Aromatherapy: A Natural Remedy for

Depression
By Therese Borchard
Published Jun 17, 2015

For nearly 6,000 years essential oils have been used for
therapeutic purposes. A number of ancient civilizations including the Chinese, Indians,
Egyptians, Greeks, and Romans used them for cosmetics and perfumes as well as for rituals and
spiritual reasons. Oils are documented by the Greek physician and botanist Pedanius Dioscorides
in the first century in his five-volume encyclopedia about herbal medicine, De Materia Medica.
Fast forward to the early 1900s, when French chemist Rene-Maurice Gattefosse burned his hand
and treated it with lavender oil. He then started to analyze the chemical properties of essential
oils and how they could be used to treat various conditions. It is commonly understood that
Gattefosse founded the science of aromatherapy in 1928. Shortly after, massage therapists,
beauticians, nurses, physiotherapists, doctors, and other healthcare professionals started to use
aromatherapy.
Aromatherapy uses the essential oils and other aromatic compounds of plants for the purposes of
healing. The plant materials and oils can be massaged into the skin or inhaled. Each essential oil
contains concentrated extracts taken from the roots, leaves, or blossoms of plants and therefore
has its own mix of active ingredients, determining unique healing faculties.
Researchers arent completely sure how aromatherapy works. Some experts believe our sense of
smell plays a role. Heres what we do know about aromatherapy:

The smell receptors in your nose communicate with parts of your brain (the amygdala and
hippocampus) that serve as storehouses for emotions and memories. When you breathe in
essential oil molecules, some researchers believe they stimulate these parts of your brain and
influence physical, emotional, and mental health. For example, scientists believe lavender
stimulates the activity of brain cells in the amygdala similar to the way some sedative
medications work. Other researchers think that molecules from essential oils may interact in the
blood with hormones or enzymes.
One study found that citrus fragrance, through stimulation of the olfactory system, could reduce
the doses of antidepressants necessary for treatment of depression. The abstract explained: The
treatment with citrus fragrance normalized neuroendocrine hormone levels and immune function
and was rather more effective than antidepressants. Another study published in the American
Journal of Hospice and Palliative Medicine measured the responses of 17 cancer hospice patients
to humidified essential lavender oil aromatherapy. Results reflected a positive change in blood
pressure and pulse, pain, anxiety, depression, and sense of well-being.
I was hesitant to explore essential oils to treat depression because they are expensive (although
considerably cheaper than a trip to a psychotherapist or psychiatrist) and because early in my
recovery, I went down a rabbit hole of new-age techniques to try to cure my depression that
delivered me straight to the psych ward. But positive experiences with aromatherapy kept
surfacing on my depression community, ProjectBeyondBlue.com, such as:
Lavender has helped me with chronic migraines for over 15 years.
I use my Eucalyptus spray all the time. Im not joking, this stuff actually lifts my mood!
Ive found that putting a drop or two of lavender essential oil on the inside of my shirt collar
helps me with being more calm.
I used some essential oils for restless leg syndrome and it worked. I even was able to rid myself
of the awful med I was [using]. I also use an oil for bladder infections and it works well.
So I tried to open my mind a little something Ive been forced to do in the last year! For the
last 10 nights I have rubbed lavender oil into my temples a half-hour or so before I go to bed.
The result? I have slept very well. It made me think more about my sense of smell, and how it
can work for me or against me in my quest for sanity. I have an extra-sensitive sniffer (of course,
because everything about me is highly sensitive). Whenever I am hit by a waft of pungent
perfume like when my daughter drags me into Bath and Bodyworks at the mall my mood
dips. I seriously respond with anxiety. But when I run a certain trail that is filled with
wildflowers, among them lavender, my mood lifts.
Coincidence?
Maybe this 6,000-year-old remedy is worth a try.

LavenderOilforAnxietyandDepression
Reviewoftheliteratureonthesafetyandefficacyoflavender
By Jeremy Appleton, ND

About The Author

Jeremy Appleton, ND, is a licensed naturopathic physician. He is a graduate of Reed College and the National
College of Natural Medicine. He served on faculty at NCNM as the nutrition department chair and has also taught at
Bastyr University, where he did his residency. Appleton left his private practice in 1998 to work in the natural products
industry. He is the author of several books and hundreds of articles on natural medicine. He currently serves as
director of scientific affairs at Integrative Therapeutics.

