Rhodiola

Rhodiola rosea is used in the ethnomedicine of Arctic peoples across its circumpolar range ^{36Reference 36Brinckmann et al. · 2021ReviewRunning out of time to smell the roseroots: reviewing threats and trade in wild Rhodiola rosea L. — reviewView study →}.

In Eastern Europe and Asia the root has traditionally been taken to stimulate the nervous system, to improve physical and mental performance, and for fatigue, psychological stress and depression ^{15Reference 15Van Diermen et al. · 2009In vitroMonoamine oxidase inhibition by Rhodiola rosea L. roots — in vitroView study →}.

The European Medicines Agency recognises an ethanol extract of the root and rhizome as a traditional herbal medicinal product for the relief of symptoms of stress, such as fatigue and exhaustion, on the basis of long-standing use ^{32Reference 32European Medicines Agency · 2024ReviewEuropean Union herbal monograph on Rhodiola rosea L., rhizoma et radix (EMA/HMPC/24177/2023, Revision 1) — pharmacopoeial monograph. https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-rhodiola-rosea-l-rhizoma-et-radix-revision-1_en.pdfView study →}.

This is rhodiola’s most replicated human indication. A double-blind crossover RCT in 56 young physicians on night duty found that one tablet a day of SHR-5 extract improved a composite mental-fatigue index during the first two weeks ^{1Reference 1Darbinyan et al. · 2000RCTRhodiola rosea in stress induced fatigue — a double blind cross-over study of a standardized extract SHR-5 — randomised controlled trialView study →}. A placebo-controlled pilot in students during an exam period found improvements in physical fitness, mental fatigue and well-being, and the authors judged the dose probably too low ^{2Reference 2Spasov et al. · 2000RCTA double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students during an examination period — randomised controlled trialView study →}.

A parallel-group RCT in 161 military cadets found a pronounced anti-fatigue effect after a single dose at both of two doses, with no advantage to the higher dose ^{3Reference 3Shevtsov et al. · 2003RCTA randomized trial of two different doses of a SHR-5 Rhodiola rosea extract versus placebo and control of capacity for mental work — randomised controlled trialView study →}.

A phase III trial in 60 adults with stress-related fatigue (576 mg/day SHR-5 for 28 days) found improvements in burnout scores and attention over placebo, and a change in the cortisol response to waking. Both groups improved on several measures, showing a strong placebo effect ^{4Reference 4Olsson et al. · 2009RCTA randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract SHR-5 of Rhodiola rosea in stress-related fatigue — randomised controlled trialView study →}.

One systematic review concluded that rhodiola may help physical and mental performance but lacks independent replication ^{7Reference 7Hung et al. · 2011Systematic reviewThe effectiveness and efficacy of Rhodiola rosea L.: a systematic review of randomized clinical trialsView study →}. Another found the evidence contradictory, with every trial at high or unclear risk of bias ^{8Reference 8Ishaque et al. · 2012Systematic reviewRhodiola rosea for physical and mental fatigue: a systematic reviewView study →}. Open-label burnout and life-stress trials of WS 1375 point the same way but are uncontrolled ^{9,10Reference 9Kasper et al. · 2017Clinical trialMulticenter, open-label, exploratory clinical trial with Rhodiola rosea extract in patients suffering from burnout symptoms — clinical trialView study →Reference 10Edwards et al. · 2012Clinical trialTherapeutic effects and safety of Rhodiola rosea extract WS 1375 in subjects with life-stress symptoms — open-label clinical trialView study →}.

Gap: a 42-day RCT in 48 nursing students on shift work found rhodiola worse than placebo for fatigue ^{6Reference 6Punja et al. · 2014RCTRhodiola rosea for mental and physical fatigue in nursing students — randomised controlled trialView study →}, and the positive trials share overlapping authorship and one extract.

A 2025 systematic review and meta-analysis of 26 RCTs (668 participants) found that rhodiola improved VO₂max, time to exhaustion and time-trial performance, with larger VO₂max gains above 600 mg/day ^{20Reference 20Wang et al. · 2025Meta-analysisThe effect of Rhodiola rosea supplementation on endurance performance and related biomarkers — systematic review and meta-analysisView study →}.

