What it's actually good for
Inositol (specifically myo-inositol) is a sugar alcohol that plays a key role in intracellular signaling, particularly in the phosphatidylinositol second messenger system involved in serotonin and insulin receptor function. For mental health, the most compelling evidence comes from a controlled trial showing that 12-18 g/day of inositol was comparable to fluvoxamine (an SSRI) for panic disorder, with fewer side effects. Additional trials support modest benefits for OCD and general anxiety, though the evidence base is smaller than for conventional pharmaceuticals and some results are inconsistent. A practical challenge is the high dose required: 12-18 grams daily is a tablespoon-plus of powder, which limits compliance. Separately, inositol has a strong and arguably more robust evidence base for polycystic ovary syndrome (PCOS), where myo-inositol at lower doses (2-4 g/day) improves insulin sensitivity and ovulatory function in multiple RCTs. Inositol earns a B because while the controlled trial data for both mood and PCOS is promising and mechanistically sound, the mood/anxiety trials are few in number and relatively small, and the clinical effect sizes, while meaningful, need replication in larger samples.