Reishi for Stress and Anxiety: What Every Human Trial Actually Measured, and What a Tincture Can Do

Reishi (Ganoderma lucidum, lingzhi in Chinese, mannentake in Japanese) is the medicinal mushroom most often sold “for stress and anxiety”, and the honest state of the human research is this: no placebo-controlled trial has tested reishi on its own in healthy adults with anxiety as the main outcome.

What exists is one 132-patient trial in a fatigue diagnosis, a 48-patient cancer pilot in which anxiety was a secondary measure, a 30-day study of 78 students, two small fibromyalgia trials with no significant difference, and a 2026 trial of a five-mushroom blend that is the source of the “reishi lowers cortisol” sentence you will find on every other page. The one trial that measured cortisol with reishi alone found no change. Below is every one of those studies with its size, dose and result, the animal work that the “calming” reputation actually rests on, and a plain account of what our 1.4 ml daily dose of fruiting-body extract can and cannot be expected to do.

Does reishi help with stress and anxiety?

In people, it has been shown to reduce fatigue and improve a sense of well-being in a fatigue diagnosis, and to lower anxiety and depression scores as secondary measures in cancer patients and in a small student study. It has not been tested on its own, against placebo, in otherwise healthy adults whose main complaint is anxiety — and the one trial that measured a stress hormone with reishi alone found nothing. That is a narrower answer than “reishi calms you”, and it is the one the trials support.

The table lists every human study we could find in PubMed in which a reishi preparation was given by mouth and a mood, stress, anxiety or well-being outcome was recorded, plus the blend trial that everyone cites. The “what it does not mean” column is where the distance between a search-result sentence and a research finding lives.

Three things stand out. First, the two reishi-alone trials with a positive mood signal were in people who were ill or exhausted — neurasthenia and cancer-related fatigue — and measured fatigue first. Second, the only trials in people who were not ill found either no mood difference (fibromyalgia, at 6 g a day) or a result without published effect sizes (students, 30 days). Third, the strongest stress-hormone result in the whole literature belongs to a five-mushroom blend, which means it cannot be credited to reishi. The original answer this article gave, in July 2026, is kept below; the trials above are the reason we would now phrase it more carefully.

What is an adaptogen, and is reishi one?

“Adaptogen” is a pharmacological label, not a botanical one: a substance that increases an organism’s resistance to stress in a non-specific way, with a biphasic dose response — mild stress-mimetic at low doses, protective under heavy stress. The 2021 review that traced the concept from traditional medical systems to modern pharmacology is a review of plant adaptogens, and it describes their effects on the neuroendocrine-immune system as pleiotropic and their potential as “poorly explored”; reishi belongs to the category by tradition and by animal data rather than by a human trial that tested the definition.

That is not a criticism of the word, which describes reishi’s traditional use in Chinese medicine well — the classical “An-Shen” or spirit-calming use for restlessness, insomnia and palpitations that the rat sleep studies below were designed to test. It is a caution about the way the label is used in supplement copy, where “adaptogen” is made to do the work a trial should do. The original explanation of the mushroom and its two compound families is kept below; it is accurate, and the one sentence we would now add is that the triterpene “calming” attribution is supported by mouse studies and not yet by a human one.

Does reishi lower cortisol?

Not in the one placebo-controlled trial that measured it with reishi alone. In the 2012 Hong Kong crossover, 26 adults took 1.44 g of reishi a day for 12 weeks and then placebo for 12 weeks; urine cortisol and catecholamines were no different on reishi than on placebo. The cortisol reduction that circulates online comes from the 2026 five-mushroom blend trial, in which serum cortisol and ACTH fell over 12 weeks in 50 people — a real result that belongs to a product containing four other mushrooms.

In animals the picture is more suggestive, and it is where the claim was born. A 28-kilodalton polysaccharide-peptide from reishi spores lowered serum corticosterone — the rodent equivalent of cortisol — in mice under chronic unpredictable mild stress, alongside higher brain-derived neurotrophic factor in the prefrontal cortex; the effect vanished when a BDNF blocker was given first. Reishi triterpenoids, injected for three weeks, reversed anxiety- and depression-like behaviour in mice that had been separated from their mothers as pups, by damping inflammation in the periphery and brain. Ganoderic acid A did the same in mice made “depressed” with a bacterial toxin. These are mechanism studies with intraperitoneal doses, and the honest sentence is that reishi’s effect on the stress axis has been demonstrated in stressed rodents and, so far, not in stressed people taking reishi alone. The original description of the HPA axis is kept below and remains a fair account of the hypothesis.

