Ginseng helps in depressive disorders in multiple ways: it regulates neurotransmitters, supports neuronal plasticity, reduces inflammation in the brain and relieves stress hormone levels. It can be a potential add-on therapy for preventing and treating depressive disorders but more research is required to ascertain its safety with conventional therapy.
Pharmacotherapy or antidepressant therapy is considered the most effective line of treatment for depressive disorders.
Interestingly not every patient prescribed antidepressants experience a significant reduction in depressive symptoms; about 33% of the patients fail to achieve remission.
Researchers are investigating various biological indicators that could help to understand why such patients have a poor treatment response.
Some herbs, especially adaptogens, serve as effective adjunct therapies and help improve the therapeutic outcomes of conventional treatment.
One such herb that we will be exploring today is Ginseng. Apart from being identified as an age-defying herb, ginseng is also known for boosting cognition and overall brain health.
The major bioactive components in the herb are ginsenosides. Other non-saponin components include essential oils, vitamins, amino acids, polysaccharides. 
Research has confirmed the medicinal benefits of the Chinese herb in cancer, heart diseases, immune disorders, central nervous system disorders, diabetes, stress etc.
It helps in depression primarily by supporting neuronal plasticity. Its adaptogenic property helps brain cells recover and rewire from the damage caused by chronic stress and ginseng also regulates brain chemistry to relieve depressive symptoms. It holds the potential of being an effective add-on therapy for major depression.
Further research must be conducted to identify an effective dose and ascertain the safety of taking ginseng when one is already taking conventional antidepressants.
6 Fantastic Benefits Of Ginseng For Anxiety and Depression
Let’s explore the research studies that investigate the benefits of ginseng in major depressive disorder.
1. Ginseng reduces depressive symptoms by a multimodal therapeutic action
Studies in animal models have confirmed that ginsenosides, active compounds mediate antidepressant property by interacting with multiple neurotransmitter systems such as serotonergic, noradrenergic and dopaminergic systems. 
20(S)-protopanaxadiol, an active metabolite derived from ginsenosides, also exerts antidepressant action but not by regulating brain chemistry. 
BDNF or Brain-Derived Neurotrophic Factor is a protein that supports the growth and development of neurons. Patients with depression have low serum BDNF levels than healthy individuals and serve as an effective biomarker for mood disorders.  
Xie and colleagues in their recent publication in Molecules, 2018 have highlighted the multiple ways by which ginsenosides benefit in depression and anxiety  :
- Regulating neurotransmitter action
- Influencing GABA and glutaminergic system
- Regulates BDNF levels
- Acts on HPA or Hypothalamus Pituitary Adrenal gland axis to influence stress hormone levels
- Acts on intracellular signaling pathways in the central nervous system
- Offers neuroprotection
The gut-brain axis is a bidirectional communication between the brain and gut and its dysregulation is commonly observed in mood disorders. Probiotics help reduce depressive symptoms by regulating the gut-brain axis.
In 1998, Vadnal and colleagues described a case report where a woman with treatment-resistant depression was successfully treated with ginseng as an adjunct to SSRI or conventional antidepressant therapy. 
In 2015, a group of Korean researchers conducted a study to assess the effect of ginseng supplementation on residual symptoms of major depression. 
35 women who remitted from Major Depressive Disorder were enrolled in the study. They were treated with a dose of 3g of Korean Red Ginseng per day for 8 weeks.
A significant decrease in residual depressive symptoms, somatic symptoms, and severity of the disorder was observed at the end of 8 weeks. Researchers stated that Korean red ginseng is an effective add-on therapy for residual depressive symptoms; further research is required to corroborate these findings.
Quick Gist: Ginsenosides have potent antidepressant and anti-anxiety action. Few studies in humans have confirmed that ginseng can benefit from depression as an add-on herbal remedy to conventional therapy.
Further research in the form of placebo-controlled blinded clinical trials is required to learn more about the effective dosage and use of Major Depressive Disorder and other forms of depression.
2. It has anti-stress property
HPA axis or hypothalamus-pituitary-adrenal axis is a network that connects the part of the brain to major hormone-secreting glands in our body. This network plays an important role in regulating our response to external stressors.
The HPA axis regulates the action of our stress hormone -cortisol. HPA axis dysfunction is observed in depression and researchers are focusing on developing drugs that can modify the HPA axis and benefit in the treatment of Major Depressive Disorder. 
It is a natural remedy that is proven to normalize HPA axis activity and lower stress hormone levels and anxiety. 
