Associations between kratom (Mitragyna Speciosa) use and real-time anxiety and sadness: A 15-day ecological momentary...

Kratom (Mitragyna Speciosa) is increasingly used in the U.S. for self-management of pain and mental health symptoms, yet its real-time effects on emotional distress remain poorly understood. We used ecological momentary assessment (EMA) to examine momentary associations of kratom use with anxiety and sadness.

A secondary analysis was conducted among 357 adult kratom consumers who adults who consume kratom completed a 15-day EMA protocol. Multilevel models assessed whether kratom use events occurring within the prior 180min were associated with momentary anxiety and sadness, and whether these associations were moderated by past 30-day use of prescribed anxiolytic or antidepressant medications.

After adjusting for covariates, both single and multiple kratom use events in the previous 180min were associated with lower momentary anxiety compared to no use. For sadness, only single use events were significantly associated with lower scores. Past 30-day prescribed anxiolytic and antidepressant use did not significantly moderate these associations. Higher baseline anxiety and depressive symptoms were associated with greater momentary anxiety and sadness across the 15-day study period.

Kratom use was associated with small reductions in anxiety and, to a lesser extent, sadness in naturalistic settings. These associations were not influenced by past 30-day history of anxiolytic and antidepressant use. These results highlight kratom's potential role in real-time self-management of emotional distress while underscoring the need for randomized controlled trials and longitudinal studies to determine its clinical significance and long-term impact on mental health.