Abstract

Lavenderfloweranditsextractshavebeenused,bothinternallyandby
olfaction,forcenturiesasatreatmentforanxietyanddepression.Modern
analyticalresearchhasidentifiedthemainactiveconstituentsoftheoil;invitro
andanimalstudieshavebeguntoelucidatemechanismsofaction;and
controlledclinicaltrialsinhumansnowdocumentlavendersefficacy,safety,
anddose.Thispaperreviewsthesedevelopments,withsummarydetailsfrom
selectedstudies,andprovidesapreliminarycomparisonoflavendersefficacy
andsafetytoitsmainbotanicalandpharmaceuticalalternatives.

Introduction
Anxiety is a common complaint and may range from every day stress to clinically relevant symptoms requiring
medical intervention. Patients with generalized anxiety disorder (GAD) can experience excessive anxiety and worry
associated with the stresses of everyday life. Most cases of GAD begin in childhood and can leadwithout treatment
to a chronic condition, with fluctuating symptoms, often exacerbated by stressful life events.1 Disturbed sleep has
been observed to be among the most frequent accompanying disorders of generalized anxiety.2 Individuals with
anxiety disorder not otherwise specified (AD NOS) also present with clinically significant symptoms, but they tend to
report less worry, negative affect, depression, and comorbidity than those with GAD.3

The most commonly prescribed agents in the medical treatment of anxiety are benzodiazepines and selective
serotonin reuptake inhibitors (SSRIs).4 The well-known side effects of benzodiazepines include drowsiness, fatigue,
confusion and disorientation, dizziness, decreased concentration, impaired memory, dry mouth, and blurred vision.
Benzodiazepines can impair the ability to drive or operate machinery and may thus interfere with essential activities of
daily living. They lower the tolerance to alcohol and are widely reported to cause physical and psychological
dependence and withdrawal symptoms.5 SSRIs, on the other hand, may cause sedation and fatigue, gastrointestinal
disturbances, agitation or insomnia.6,7 The risks and inconveniences associated with available anxiolytic
pharmaceutical medications may be one of the reasons anxiety disorder is considered an undertreated condition.8

Herbal preparations have long been a mainstay for treating anxiety and depression. Some botanical agents, most
notably kava (Piper methysticum), have demonstrated efficacy for clinically diagnosed anxiety disorders.9-13 Others,
such as St. Johns wort (Hypericum perforatum), are clinically efficacious for depression in most,14-25 though not all26,27
clinical studies. Kava, however, has been withdrawn by many manufacturers due to concerns over potential
hepatotoxicity,28-32 even though these effects may have been primarily due to drug interactions, misuse, and poor
quality extracts of this otherwise well-tolerated phytomedicine; St. Johns worts popularity has suffered because it
was found to stimulate cytochrome P450 34, an enzyme that metabolizes at least half of the known pharmaceuticals
sold today.33 A safe, non-sedating, nonhabit forming herbal anxiolytic with proven efficacy for GAD and depression
is, therefore, of interest to clinicians.

Throughout history, lavender has been cultivated for its flowers and oils and used both cosmetically and medicinally. A
member of the Labiatae family, lavender is primarily used either dried or as an essential oil. Historical use includes
documented activity as an antibacterial, antifungal, carminative, sedative, and antidepressant.34 Lavandula
angustifolia, Mill. is the most common species of lavender utilized for health purposes.35 Lavender is native to the
Mediterranean, the Arabian Peninsula, Russia, and Africa.

