NAD+ and Anxiety: What a 2025 Randomized Trial Actually Found

Written by the Nuvirox Research Team

Short answer: the best available randomized trial data found no measurable anxiety benefit from an NAD+ precursor over placebo. That's a more direct answer than most NAD+ topics get, because anxiety symptoms have actually been measured as an outcome in at least one real randomized controlled trial — and the result was null. That doesn't mean NAD+ metabolism has zero relationship to anxiety biology; it means the one rigorous human test we have didn't show a supplement effect large enough to detect.

Why anxiety and NAD+ get connected at all

Anxiety involves the autonomic nervous system, HPA-axis (stress hormone) signaling, and neurotransmitter systems that all depend on adequate cellular energy production to function normally. NAD+ is essential for mitochondrial ATP synthesis in neurons, and chronic stress is known to increase metabolic demand on the brain. The mechanistic argument for a link is reasonable on paper: if NAD+ availability affects neuronal energy metabolism, and neurons under chronic stress need more of it, then boosting NAD+ could theoretically support better stress-response regulation. That's the hypothesis. What matters more is what happens when it's actually tested.

The one randomized trial that measured this directly

In 2025, researchers published a 24-week, double-blind, placebo-controlled trial of nicotinamide riboside (2000 mg/day) in 58 adults with long-COVID, a condition that commonly includes elevated anxiety and depression symptoms. The trial's secondary outcomes explicitly included the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) — validated, widely used clinical symptom scales. NAD+ levels rose substantially in the NR group within five weeks, confirming the supplement was doing what it's supposed to do metabolically. But when anxiety symptoms were compared between the NR group and the placebo group, there was no significant difference (p = 0.84). The same null result held for depression symptoms between groups (p = 0.20), fatigue, and sleep quality.

It's worth being precise about what a null result like this does and doesn't tell you. In an exploratory, within-group analysis (comparing people to their own baseline rather than to the placebo group), the researchers did find some signal for improvement in depression symptoms after 10 weeks of NR — but that's a weaker type of evidence than the primary between-group comparison, and the authors themselves flagged it as needing confirmation in larger trials. The headline, controlled result for both anxiety and depression was no significant difference from placebo.

What about the case reports mentioning anxiety?

Separately from the trial above, a case report from NAD Research, Inc. describes a patient receiving intranasal NAD+ for migraine who also had co-occurring anxiety symptoms, and reported reduced anxiety alongside reduced headache pain. That's a real, published observation, and it's worth including for completeness — but it's a single case, using an intravenous/intranasal delivery route rather than an oral capsule, without a placebo comparison. It sits at the opposite end of the evidence spectrum from the randomized trial above, and shouldn't be weighted the same way.

What this means if you're dealing with anxiety

The fair reading of the current evidence is: NAD+ precursor supplementation has been tested for anxiety symptoms in at least one well-designed randomized trial, and it didn't outperform placebo. That's a more definitive answer than most wellness claims get, and it's worth taking seriously rather than explaining away. Anxiety that's frequent, distressing, or interfering with daily life deserves an evidence-based approach — cognitive behavioral therapy has strong trial support, and several classes of medication (SSRIs, SNRIs, and others) are well studied for anxiety disorders specifically. A conversation with a doctor or therapist is a more productive starting point than a supplement.

What NAD+ supplementation won't do

Based on the available trial, an NAD+ precursor should not be expected to meaningfully reduce clinical anxiety symptoms on its own. It may still support general cellular energy metabolism, which is a separate and legitimate reason people take it — but that's a different claim than an anxiety benefit, and the two shouldn't be conflated. If anxiety comes with physical symptoms like chest tightness, a racing heart, or panic attacks, or if it's accompanied by thoughts of self-harm, that warrants prompt attention from a healthcare professional.

Frequently asked questions

Did the 2025 trial find NAD+ supplementation harmful for anxiety?

No — the trial found no significant difference between the NR group and placebo group, in either direction. It wasn't shown to help, but it also wasn't shown to worsen anxiety symptoms.

Could a longer trial or higher dose show a benefit?

Possibly — the study authors themselves noted the need for larger trials to confirm or rule out smaller effects, and the population studied (long-COVID patients) may not represent everyone with anxiety. But based on what's published now, there isn't evidence of an anxiety benefit.

Is it safe to take an NAD+ supplement alongside anxiety medication?

This is a question for a pharmacist or prescribing doctor, since it depends on your specific medications. Nicotinamide riboside has a favorable safety profile in trials generally, but individual interaction questions should go through a professional who knows your full medication list.

What has the strongest evidence for anxiety relief?

Cognitive behavioral therapy (CBT) has some of the strongest trial evidence for anxiety disorders. SSRIs and SNRIs are well-studied medication options. Regular aerobic exercise and structured relaxation techniques also have reasonable supporting evidence as adjuncts.

FROM NUVIROX

Why we formulated NAD+ Restore

We built NAD+ Restore for general cellular energy support — not as an anxiety treatment, since the best trial evidence doesn't support that specific claim. Each 2-capsule serving delivers 500 mg of Nicotinamide Riboside Chloride, one of the two most-researched NAD+ precursors, within the dose range used in published human trials, alongside 150 mg trans-resveratrol and 50 mg quercetin, polyphenols studied alongside NAD+ pathways for cellular health support. 10 mg of galactomannans from fenugreek is included to support absorption.

Backed by a 60-day money-back guarantee — long enough to actually evaluate it the way the research says you should.

Learn more about NAD+ Restore →

The bottom line

Anxiety is one of the few topics on this blog where a real randomized, placebo-controlled trial directly measured the outcome people usually want to know about — and the result was a clean null. That's a more useful answer than speculation, even though it's not the answer a supplement company would prefer to write. If you're managing anxiety, the evidence points toward therapy and, where appropriate, medication as the higher-confidence paths forward; an NAD+ precursor can still be reasonable to take for its studied effects on cellular NAD+ levels, just not with an anxiety claim attached. See our related coverage of NAD+ and stress resilience and NAD+ and depression for the adjacent evidence.

References

1. Wu CY, Reynolds WC, Abril I, et al. Effects of nicotinamide riboside on NAD+ levels, cognition, and symptom recovery in long-COVID: a randomized controlled trial. eClinicalMedicine. 2025. PMID: 41357333.
2. White J, Podesta A, Dyess GA, Broom SL, Mestayer RF. IN NAD, migraine headaches and anxiety disorders: a case report. NAD Research, Inc. Available at: nadresearch.org.
3. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017;19(2):93-107. PMID: 28867934.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. This article is for informational purposes only and is not a substitute for professional medical advice.