The majority of people live with stress on a daily basis. We are almost continuously exposed to stressors, whether environmental or physical, even mental. The HPA Axis (Hypothalamic-Pituitary-Adrenal) is a centralized stress response system, intertwining the central nervous system and the endocrine system, providing the “neuroendocrine adaptation component of the stress response” by releasing a Hypothalamic “corticotropin-releasing factor (CRF)” or “corticotropin-releasing hormone (CRH)”; this binds to CRF/CRH receptors in the pituitary which then releases adrenocorticotropic hormone (ACTH) binding to receptors in the adrenal cortex which allows the release of glucocorticoids and cortisol (can be released for several hours depending on the stressor (Alschuler, 2016). In the attempt to control these events, a feedback is initiated by the behavioral and physiological effects exerted by cortisol and glucocorticoid release to regulate this response and magnitude; furthermore, the HPA is regulated by the Hypothalamus (Smith, 2006). In many cases, people who experience continual stress over time could lead to more serious consequences such as a burnout/exhaustion, leading to thyroid dysfunction and even depression. A recent study on adolescent girls’ (aged 12-16) depressive symptoms showed a relationship of stress impacting the HPA Axis actually heightened depressive states (Owens, Helms, Rudolph, Hastings, Nock, & Prinstein, 2019).  Healthcare providers should look into alternative medicinal ways in which the HPA Axis stress response can be supported to alleviate prolonged stress response exhaustion and even prevent damages caused by an exhausted hormonal response to stress. Approaching support for the HPA Axis in regulating the stress response, many herbs are available to assist the HPA Axis function in its attempt to regulate and bring about homeostasis of the stress response. The most beneficial herbs are called adaptogens. In short, this chain of events is the hormonal response to stress, where herbal support of the HPA Axis function on the stress response can alleviate or even prevent certain consequential outcomes of an over stimulated stress response.


Adaptogens are herbs which increase the body’s resistance to stress by improving resilience, supporting adrenal function, and enabling it to physiologically adapt to stressors before a collapse occurs along with health repercussions (Hoffman, 2003). Adaptogenic herbs such as Panax spp. (Ginseng), Eleutherococcus senticosus (Siberian Ginseng), Ocimum tenuiflorum (Holy Basil), and Withania somnifera (Ashwagandha), are the most useful when assisting the HPA Axis regulation, in particular the Adrenal Medulla and Cortex: response to ACTH, of the stress response. In a 2010 study on the effectiveness of these adaptogens “It was discovered that the stress—protective activity of adaptogens was associated with regulation of homeostasis via several mechanisms of action, which was linked with the hypothalamic-pituitary-adrenal axis and the regulation of key mediators of stress response” (Panossian & Wikman, 2010).  Panax ginseng is the most widely used herb for increasing resistance to stress and “has been the most commonly used as an adaptogenic agent and has been shown to enhance physical performance, promote vitality, increase resistance to stress and aging, and have immunomodulatory activity”; with its phytochemicals such as ginsenosides, saponins, polysaccharides, etc., are the primary constituents which assist in the HPA Axis’ stress resistance (Kim, 2012). Ocimum tenuiflorum is another wonderful adaptogen with ‘anti-stress’ properties; “not only prevented the decrease of adrenal cortisol after stress but it significantly increased the cortisol content of the adrenals. This would suggest cortisol sparing effect of [Holy Basil] during stress” in a 1980’s clinical trial of mice (Bhargava & Singh, 2013). Withania somnifera has been known to support the homeostasis of the HPA Axis, and allows for a greater resistance to stress related damages. Furthermore, these adaptogenic herbs are that “they minimized the bodily response to stress, reducing the negative reactions during the alarm phase and eliminating, or at least decreasing, the onset of the exhaustion phase that is part of the so-called general adaptation syndrome” (Liao, He, Li, Meng, Dong, Yi, & Xiao, 2018).


As a health care provider, when assisting someone who has HPA Axis stress response exhaustion, utilizing these adaptogenic herbs are the best and most efficient way to reduce and even assist in reversing stress response exhaustion, otherwise irreversible health damage could occur. When taken properly, these herbs have no side effects, and are easily taken throughout the day. Educating patients is very important in which taking these herbs daily can greatly reduce the risk of stress response exhaustion; preventive care is always important. These adaptogenic herbs can greatly increase the quality of life for those who experience many daily stressors.


-Alison Zahn MLS, PBCHS



Alschuler, L. (2016, October 31). The HPA Axis. Retrieved from

 Bhargava, K. P., & Singh, N. (2013). Anti-stress activity of Ocimum sanctum Linn. Indian Journal of Medical Research, 137(3), 443–451. Retrieved from

 Hoffmann, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press.

 Kim D. H. (2012). Chemical Diversity of Panax ginseng, Panax quinquifolium, and Panax notoginseng. Journal of ginseng research, 36(1), 1–15. doi:10.5142/jgr.2012.36.1.1

 Liao, L. Y., He, Y. F., Li, L., Meng, H., Dong, Y. M., Yi, F., & Xiao, P. G. (2018). A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chinese medicine, 13, 57. doi:10.1186/s13020-018-0214-9

 Owens, S. A., Helms, S. W., Rudolph, K. D., Hastings, P. D., Nock, M. K., & Prinstein, M. J. (2019). Interpersonal Stress Severity Longitudinally Predicts Adolescent Girls’ Depressive Symptoms: the Moderating Role of Subjective and HPA Axis Stress Responses. Journal of Abnormal Child Psychology, 47(5), 895–905.

 Panossian, A., & Wikman, G. (2010). Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel, Switzerland), 3(1), 188–224. doi:10.3390/ph3010188

 Smith, S. M., & Vale, W. W. (2006). The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues in clinical neuroscience, 8(4), 383–395.