Lavender has a high concentration of volatile oils, which impart its distinctive and pleasing fragrance. The relaxing
experience of lavender fragrance led to its deliberate, therapeutic use in aromatherapy to relieve mild anxiety.
Lavender has been also used internally for mood imbalances such as anxiety, insomnia, and gastrointestinal distress,
including nervous stomach.36

Lavender Constituents
Lavender essential oil is obtained from steam distillation processing of the flowering tops of L. angustifolia. Modern
analytical methods, such as capillary gas chromatography, have demonstrated that lavender oil contains more than
160 constituents, many of which interact synergistically to contribute to its healing effects. The main active
constituents of lavender oil are linalool, linalyl acetate, terpinen-4-ol, and camphor. The quantity of the linalyl acetate
is determined by the method of steam distillation as it degrades upon distillation to yield linalool. The highest content
of linalyl acetate is obtained when fresh lavender flowers are steam distilled right after harvest. Other constituents
found in lavender include: cis-ocimene; terpinen-4-ol, -caryophyllene; lavandulyl acetate; 1,8-cineole; and small
amounts of limonene, geraniol, lavandulol, -pinene, camphene, geranyl acetate, and neryl acetate.37,38

Relative amounts of bioactive constituents can vary significantly from one lavender oil to another. The European
Pharmacopoeia includes limits or ranges for the content of the predominant components. Specifically, oils with high
concentrations of esters and low concentrations of cineol and other minor components are generally considered to be
of higher quality because these parameters indicate that a gentle and careful production process was applied and that
high quality raw materials were used. A high quality lavender extract would not only comply with this monograph but

would ideally exceed those specifications with a higher content of linalyl acetate (ideally 3345%) and lavandulyl
acetate (1.5%), and a lower limit for the content of cineol (2 %).39

Mechanisms of action
In vitro and in vivo studies have demonstrated multiple possible mechanisms of action of lavender oil, as well as its
individual constituents, which may partly account for its relaxing effects when taken orally. Lavender oil has
potentiated expression of GABA-A receptors in cell culture;40 it has shown spasmolytic activity on guinea pig ileum;41
linalool, a main active ingredient of lavender oil, has been shown in animals to inhibit glutamate binding in the brain;42
linalool has also inhibited acetylcholine release and influenced ionic conductance in neurons;43 linalyl acetate is
described to exert a relaxing effect.44 Lavender oil has reduced dose-dependently spontaneous motility and caffeineinduced hyperactivity of mice.45

Lavenderoilaromatherapyhasbeenshownto
beeffectiveinthemanagementofanxietyand
depressionandsmallandmediumsized
controlledanduncontrolledclinicaltrials.

Clinical Efficacy of Lavender

Lavender Aromatherapy
Much prior research on lavender has focused on the administration of lavender via an olfactory route. The anxiolytic
activity of lavender olfaction has been demonstrated in several small and medium-sized clinical trials.46-53 The efficacy
of aromatherapy of lavender is thought to be due to the psychological effects of the fragrance combined with
physiological effects of volatile oils in the limbic system.54 These calming effects of lavender oil and single constituents
may be the origin of the traditional use of lavender. Lavender oil olfaction has been shown to decrease anxiety, as

measured by the Hamilton rating scale,51 and can increase mood scores.55The following are selected examples of
clinical trials on lavender aromatherapy:

Dunn and colleagues demonstrated anxiolytic activity of lavender oil aromatherapy in patients in intensive
care units. Subjects received at least 1 session of aromatherapy with 1% lavender essential oil. Significant
anxiolytic effects were noted in the 1st treatment, though 2nd and 3rd treatments did not appear to be as
effective.47

Alaoui-Ismaili and colleagues found that the aroma of lavender is considered by subjects to be very pleasant
and is correlated with changes in the autonomic nervous system.56

Tysoe and colleagues conducted a study of lavender oil in burner use on staff mood and stress in a hospital
setting. A significant number of respondents (85%) believed that lavender aroma improved the work
environment following the use of the lavender oil burners.57

Diego and colleagues demonstrated that people receiving lavender oil (10%) olfaction for 3 minutes felt
significantly more relaxed and had decreased anxiety scores, improved mood and increased scores of alpha
power on EEG (an indicator of alertness), and increased speed of mathematical calculations.58

Lewith and colleagues investigated the effects of lavender aromatherapy on depressed mood and anxiety in
female patients being treated with chronic hemodialysis.59 The effects of aromatherapy were measured using
the Hamilton rating scale for depression (HAMD) and the Hamilton rating scale for anxiety (HAMA).
Lavender aroma significantly decreased the mean scores of HAMA, suggesting an effective, noninvasive
means for the treatment of anxiety in hemodialysis patients.