What did the largest reishi trial actually measure?

Fatigue, in people diagnosed with neurasthenia. The 2005 multicentre trial randomised 132 Chinese patients to 1,800 mg of a reishi polysaccharide extract three times a day — 5.4 g a day — or placebo for eight weeks. On the fatigue scale the reishi group fell 28.3% against 20.1% on placebo; on the clinician’s severity rating, 15.5% against 4.9%; on well-being, a 38.7% rise against 29.7%. Just over half the reishi group (32 of 62) were rated at least minimally improved, against a quarter of the placebo group (15 of 61).

Two details deserve more attention than they get in the copies of this study that circulate. The first is the placebo response: a 20.1% fall in fatigue and a 29.7% rise in well-being with a sugar pill is a reminder that a stressed person who starts anything, and is asked about it every week, tends to feel better. The second is the diagnosis. Neurasthenia in the ICD-10 is a condition of persistent exhaustion after mental or physical effort, with irritability and tension among its features; it overlaps with what a stressed person feels, but it is not generalised anxiety, and the trial did not use an anxiety scale. The original fatigue section of this article is kept below; its numbers match the paper.

What does the 2026 mushroom-blend trial show — and what does it not?

It shows that a commercial five-mushroom product, taken for 12 weeks by 50 adults, lowered anxiety on two scales at 6 and 12 weeks, lowered depression and fatigue scores, improved sleep-quality scores, and reduced serum cortisol and ACTH, with no adverse effects reported. It does not show what reishi does, because reishi was one of five ingredients — lion’s mane, cordyceps, reishi, shiitake and maitake — and the trial had no reishi-only arm.

We say this on a page that sells reishi because the alternative is to let you believe a number that is not ours to use. The blend result is genuinely the best stress data in the mushroom literature — validated scales, biomarkers, three time points — and it is a reason to think mushrooms as a class deserve a proper trial. It is also, for that reason, the study most often quoted as if it were about reishi. A 2025 conference abstract of a reishi-plus-ashwagandha product on perceived stress has the same problem twice over: a blend, and not yet a peer-reviewed paper. The original research summary from this article is kept below; it flagged the blend caveat correctly, and we have only made the point louder.

Does reishi calm you the way a sedative does?

In rats, partly, and at doses no tincture approaches; in people, it has never been measured. A 2007 Beijing study gave rats a water extract of reishi at 80 and 120 mg per kilogram: it did nothing to the sleep of normal rats, but in rats already given the barbiturate pentobarbital it shortened the time to fall asleep and lengthened sleep — and flumazenil, the drug that blocks benzodiazepine receptors, blocked most of that effect. That is the origin of the “reishi works on GABA” claim: a benzodiazepine-like action, in drugged rats, on a receptor the study did not measure directly.

The compounds behind it have since been named. In 2024 a Chinese group compared five polypore mushrooms used for insomnia — reishi among them — and found six shared triterpenes, four ganoderic acids and two ganoderenic acids, that were sedative in the same mouse model. Lucidone D, another reishi terpene, was sedative and pain-relieving in mice in 2019. This is real pharmacology, and it is why the bitter fraction of a reishi extract has always been the one traditional use pointed to. What is missing is the human step: no trial has given reishi to people and measured reaction time, drowsiness, sedation scales or GABA activity. The 2019 review of reishi’s neuropharmacology says it directly — clinical trials in these disorders “are still rare”, and no reishi-derived drug has been approved by the US Food and Drug Administration. So “reishi calms the nervous system” is a mouse result and a tradition, and the useful practical corollary is the one the original article drew: it is not a fast-acting pill, and anyone expecting a benzodiazepine-like effect within an hour will be disappointed.

How does reishi relate to sleep?

Through the same animal literature, and through one human finding that was not about sleep. A fruiting-body extract of reishi at 80 mg per kilogram increased total and non-REM sleep in freely moving rats over three days, apparently by raising the cytokine TNF-α — the effect disappeared when a TNF-α antibody was injected into the brain. A 2021 study found that the acidic fraction of a reishi mycelium extract promoted sleep in mice over 28 days through serotonin, and that the effect vanished entirely when the gut bacteria were wiped out with antibiotics. In people, the five-mushroom blend improved sleep-quality scores, and no reishi-alone trial has had sleep as a primary outcome.