A recent study published in Biomedicine and Pharmacotherapy, 2017 revealed that restoring HPA axis is a part of the antidepressant activity of ginsenosides. 
Quick Gist: Ginseng is an adaptogen; it acts on the HPA axis to modulate our stress response. Its stress relief action can help in the prevention and treatment of depression.
3. It lowers neuroinflammation and restores immune function in depression
Neuroinflammation or inflammation in the brain is an innate immune response against harmful agents in the body such as heavy metal toxicity and pathogens.
Interestingly, neuroinflammation is also observed in depression. Inflammasomes are protein complexes that initiate the inflammatory process and their activity has been observed in many disease conditions including depression.
Researchers hypothesize that by developing therapeutic agents that target inflammasomes, it is possible to halt neuroinflammation and prevent disease progression in mental health conditions. 
Panax ginseng extracts mediate antidepressant activity by counteracting neuroinflammation. (Journal of Ginseng Research, 2018) 
It inhibits activation of microglial (immune cells of the central nervous system) and lowers the levels of pro-inflammatory agents that cause inflammation in the brain.
Some studies suggest that active components of ginseng do not reach the body tissues in sufficient concentration to mediate a neuroprotective and antidepressant effect.
Researchers from China Pharmaceutical University conducted this interesting study on an animal model to explain the paradox as to how ginsenosides mediate an antidepressant effect if they do not reach the tissue in sufficient concentrations. 
In their study, they observed that bioactives from ginseng exert an anti-inflammatory and lowers inflammation in parts of the body other than the brain. This reduction in inflammation, in turn, influences brain chemistry as well as ameliorates neuroinflammation; thus supporting an antidepressant action.
Indeed, high levels of pro-inflammatory agents in the blood have been associated with increased severity of depression. 
Kang and colleagues suggest that reduction of peripheral inflammation (inflammation in parts of the body other than the brain) is a major premise of ginseng’s antidepressant action.
High levels of serum inflammatory agents in depression have been linked to immune system dysfunction as well. 
With relevance to this symptom, it is important to note that ginseng has an immunomodulatory action that can help regulate immune responses. 
Researchers from The University of Western Ontario, Canada refer to this property as the ‘Yin and Yang’ actions of ginseng: it can stimulate or inhibit immune responses. 
Quick Gist: Ginseng extracts are natural anti-inflammatory agents that can effectively lower the levels of pro-inflammatory agents in the brain and body and attenuate depressive symptoms and comorbid pain in MDD.
It also possesses immunomodulatory action that can help normalize immune responses and curb inflammation in depression.
4. Ginseng can improve sleep in depressed individuals
Sleep disturbances in depression can present as insomnia or hypersomnia (increased sleep duration). For many individuals sleep disturbances may persist even after treating mood-related symptoms.
Patients with insomnia have poor treatment outcomes than those without sleep issues.
GABA or Gamma-aminobutyric acid is an important neurotransmitter for initiating and maintaining sleep.
Lee et.al have demonstrated via an animal study that Korean Red Ginseng extract helps improve sleep by interacting with the GABAergic system. 
Chanana and Kumar have shown that American ginseng can be a potential neuroprotective agent for sleep disturbances and deprivation. (Frontiers in Neuroscience, 2016) 
They observed that extracts from Panax quinquefolius interacted with GABA receptors to reduce sleep deprivation induced abnormalities such as anxiety, raised stress hormone levels, oxidative stress, and neuroinflammation.
I came across this one study where the effects of ginseng supplementation on sleep behavior have been evaluated in humans. 
15 healthy male volunteers were enrolled in the 7-day study. The dose used was 1500mg three times a day. Sleep tests were conducted on Day 1 and Day 7.
Total wake time reduced while sleep efficacy and non-rapid eye movement sleep were increased after ginseng supplementation. Overall ginseng supplementation resulted in modest improvements in sleep quality.
Quick Gist: Ginseng extracts interact with the GABAergic system to modulate and improve sleep duration and efficacy. This property of the Chinese herb could benefit in combating sleep issues in major depression.
5. Ginseng can help protect from cognitive deficits and memory issues
Cognitive deficits are a prominent yet overlooked feature of Major Depressive Disorder. This can range from slight memory lapses, calculation errors, reduced focus, frequent spelling errors and even difficult to find the right words while speaking.
Certain antidepressants can worsen these deficits. Herbs emerge as a potential remedy for such impaired cognition and memory in depression.
Personally, turmeric worked for me. Curcumin helped strengthen my cognition during recovery from Major Depressive Disorder.