Lavender aromatherapy, with or without massage, may also reduce the perception of pain and the need for
conventional analgesics in adults and children, though more rigorously controlled trials are needed.60

Oral Lavender Supplementation: Anxiety

Lavender oil has also been shown to be effective via the oral route. Several clinical studies have demonstrated the
benefit of lavender extracts in comparison to reference or placebo in decreasing symptoms of anxiety and depression.

Orally administered lavender capsules (100 mL and 200 mL) were tested in 97 healthy subjects in a randomized
double-blind, placebo-controlled clinical trial.61 Film clips were used to elicit anxiety. Measures included anxiety, State
Trait Anxiety Inventory (STAI), mood, positive and negative affect scale (PANAS), heart rate (HR), galvanic skin
response (GSR), and heart rate variation (HRV). After baseline measurements, capsules were administered.
Participants viewed a neutral film clip, then an anxiety-provoking and light-hearted recovery film clip. For the 200 mL
lavender dose during the neutral film clip, there was a trend toward reduced state anxiety, GSR, and HR and
increased HRV. In the anxiety-eliciting film, lavender was mildly beneficial in females but only on HRV measures. In
males, sympathetic arousal increased during the anxiety film (GSR). HRV significantly increased at 200 mL during all
3 film clips in females, suggesting decreased anxiety. The authors concluded that lavender has anxiolytic effects in
humans under conditions of low anxiety, but they were unable to draw conclusions about high anxiety or clinical
anxiety disorders.

Kasper and colleagues investigated the efficacy of lavender oil (WS 1265) for AD NOS in comparison to placebo in a
primary care setting.62 This study was the first double-blind, randomized, placebo-controlled trial to document the
anxiolytic efficacy of orally administered lavender essential oil for anxiety disorder. In 27 general and psychiatric
practices, 221 adults reporting unspecified anxiety were randomized to receive 80 mg per day of lavender oil or
placebo for 10 weeks with office visits every 2 weeks. A baseline HAMA total score of ?18 and a total score > 5 for the
Pittsburgh Sleep Quality Index (PSQI) were required. The primary outcome measures were HAMA and PSQI total
score decrease between baseline and week 10. Secondary efficacy measures included the Clinical Global
Impressions scale, the Zung Self-rating Anxiety Scale, and the SF-36 (Quality of Life) Health Survey Questionnaire.
Subjects taking WS 1265 showed a total score decrease by 16.0 8.3 points (mean SD, 59.3%) for the HAMA and
by 5.5 4.4 points (44.7%) for the PSQI compared to 9.5 9.1 (35.4%) and 3.8 4.1 points (30.9%) in the placebo
group (P<0.01 one-sided, intention to treat). WS 1265 was superior to placebo regarding the percentage of
responders (76.9 vs. 49.1%, P<0.001) and remitters (60.6 vs. 42.6%, P=0.009). Adverse effects were uncommon and
included dyspepsia (4.7% in the treatment group vs 1.8% in the placebo group) and eructation (3.7% in the treatment
group and none in the placebo group). Lavender had a significant beneficial influence on quality and duration of sleep
and improved general mental and physical health without causing any unwanted sedative or other drug-like effects.

Researchers concluded that the lavender oil is both efficacious and safe for AD NOS and predicted that it could
emerge as a gentle therapeutic alternative in the treatment of anxiety.