That is why the mushrooms for sleep page on this site opens by saying that reishi has no human trial with sleep as the main outcome, and why we describe reishi as regulating rather than sedating. The link between stress and sleep the original article drew is correct and is kept below; what we would add is that “supports better-quality sleep” is, at present, a customer report and a rodent result, not a trial result. Our own customers’ reviews on this page say exactly that, and are labelled as reviews.

Is reishi better than ashwagandha or lion’s mane for stress?

On human evidence for stress and anxiety specifically, no — ashwagandha has far more, and lion’s mane has a little. Two meta-analyses of ashwagandha pooled 12 randomised trials with 1,002 participants and 9 trials with 558: perceived-stress scores fell by about 4.7 points and clinician-rated anxiety by about 2.2 points against placebo, and serum cortisol fell too, though the certainty of the evidence was rated low and the trials were heterogeneous. Reishi has no meta-analysis on this outcome because there is nothing to pool.

Lion’s mane sits between the two. A 4-week trial of 30 women found depression scores lower than at baseline on lion’s mane cookies, and a trend toward less anxiety than placebo; a 28-day trial of 41 healthy adults found a trend toward lower subjective stress that just missed significance. Both are small, and the lion’s mane calm and mood page and the focus and concentration page lay them out. We wrote the ashwagandha versus medicinal mushrooms comparison for exactly this reason — it is more honest to tell you where the trials are than to pretend the category is interchangeable. The practical consequence for a reishi buyer is not “don’t”; it is “know which claim you are paying for”: the fatigue and well-being data are reishi’s own, the cortisol data are a blend’s, and the sedative data are a rat’s.

How much reishi did the trials use — and how much is in a tincture?

Grams, versus drops. The neurasthenia trial used 5.4 g a day of a polysaccharide extract; the fibromyalgia trials used 6 g a day of milled fruiting body; the Hong Kong crossover used 1.44 g; the student study used 0.5–1 g of a supplement; the cancer pilot used spore powder. Our label dose is 1.4 ml of extract a day — about a quarter of a teaspoon. Whatever else that dose does, it is not the dose the trials used, and we will not tell you it is.

Here is exactly what we know about our own extract, so that you can decide with the numbers in front of you. It is a triple extraction — water, alcohol and ultrasonic — of fresh reishi fruiting bodies that go from harvest to extraction without a drying step, with the alcohol phase lasting seven weeks. The mushroom-to-liquid ratio is 1:3, which means about 16–17 g of fresh mushroom went into every 50 ml bottle. The beta-glucan content of the dried extract is 25.65%, measured by TÜV Austria with the report published on our lab-testing page, and alpha-glucan — the starch that betrays grain-grown mycelium — was not detected. What we do not measure is the triterpene content, which is the fraction the sedation studies point to; we could tell you the extract is bitter, which is what triterpenes taste like, but a taste is not a number, so we do not print one. Nor do we convert the beta-glucan percentage into a per-drop figure, because that would need an extraction-yield number we have not verified — the beta-glucan page explains why. The reasonable reading is that an alcohol–water extract concentrates the soluble polysaccharides and triterpenes that the immune and animal work point to, at a fraction of the trial doses. The dosage guide puts the trial doses beside the bottle for every mushroom we sell, and the extraction-ratio page explains why a “1:3” from fresh mushroom is not comparable to a ratio from dried.

What reishi does not do

It does not treat an anxiety disorder, it does not act within an hour, it does not lower cortisol in the one trial that checked, and it does not substitute for the things with better evidence — sleep, exercise, therapy, and for clinical anxiety a physician. It is a mushroom with a real but small human literature on fatigue and well-being, a rich animal literature on sedation and stress, and a tradition that the animal work has partly vindicated.

The original honesty section of this article is kept below because it was right, and because it is the part we would least want to lose. We have added the fourth limit — cortisol — from the trial table above.

Who should not take reishi for stress?