A single dose has the clearest effect. In a crossover RCT, 200 mg of an extract taken an hour before exercise lengthened time to exhaustion and raised VO₂peak, and four weeks of daily intake changed nothing ^{17Reference 17De Bock et al. · 2004RCTAcute Rhodiola rosea intake can improve endurance exercise performance — randomised controlled trialView study →}. A 3 mg/kg dose lowered heart rate during a standard warm-up, lowered perceived exertion and gave a faster 6-mile cycling time trial ^{18Reference 18Noreen et al. · 2013RCTThe effects of an acute dose of Rhodiola rosea on endurance exercise performance — randomised controlled trialView study →}.

A systematic review found that single doses help endurance and perceived exertion, while daily use helps anaerobic performance rather than endurance ^{19Reference 19Sanz-Barrio et al. · 2023Systematic reviewRhodiola rosea supplementation on sports performance: a systematic review of randomized controlled trialsView study →}. Another review reports less muscle damage and oxidative stress after exercise ^{21Reference 21Lu et al. · 2022Systematic reviewEffects of Rhodiola rosea supplementation on exercise and sport: a systematic reviewView study →}.

A 2024 RCT of pure biosynthetic salidroside (60 mg/day for 16 days) improved oxygen uptake during high-intensity intermittent exercise and reduced a marker of muscle damage ^{22Reference 22Schwarz et al. · 2024RCTSalidroside and exercise performance in healthy active young adults — exploratory randomised, double-blind, placebo-controlled studyView study →}. Effect sizes are modest and protocols vary widely, and the results for single doses and for daily use differ.

A phase III RCT in 89 adults with mild to moderate depression found that SHR-5 at 340 or 680 mg/day for 6 weeks improved overall depression, insomnia and emotional instability, while placebo did not ^{11Reference 11Darbinyan et al. · 2007RCTClinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression — randomised controlled trialView study →}.

A US proof-of-concept RCT in 57 people compared rhodiola, sertraline and placebo over 12 weeks. All three groups improved modestly, and the differences between them were not significant. Sertraline gave the largest fall in depression scores, and rhodiola caused far fewer adverse events than sertraline ^{12Reference 12Mao et al. · 2015RCTRhodiola rosea versus sertraline for major depressive disorder — randomised placebo-controlled trialView study →}.

A 2025 systematic review of treatments for milder depression included one placebo-controlled trial of rhodiola, which found a significant improvement in depressive symptoms ^{14Reference 14Urata et al. · 2025Meta-analysisEfficacy of pharmacological interventions in milder depression — systematic review and meta-analysisView study →}.

Root extracts inhibit monoamine oxidase A and B in vitro ^{15Reference 15Van Diermen et al. · 2009In vitroMonoamine oxidase inhibition by Rhodiola rosea L. roots — in vitroView study →}, and a review collates the animal and human evidence for an antidepressant action ^{13Reference 13Amsterdam et al. · 2016ReviewRhodiola rosea L. as a putative botanical antidepressant — reviewView study →}.

Gap: Only two placebo-controlled RCTs exist, and one was inconclusive ^{12Reference 12Mao et al. · 2015RCTRhodiola rosea versus sertraline for major depressive disorder — randomised placebo-controlled trialView study →}. There is no evidence for severe depression, and rhodiola should not be assumed to substitute for established antidepressants.

The cognitive benefits follow the anti-fatigue data. They appear mainly as preserved attention, speed and accuracy in people who are tired or stressed, rather than as enhancement in people who are rested. The night-duty physician and cadet RCTs measured cognition through fatigue indices and found gains during treatment ^{1,3Reference 1Darbinyan et al. · 2000RCTRhodiola rosea in stress induced fatigue — a double blind cross-over study of a standardized extract SHR-5 — randomised controlled trialView study →Reference 3Shevtsov et al. · 2003RCTA randomized trial of two different doses of a SHR-5 Rhodiola rosea extract versus placebo and control of capacity for mental work — randomised controlled trialView study →}.

A double-blind RCT of ADAPT-232, a fixed combination of rhodiola, schisandra and eleutherococcus, improved attention, speed and accuracy two hours after a single dose in 40 stressed women ^{16Reference 16Aslanyan et al. · 2010RCTDouble-blind, placebo-controlled, randomised study of single dose effects of ADAPT-232 on cognitive functions — randomised controlled trialView study →}. As a combination product it cannot isolate rhodiola’s contribution. A review frames the cognitive effect as secondary to reduced fatigue and stress ^{13Reference 13Amsterdam et al. · 2016ReviewRhodiola rosea L. as a putative botanical antidepressant — reviewView study →}.