Woelk and Schlaefke conducted a multicenter, double-blind, randomized Phase III study of lavender oil (Silexan, WS
1265, Dr. Willmar Schwabe, Karlsruhe, Germany) in comparison to low-dose lorazepam for patients with GAD.63 The
Hamilton Anxiety Rating Scale (HAMA-total score) was used as the primary objective measurement to monitor
changes in the level of tension and relaxation beginning at baseline through week 6 of the trial. Additional data were
collected using the Self-rating Anxiety Scale, Penn State Worry Questionnaire, SF-36 Health Survey Questionnaire,
and specific sections of the Clinical Global Impressions of severity disorder. A total of 77 female (76.6%) and male
(23.4%) subjects 1865 years of age were randomized into groups. Participants were eligible for the study if they met
the inclusion criteria of a HAMA-total score of greater than 18, as well as a score equal to or greater than 2 on both
anxious mood and tension items. Secondary objective outcome data were obtained from responder and remission
rate comparisons made between the 2 treatment groups. In order for a participant to qualify as having a significant
response to treatment they were required to have a reduction of at least 50% in the HAMA-total score during the 6week trial. Remission was defined as a HAMA-total score of less than 10 points at the end of the 6-week study. The
results demonstrated that WS 1265 was comparable to the conventional approach in its ability to promote
relaxation.* The HAMA-total score decreased by 45% in the WS 1265 group and decreased by 46% in the
conventional group. At the conclusion of the 6-week intervention, 40% of the WS 1265 group and 27% of the
conventional treatment group were determined to be in remission. The WS 1265 group had a response rate of 52.5%
compared to only 40.5% taking the conventional option. Adverse effects in the WS 1265 group were uncommon and
included nausea (5.2%), eructation (3.9%), and dyspepsia (2.6%).

Oral Lavender Supplementation: Depression

In a 4-week randomized, double-blind study, researchers compared the efficacy of a tincture of L. angustifolia with
imipramine in the treatment of mild to moderate depression.64 Forty-five adult outpatients who met the Diagnostic and
Statistical Manual of Mental Disorders, 4th edition (DSM-IV) for major depression based on the structured clinical
interview for DSM-IV participated in the trial. Patients had a baseline Hamilton Rating Scale for Depression (HAMD)

score of at least 18. In this study, patients were randomly assigned to receive lavender tincture (1:5 in 50% alcohol )
60 drops per day plus placebo tablet (Group A), imipramine tablet 100 mg per day plus placebo drops (Group B), or
imipramine tablet 100 mg/per day plus lavender tincture 60 drops per day (Group C) for 4 weeks. Lavender tincture at
this concentration was found to be less effective than imipramine in the treatment of mild to moderate depression
(P=0.001). In the imipramine group, anticholinergic effects such as dry mouth and urinary retention were observed,
whereas headache was observed more in the lavender tincture group. The combination of imipramine and lavender
tincture was more effective than imipramine alone (P<0.0001). Researchers concluded that lavender tincture may be
of therapeutic benefit in the management of mild to moderate depression, but only as adjuvant therapy.

In an open-label Phase II trial, Stange and colleagues administered 80 mg per day of lavender oil (Silexan, WS 1265,
Dr. Willmar Schwabe Pharmaceuticals, Karlsruhe, Germany) to 50 patients with neurasthenia, post-traumatic stress
disorder, or somatization disorder for 3 months.65 Using the State Trait Anxiety Inventory, von Zerssens Depression
Scale, and a sleep diary for assessment, researchers found that state and trait anxiety as well as depression were
reduced and efficiency of sleep was improved significantly. Controlled clinical trials are needed to confirm whether
oral lavender oil is an effective treatment for depression.

Comparison to Kava, Benzodiazepines, and Antidepressants

To date, lavender has been compared to benzodiazepines,66 paroxetine (an SSRI antidepressant), and imipramine (a
tricyclic antidepressant). It has also been compared to kava.67 Kava was perhaps the best studied botanical anxiolytic
and was the leading product in this category until concerns about liver toxicity prompted many companies to
discontinue offering it. In a 6-week study, kava was found to produce a mean reduction of the HAMA score of 10
points, whereas the mean reduction of that score from lavender (WS 1265) has ranged from 11.3 points (6-week
study)63 to 16 points (10-week study),62 suggesting comparable to superior efficacy. Pharmaceutical anxiolytics
(primarily benzodiazepines) typically produce HAMA reductions in the range of 11 to 15.3, suggesting comparable to
superior efficacy of WS 1265 without the attendant side effects.62,63,68,69

The Hamilton Anxiety Scale is used in most clinical trials of anxiolytic agents for GAD. In the study by Kasper and
colleagues,62 a diagnosis of AD NOS was used instead, but the HAMA scale was still employed and baseline HAMA
scores were similar across all trials (ie, > 18). At first glance it might appear that patients with AD NOS responded
better to lavender than patients with GAD. However, the study of lavender for GAD was of shorter duration (6 weeks)
than the study of lavender for AD NOS. In the longer study, the mean HAMA score change at the 6-week mark was
nearly identical to that seen at the end of the 6-week study of patients with GAD. Therefore, the additional month of
therapy at the same dose is likely to have had additional effects.