Anyone with a diagnosed anxiety or mood disorder who has not told their clinician; anyone on sedatives, antidepressants or other drugs acting on the nervous system, because the animal work suggests a benzodiazepine-like action and no interaction study exists; anyone on blood thinners or due for surgery, as a precaution, even though a 4-week trial of 1.5 g a day in 40 healthy volunteers found no effect on clotting; anyone with liver disease or who drinks heavily; and, by our own rule rather than by evidence of harm, anyone pregnant, breastfeeding or under 18, because our tinctures contain alcohol and there is no safety research in those groups.

The liver point deserves a paragraph, because it is the one serious adverse event in the reishi literature. A 47-year-old man developed acute hepatitis after taking reishi powder together with alcohol in 2023; it resolved within two weeks. In 2005 a Thai patient died of fulminant hepatitis after switching from traditionally boiled reishi to a powder for one to two months, while also taking other agents, and a similar Hong Kong case had been described in 2004. These are case reports, not rates, and the controlled trials — 16 volunteers on 4 g a day for 10 days, 84 diabetic patients on 3 g a day for 16 weeks, 42 people with dementia for 6 weeks — recorded no liver signal. But they are a reason we say plainly that our extract is 32–33% alcohol by volume, that 1.4 ml of it is a little under half a millilitre of alcohol, and that “reishi powder plus a drinking habit” is the one combination the case literature warns about. The most common side effects in the 1,374-patient survey were dry mouth, constipation, insomnia, itching and vertigo, each in 3–5% of users — insomnia, note, on a mushroom sold for calm. The drug-interactions page, the side-effects page, the pregnancy and breastfeeding page and the children’s page hold the detail.

How do you use reishi for everyday stress?

Daily, at the same time, for at least the four to eight weeks the trials ran, with a note of what you want to change written down before you start. The trials measured fatigue, well-being and mood at 4, 6, 8 and 12 weeks; none measured anything at day 3. A 50 ml bottle at 1.4 ml a day is about 35 days, which is a fair first window.

Timing is a matter of preference rather than evidence — no trial compared morning with evening — but the traditional use and the rat sleep data both point to the evening if sleep is the part of stress that bothers you most, and the timing and stacking guide explains the logic. Take it with a little water or in a warm drink that has cooled slightly; the powder, capsules or tincture page explains why we make a liquid. The original how-to list is kept below with one note: its “500 to 1,500 mg per day” range describes capsule products and comes from the supplement market, not from a trial, and the trials in this article used between one and six grams.

How long before reishi has an effect on stress?

The shortest trial with a mood result lasted 4 weeks (the cancer pilot), the student study 30 days, the fibromyalgia trials 6 weeks, the neurasthenia trial 8 weeks, and the blend trial reported its first anxiety difference at 6 weeks. Nothing in the human literature supports an effect within days, and the rat sedation studies used doses and routes that do not translate to a dropper.

So the fair test is the one we suggest on the how long do medicinal mushrooms take to work page: write down, before you start, what you want to change and how often it happens now — how many nights you lie awake, how many afternoons you feel wrung out — give it a month, and compare notes rather than impressions. If nothing has moved after a bottle, the 100-day trial exists so that you can stop without losing money, and we would rather you did that than kept buying on hope.

What does the research still not know?

Whether reishi on its own reduces anxiety in otherwise healthy adults, since no trial has asked. Whether it changes cortisol in stressed people, since the one measurement was in people selected for blood pressure, and found nothing. Whether the benzodiazepine-like effect seen in drugged rats exists at all in people at supplement doses. Which fraction matters — the polysaccharides that the neurasthenia trial used, or the triterpenes the sedation studies point to — and therefore whether a water extract, an alcohol extract or a spore powder is the right form for this use. And whether any of the animal stress results survive at oral doses rather than injections.

The reviews agree with this list. The 2021 critical review of reishi in Phytotherapy Research found pharmacological signals for anxiety, sedation and depression and then wrote that “most of the studies are preclinical” and that “quality clinical data are intensely needed”; a 2025 systematic review of mushrooms as candidate antidepressants ended on “lack of clinical validation”. What we can measure, we do: the beta-glucan content of the finished extract, its heavy-metal, pesticide and PAH results, and the ratio of fresh mushroom to liquid. “Calms the nervous system” is not something we can put on a certificate. A laboratory result is, which is why the proof panel below this article shows a percentage with a report number rather than a sentence about cortisol.