Gap: some of the cognitive evidence comes from multi-herb formulations, and Cropley’s single-extract trial found no change in cognition despite better mood ^{5Reference 5Cropley et al. · 2015The effects of Rhodiola rosea L. extract on anxiety, stress, cognition and other mood symptoms — controlled trialView study →}. The benefit appears only under fatigue.

The human antioxidant evidence comes from exercise studies. The 2025 endurance meta-analysis found that rhodiola raised total antioxidant capacity and superoxide dismutase and lowered malondialdehyde, a marker of lipid damage ^{20Reference 20Wang et al. · 2025Meta-analysisThe effect of Rhodiola rosea supplementation on endurance performance and related biomarkers — systematic review and meta-analysisView study →}. An exercise systematic review also reported greater antioxidant capacity and less oxidative stress ^{21Reference 21Lu et al. · 2022Systematic reviewEffects of Rhodiola rosea supplementation on exercise and sport: a systematic reviewView study →}.

In animal models of Alzheimer’s disease, salidroside raised superoxide dismutase and lowered malondialdehyde ^{23Reference 23Zhang et al. · 2023Meta-analysisNeuroprotective mechanisms of salidroside in Alzheimer’s disease — systematic review and meta-analysis of preclinical studiesView study →}.

The human data are biomarkers measured around exercise, not clinical endpoints.

A 2023 systematic review and meta-analysis of 20 preclinical studies found that salidroside improved behaviour and biochemical markers in animal models of Alzheimer’s disease. It lowered amyloid-β, inflammatory cytokines and oxidative stress ^{23Reference 23Zhang et al. · 2023Meta-analysisNeuroprotective mechanisms of salidroside in Alzheimer’s disease — systematic review and meta-analysis of preclinical studiesView study →}.

Salidroside also protects the brain and other organs against injury when blood flow returns after ischaemia in animal studies, through antioxidant, anti-inflammatory and anti-apoptotic effects ^{38Reference 38Chi et al. · 2026ReviewProtective effect of salidroside against multiple organs ischemia-reperfusion injury: new insights from common and specific pharmacological mechanisms — reviewView study →}. Root extracts inhibit MAO-A and MAO-B in vitro ^{15Reference 15Van Diermen et al. · 2009In vitroMonoamine oxidase inhibition by Rhodiola rosea L. roots — in vitroView study →}.

Every neuroprotection finding is preclinical. There are no human trials in dementia, stroke or neurodegeneration.

Most of the cardioprotective evidence is preclinical and centred on salidroside, which reduces heart injury after ischaemia and reperfusion in animal models. Its effects include lowering oxidative stress and inflammation and inhibiting ferroptosis ^{38Reference 38Chi et al. · 2026ReviewProtective effect of salidroside against multiple organs ischemia-reperfusion injury: new insights from common and specific pharmacological mechanisms — reviewView study →}.

In one randomised trial, 60 women with breast cancer took salidroside (600 mg/day) or placebo from a week before chemotherapy with epirubicin. With salidroside, left-ventricular function recovered at higher cumulative doses and blood levels of reactive oxygen species stayed steady ^{31Reference 31Zhang et al. · 2012RCTProtective effects of salidroside on epirubicin-induced early left ventricular regional systolic dysfunction in patients with breast cancer — randomised controlled trialView study →}.

Whole-root rhodiola has no cardiovascular outcome data in people. The single positive trial is small, in a narrow chemotherapy setting, and used isolated salidroside rather than the standardised extract.

An open trial in 80 mildly anxious adults (2 × 200 mg Vitano daily for 14 days) found lower self-rated anxiety, stress, anger, confusion and depression than in an untreated control group, with good tolerability ^{5Reference 5Cropley et al. · 2015The effects of Rhodiola rosea L. extract on anxiety, stress, cognition and other mood symptoms — controlled trialView study →}.

The only dedicated anxiety trial had no placebo group, so a placebo effect cannot be excluded, and there was no accompanying change in cognition ^{5Reference 5Cropley et al. · 2015The effects of Rhodiola rosea L. extract on anxiety, stress, cognition and other mood symptoms — controlled trialView study →}.