Studies conducted in healthy individuals confirm that both American ginseng and Panax ginseng at a dose of 200-400mg per day help improve memory, mental power, performance on arithmetic tasks.  
Though ginsenosides’ cognition enhancing ability has not been tested in patients with MDD, it has been studied in a group of individuals with neurasthenia.
Neurasthenia involves physical and mental exhaustion and presents with symptoms such as fatigue, headache, insomnia, and irritability. Its features significantly overlap with that of depression. 
In 1997, Wesnes and colleagues conducted a study which involved 64 individuals who fulfilled the ICD 10 criteria for neurasthenia.
They were treated with 80mg, 160mg or 320 mg combination of ginseng and gingko biloba twice a day or place. The treatment lasted for 90 days.
The 320 mg dose was found to be better than the placebo in reducing symptoms and improving cognition in neurasthenia.
Quick Gist: The traditional reputation, as well as currently available research (on healthy populations), does suggest that ginseng is an amazing herbal remedy for boosting cognition.
Though not confirmed by studies in depressed individuals, improved cognition and memory and reduced brain fog are an additional benefit that one can expect when using ginseng as an adjunct therapy for depression.
6. Ginseng is a natural neuroprotective agent
Herbs serve as neuroprotective agents- they protect neuronal structure and activity. The conventional treatment module for depressive disorders does not involve targeted therapeutics for neuroprotection.
Add-on therapies with standardized herb extracts or complementary therapies such as yoga can provide much-needed protection and a supportive environment for neurons to recover from damage caused by chronic stress.
Quick Gist: Restoration of neuronal structure and function post damage occurring as a result of chronic stress and depression is a vital aspect of recovery from MDD.
It is a natural neuroprotective agent-its anti-inflammatory, antioxidant and neurotrophic properties help protect brain cells from stress-induced impairments.
The dosage of Ginseng For Depression
It is consumed and distributed as 4 types  :
- Fresh ginseng harvested from fields
- White ginseng which is dried ginseng
- Taekuksam is fresh ginseng blanched in water
- Red ginseng which is steamed fresh ginseng and dried
The first 3 types are primarily consumed as roots while the fourth type is mainly processed into products like powder, tablets, capsules, candy, granules, beverages, concentrated extracts.
One study has found that a dose of 3g of ginseng per day effective for supporting remission from Major Depressive Disorder. 
200-400mg of standardized ginseng extracts have beneficial ‘memory enhancing’ effects. Both Panax and American ginseng are effective in improving memory.
It is best to consult a health practitioner about the ideal dosage and duration of therapy.
Precautions with Ginseng Use
Ginseng has antiplatelet activity, and this may affect the activity of blood thinners such as warfarin. 
The herb’s use is to be discontinued 1 week before surgery to avoid interference of antiplatelet activity.
If taking any medications, avoid taking ginseng at the same time since it may interfere with drug metabolism.  Please maintain 3-4 hours gap between the two.
In a few cases, ginseng was used in combination with cannabis and Yohimbe and cessation of ginseng use resolved the mania symptoms. 
Dosages higher than what is prescribed by Traditional Chinese Medicine and taken for long durations may be one of the factors for developing mania. Also, its combined use of certain herbs may not be safe.
Michael.S.Barkhe points out that there could be a possibility that the patient experienced mania as a result of the discontinuation of prescribed meds or an interaction of the herb with the medication before the washout.
Another important thing that he points out that the mania could have the result of impure and non-standardized herb extracts. 
Always opt for good quality, standardized herbal extracts.
There is not enough study to comment on the possible drug interactions and safety of taking ginseng when taking conventional antidepressants.
Please consult your health practitioner or a TCM expert before taking ginseng supplements.
Apart from simply regulating brain chemistry, supporting neuronal plasticity and protecting neuronal structure and function can result in better therapeutic outcomes in depression and other mood disorders.
Ginseng is a Chinese herb that helps in depression in multiple ways: supporting neuroplasticity, offering neuroprotection, regulating stress and HPA axis, normalizing brain chemistry and lowering inflammation in the brain.
The evidence available to date suggests that ginseng can be used for supporting remission from Major Depressive Disorder and preventing relapse.
The herb has multiple pharmacological properties that can make it an effective add-on therapy for depression.
Further research is necessary to understand the safety of taking standardized ginseng extracts with conventional antidepressants.
Hey, Ginseng has also a lot of other Health Benefits -> Learn about all the Health Benefits of Ginseng by clicking here <-