The bottom line

Reishi has one solid human result — less fatigue and more well-being in 132 exhausted patients over eight weeks — a handful of small trials with secondary mood signals, two null trials for mood at a large dose, and a rich animal literature that explains why it has been used for calm for two thousand years. The cortisol claim is a five-mushroom blend’s; the sedative claim is a rat’s. A tincture delivers a fraction of the trial doses, and we do not claim otherwise. If your goal is calm, sleep, movement and, where needed, professional help come first. If you want the extract for the fatigue and well-being evidence around it, choose one made from fruiting bodies with beta-glucan measured on the finished product, take it daily for a month, and talk to a physician before you start if you have a diagnosed condition or take medication for your mood, your blood or your liver. The original closing of this article is kept below.

Frequently asked questions about reishi, stress and anxiety

Sources (peer-reviewed)

1. Reishi polysaccharide extract in 132 neurasthenia patients, 8 weeks — fatigue −28.3% vs −20.1%, well-being +38.7% vs +29.7%. Tang W, Gao Y, Chen G, et al. Journal of Medicinal Food, 2005. View on PubMed
2. Reishi spore powder in 48 breast-cancer patients, 4 weeks — less fatigue, anxiety and depression as secondary measures. Zhao H, Zhang Q, Zhao L, et al. Evidence-Based Complementary and Alternative Medicine, 2012. View on PubMed
3. Reishi 500 or 1,000 mg a day in 78 female students, 30 days — mood and fitness scores improved at 1,000 mg. Mitra S, Mitra M, Nandi DK, et al. International Journal of Medicinal Mushrooms, 2024. View on PubMed
4. Milled reishi 6 g a day in women with fibromyalgia, 6 weeks — no significant mood or quality-of-life difference from placebo. Pazzi F, Adsuar JC, Domínguez-Muñoz FJ, et al. Healthcare, 2020. View on PubMed
5. Milled reishi 6 g a day in 64 women with fibromyalgia, 6 weeks — better aerobic endurance and flexibility. Collado Mateo D, Pazzi F, Domínguez Muñoz FJ, et al. Nutrición Hospitalaria, 2015. View on PubMed
6. Five-mushroom blend in 50 adults, 12 weeks — lower anxiety, depression, fatigue, cortisol and ACTH; better sleep scores. Hisamuddin AS, Ramli F, Leo TK, et al. Brain and Behavior, 2026. View on PubMed
7. Reishi 1.44 g a day in 26 adults with borderline blood pressure or cholesterol, 12-week crossover — urine cortisol and catecholamines unchanged. Chu TT, Benzie IF, Lam CW, et al. British Journal of Nutrition, 2012. View on PubMed
8. Survey of 1,374 cancer patients using reishi — symptom improvements and 9.1% adverse effects. Li X, Sun L, Chimonas S, et al. Integrative Medicine Research, 2024. View on PubMed
9. Reishi spore powder in 42 people with Alzheimer’s disease, 6 weeks — no benefit; adverse events mild. Wang GH, Wang LH, Wang C, et al. Medicine, 2018. View on PubMed
10. Reishi 3 g a day in 84 people with type 2 diabetes and metabolic syndrome, 16 weeks — no effect; no excess adverse events. Klupp NL, Kiat H, Bensoussan A, et al. Scientific Reports, 2016. View on PubMed
11. Reishi 2 g twice a day in 16 healthy volunteers, 10 days — no adverse effects; safety and tolerability trial. Wicks SM, Tong R, Wang CZ, et al. American Journal of Chinese Medicine, 2007. View on PubMed
12. Reishi 1.5 g a day in 40 healthy volunteers, 4 weeks — no impairment of platelet function or clotting. Kwok Y, Ng KFJ, Li CCF, et al. Anesthesia & Analgesia, 2005. View on PubMed
13. Reishi water extract in rats — no effect on normal sleep; lengthened barbiturate sleep, blocked by flumazenil (benzodiazepine-like). Chu QP, Wang LE, Cui XY, et al. Pharmacology, Biochemistry and Behavior, 2007. View on PubMed
14. Reishi fruiting-body extract in freely moving rats, 3 days — more total and non-REM sleep via TNF-α. Cui XY, Cui SY, Zhang J, et al. Journal of Ethnopharmacology, 2012. View on PubMed