In lung cells exposed to low oxygen, R. crenulata extract and its components salidroside and tyrosol protected the sodium-potassium pump (Na⁺/K⁺-ATPase) through the ROS-AMPK-PKCζ pathway. The extract had a similar effect in rats kept in a low-pressure chamber ^{25Reference 25Lee et al. · 2013In vitroRhodiola crenulata and its bioactive components, salidroside and tyrosol, reverse the hypoxia-induced reduction of Na,K-ATPase expression — in vitroView study →}.

A randomised, double-blind, placebo-controlled crossover trial in 102 people ascending rapidly to 3,421 m found that R. crenulata extract (800 mg/day) did not reduce the incidence or severity of acute mountain sickness ^{24Reference 24Chiu et al. · 2013RCTRhodiola crenulata extract for prevention of acute mountain sickness — randomised, double-blind, placebo-controlled crossover trialView study →}.

Gap: the supporting work uses R. crenulata, not R. rosea, and the only powered human RCT was negative.

Tolerability. Rhodiola is well tolerated in short-term trials, with no serious adverse events attributed to the extract ^{4,11,12Reference 4Olsson et al. · 2009RCTA randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract SHR-5 of Rhodiola rosea in stress-related fatigue — randomised controlled trialView study →Reference 11Darbinyan et al. · 2007RCTClinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression — randomised controlled trialView study →Reference 12Mao et al. · 2015RCTRhodiola rosea versus sertraline for major depressive disorder — randomised placebo-controlled trialView study →}. In a head-to-head trial it caused fewer adverse events than sertraline (30% against 63%) ^{12Reference 12Mao et al. · 2015RCTRhodiola rosea versus sertraline for major depressive disorder — randomised placebo-controlled trialView study →}. The EMA lists headache, nausea, abdominal pain, diarrhoea, skin rash and itching as possible side effects ^{32Reference 32European Medicines Agency · 2024ReviewEuropean Union herbal monograph on Rhodiola rosea L., rhizoma et radix (EMA/HMPC/24177/2023, Revision 1) — pharmacopoeial monograph. https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-rhodiola-rosea-l-rhizoma-et-radix-revision-1_en.pdfView study →}.

CYP2C9. In a controlled study in 13 healthy volunteers, 14 days of rhodiola reduced CYP2C9 activity by about 21%, most in people who metabolise CYP2C9 drugs normally ^{28Reference 28Thu et al. · 2016RCTEffect of commercial Rhodiola rosea on CYP enzyme activity in humans — randomised cross-over studyView study →}. The effect is modest but may matter for narrow-margin CYP2C9 drugs such as warfarin and phenytoin. The same study found no effect on CYP1A2, CYP2C19, CYP2D6 or CYP3A4 ^{28Reference 28Thu et al. · 2016RCTEffect of commercial Rhodiola rosea on CYP enzyme activity in humans — randomised cross-over studyView study →}.

Other enzymes in vitro. Rhodiola extracts strongly inhibit CYP3A4 and P-glycoprotein in vitro ^{26Reference 26Hellum et al. · 2010In vitroPotent in vitro inhibition of CYP3A4 and P-glycoprotein by Rhodiola rosea — in vitroView study →}, and two constituents, rhodiosin and rhodionin, inhibit CYP2D6 ^{27Reference 27Xu et al. · 2013In vitroTwo potent cytochrome P450 2D6 inhibitors found in Rhodiola rosea — in vitroView study →}. The EMA notes that no clinically relevant interactions have been observed ^{32Reference 32European Medicines Agency · 2024ReviewEuropean Union herbal monograph on Rhodiola rosea L., rhizoma et radix (EMA/HMPC/24177/2023, Revision 1) — pharmacopoeial monograph. https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-rhodiola-rosea-l-rhizoma-et-radix-revision-1_en.pdfView study →}.

Stimulating effect. Rhodiola is generally taken earlier in the day. Use caution alongside antidepressants, particularly MAO inhibitors, given its MAO-inhibiting activity in vitro ^{15Reference 15Van Diermen et al. · 2009In vitroMonoamine oxidase inhibition by Rhodiola rosea L. roots — in vitroView study →}.

Children. The EMA does not recommend use under 18 because there are not enough data ^{32Reference 32European Medicines Agency · 2024ReviewEuropean Union herbal monograph on Rhodiola rosea L., rhizoma et radix (EMA/HMPC/24177/2023, Revision 1) — pharmacopoeial monograph. https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-rhodiola-rosea-l-rhizoma-et-radix-revision-1_en.pdfView study →}.