In a meta-analysis of 21 double-blind, placebo-controlled trials in patients with GAD, Hidalgo and colleagues
determined average effect sizes for HAMA total score change versus baseline of 0.50 for pregabalin, 0.45 for
hydroxyzine, 0.42 for venlafaxine XR, 0.38 for benzodiazepines, 0.35 for selective serotonin reuptake inhibitors
(SSRIs) and 0.17 for buspirone.70 The effect size of lavender (WS 1265) was computed to be 0.75 in AD NOS. The
significant reduction of anxiety-related symptoms in patients treated with lavender was not only evident in the
judgment of the investigators, but was also perceived by the study participants subjectively according to the results of
the self-rating questionnaire.

The effects of lavender extract (WS 1265) and other anxiolytic agents on HAMA scores are compared in Table 1
below. They are expressed as a mean HAMA score change.

TABLE 1

Dose

Lavender (WS
1265)62

80 mg/d

Length of
study

10 weeks

Diagnosis

AD NOS

HAMA score Mean HAMA

at baseline

score change

26.8

-16

Lavender (WS

80 mg/d

6 weeks

GAD

25

-11.3

Lorazepam63

0.5 mg/d

6 weeks

GAD

25

-11.6

Bromazepam71

3 mg TID

6 weeks

GAD

28.07

-13

Oxazepam70

5 mg TID

6 weeks

GAD

28.24

-11

Kava(WS

100 mg (70%

1490)70

kavalactones) TID

6 weeks

GAD

28.35

-10

Escitalopram72

10-20 mg/d

24 weeks

GAD

23.7

-15.3

1265)63

Paroxetine71

20-50 mg/d

24 weeks

GAD

Duloxetine68

60-120 mg/d

9-10 weeks GAD

23.4

-13.3
-11.1

Based upon the available data, it appears that therapy with at least some lavender extracts is comparable or superior in
efficacy to many commonly prescribed anxiolytics, including benzodiazepines, SSRIs, and kava. The adverse event profile
for lavender is the least severe of these options by a wide margin. In particular, benzodiazepines are well-known for their
significant habit-forming potential, a drawback not found with lavender preparations.

Adverse Events, Safety and Dosage

The German Commission E Monographs list no contraindications, side effects, or drug interactions for lavender
flower. Internal use of the volatile oil of lavender oil has been reported to cause nausea73 and drowsiness after
excessive intake.74 This effect may be dose- and/or quality-dependent, as the occurrence of nausea was higher in the

placebo group than in the treatment group (WS 1265) in the largest and longest controlled clinical trial of lavender oil
supplementation.62

In a brief report, Henley and colleagues described 3 cases of otherwise healthy boys with prepubertal
gynecomastia,75 all of whom had normal serum concentrations of endogenous steroids and none of whom had been
exposed to any known exogenous endocrine disruptors. The repeated topical application of 1 or more over-thecounter personal care products that contained lavender oil or lavender oil and tea tree oil was documented for all 3
patients. The authors performed in vitro tests that suggested weak estrogenic and antiandrogenic activities of the oils
that may have contributed to an imbalance in estrogen and androgen pathway signaling.

The effective dose of lavender oil is suggested to be 2080 mg per day.36 The best-designed clinical studies with the
most robust combination of efficacy and tolerability used 80 mg per day of a well-defined lavender oil. No serious
adverse events during either of the published studies on this extract were reported.
Conclusion

Lavender oil aromatherapy has been shown to be effective in the management of anxiety and depression and small
and medium-sized controlled and uncontrolled clinical trials. The best validated use of lavender as an anxiolytic agent
is oral supplementation of 80 mg per day of a high-quality, well-defined lavender essential oil that has a demonstrated
efficacy comparable or superior to benzodiazepines and kava, with a super safety profile.
Conflict of Interest Statement

Jeremy Appleton, ND, is an employee of Schwabe North America, a subsidiary of Dr. Willmar Schwabe GmbH & Co,
which manufactures and distributes WS 1265, discussed in this article.