15. Reishi mycelium extract in mice, 28 days — sleep promoted through serotonin; effect abolished by antibiotics. Yao C, Wang Z, Jiang H, et al. Scientific Reports, 2021. View on PubMed
16. Six reishi triterpenes identified as the sedative compounds shared by five polypore mushrooms — mouse model. Chen W, Yu JW, Deng YY, et al. Phytomedicine, 2024. View on PubMed
17. Lucidone D from reishi — anti-inflammatory, analgesic and sedative activity in cells and mice. Feng X, Wang Y. Cellular and Molecular Biology, 2019. View on PubMed
18. Reishi triterpenoids in mice separated from their mothers — anxiety- and depression-like behaviour reversed by damping inflammation. Mi X, Zeng GR, Liu JQ, et al. Nutrients, 2022. View on PubMed
19. Reishi spore polysaccharide-peptide in stressed mice — lower corticosterone, higher prefrontal BDNF; antidepressant-like. Zhao S, Rong C, Gao Y, et al. Applied Microbiology and Biotechnology, 2021. View on PubMed
20. Reishi ethanol extract in mice, 30 days — antidepressant-like at 100–200 mg/kg; 80% survival at 400 mg/kg. Ezurike PU, Odunola E, Oke TA, et al. Physiology & Behavior, 2023. View on PubMed
21. Ganoderic acid A in mice — depression-like behaviour reduced by suppressing brain inflammation. Li H, Yue J, Luo S, et al. Journal of Natural Medicines, 2025. View on PubMed
22. Reishi neuropharmacology — sedative, neuroprotective and antidepressant effects; clinical trials “still rare”; review. Cui X, Zhang Y. Advances in Experimental Medicine and Biology, 2019. View on PubMed
23. Reishi — comprehensive critical review: “most of the studies are preclinical”; quality clinical data needed. Ahmad R, Riaz M, Khan A, et al. Phytotherapy Research, 2021. View on PubMed
24. Edible and medicinal fungi as candidate antidepressants — systematic review; “lack of clinical validation”. Gong P, Wang J, Long H, et al. Molecular Nutrition & Food Research, 2025. View on PubMed
25. The adaptogen concept from traditional use to modern pharmacology — definition, biphasic dose response; review. Panossian AG, Efferth T, Shikov AN, et al. Medicinal Research Reviews, 2021. View on PubMed
26. Ashwagandha for anxiety and stress — meta-analysis of 12 randomised trials, 1,002 participants; certainty low. Akhgarjand C, Asoudeh F, Bagheri A, et al. Phytotherapy Research, 2022. View on PubMed
27. Ashwagandha for stress and anxiety — meta-analysis of 9 randomised trials, 558 participants; perceived stress, anxiety and cortisol lower. Arumugam V, Vijayakumar V, Balakrishnan A, et al. Explore, 2024. View on PubMed
28. Lion’s mane in 30 women, 4 weeks — lower depression scores; anxiety tended lower than placebo. Nagano M, Shimizu K, Kondo R, et al. Biomedical Research, 2010. View on PubMed
29. Lion’s mane 1.8 g in 41 healthy adults, 28 days — trend toward lower subjective stress; pilot. Docherty S, Doughty FL, Smith EF. Nutrients, 2023. View on PubMed
30. Acute liver injury after reishi powder taken with alcohol — case report, resolved in two weeks. Guedikian R, Kim B, Singh G, et al. Cureus, 2023. View on PubMed
31. Fatal fulminant hepatitis associated with reishi powder — case report, with a 2004 Hong Kong case. Wanmuang H, Leopairut J, Kositchaiwat C, et al. Journal of the Medical Association of Thailand, 2007. View on PubMed

Further reading on this site: Reishi science · the complete reishi guide · the research hub, filtered for mood and stress · reishi for calm — our extract page · the complete guide to medicinal mushrooms · all solutions by goal · mushrooms for sleep · reishi and inflammation · mushrooms for the immune system · lion’s mane for brain fog · fresh versus dried mushroom extract · fruiting body or mycelium · how to read a COA.

*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 page is an educational overview of published research and does not constitute medical advice. Medicinal mushroom extracts are dietary supplements. Do not begin use while taking medication, during pregnancy or nursing, or with an existing medical or mental-health condition, without consulting a physician.