping the body manage stress through changes in specific stress-response proteins and hormones.
Why It Matters
For ME/CFS patients seeking non-pharmacological interventions, this review provides systematic evaluation of herbal options with documented clinical efficacy. Understanding potential molecular mechanisms helps distinguish plausible candidates from unfounded claims and may inform future targeted research in ME/CFS populations specifically.
Observed Findings
Rhodiola rosea SHR-5 extract demonstrated improved attention, cognitive function, and mental performance in fatigue and chronic fatigue syndrome in clinical trials.
Schisandra chinensis and Eleutherococcus senticosus increased endurance and mental performance in patients with mild fatigue and weakness.
Adaptogens appear to regulate stress response through multiple pathways involving Hsp70, JNK1, DAF-16, cortisol, and nitric oxide (NO).
Hsp70 up-regulation by adaptogens may prevent stress-induced increases in nitric oxide that impair ATP production.
Inferred Conclusions
Adaptogens can be defined as herbal preparations that increase tolerance to mental exhaustion and enhance mental endurance during decreased performance.
The stress-protective effects of adaptogens operate primarily through HPA-axis regulation and increased expression of the stress-sensor protein Hsp70.
Adaptogen-induced enhancement of stress resistance pathways may improve both mental and physical performance, with possible effects on longevity.
Remaining Questions
Is the efficacy of Rhodiola rosea and other adaptogens sustained in long-term ME/CFS treatment, and do patients develop tolerance?
How do adaptogen effects compare to standard pharmacological treatments for fatigue in controlled head-to-head trials?
What This Study Does Not Prove
This review does not establish that adaptogens are effective specifically in ME/CFS beyond the initial mention of one study; most included trials examined mild fatigue or general populations. The proposed molecular mechanisms are theoretical frameworks that require direct experimental validation in ME/CFS patients. This is a review of existing literature, not new clinical evidence, and efficacy in one adaptogen does not guarantee efficacy in others.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →