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Case Series on the Use of Oral Lavender Oil in Major Depressive Disorder; Effects on Agitation, Anxiety, and Insomnia
Date 10-31-2014
HC# 051452-507
Lavender (Lavandula angustifolia) Essential Oil
Major Depressive Disorder

Fißler M, Quante A. A case series on the use of lavendula [sic] oil capsules in patients suffering from major depressive disorder and symptoms of psychomotor agitation, insomnia and anxiety. Complement Ther Med. February 2014;22(1):63-69.

Patients with major depressive disorder (MDD) may also suffer from symptoms of anxiety, psychomotor agitation, and insomnia. These symptoms are often treated with benzodiazepines, which can have many unwanted side effects. Traditionally used in aromatherapy as a calming herb to counteract stress, clinical trials of orally administered lavender (Lavandula angustifolia) essential oil have provided evidence that it is an effective anxiolytic treatment. Lasea® capsules (Dr. Willmar Schwabe GmbH & Co. KG; Karlsruhe, Germany) contain Silexan® (Dr. Willmar Schwabe GmbH & Co. KG), a steam-distilled L. angustifolia flowers essential oil that has a high concentration of linalool and linalyl acetate, besides 1,8-cineole, terpinen-4-ol, and some other components. Lasea has been approved for use in Germany for treatment of restless states accompanying anxious mood. Although not authorized for the treatment of MDD, Lasea is used "off-label" to treat symptoms of anxiety, psychomotor agitation, and insomnia in patients with MDD. The purpose of this retrospective case series was to analyze the effectiveness of Lasea for patients with MDD and symptoms of anxiety, restlessness, and sleep disturbances. 

Eight cases involving patients aged 28-85 years diagnosed with MDD who also had symptoms of anxiety, insomnia, and psychomotor agitation were evaluated. The patients were treated at the department of psychiatry at Charité — University Medicine Berlin, Campus Benjamin Franklin (Berlin, Germany) between September 2011 and September 2012.

All patients explicitly requested alternative herbal therapies. Two of the patients declined antidepressant drugs and took only Lasea, and 6 patients took conventional pharmaceutical treatments plus Lasea. Three patients used 160 mg/day Lasea, and 5 patients used 80 mg/day Lasea. The duration of treatment was 3 weeks.  All cases were evaluated in terms of the dosage, potential drug interactions, adverse effects, and the effectiveness of Lasea. Effectiveness was assessed weekly using the Hamilton Rating Scale for Depression (HAMD-17) and its subscales (insomnia, agitation, and anxiety).

The HAMD-17 total score was reduced in 6 of 8 patients. The effect of Lasea on sleep disturbances was inconsistent; the latency of falling asleep and the frequency of waking up decreased in 3 patients, while there was no improvement in sleep-onset insomnia in 4 patients and 1 patient had an increase in sleep-onset insomnia. There was no improvement in sleep-maintenance insomnia in 3 patients, and the frequency of waking up increased in 2 patients.

Agitation improved in 6 patients; did not improve in 1 patient; and fluctuated in 1 patient. Psychological anxiety (psychomotor agitation) was reduced in 5 patients; remained stable in 2 patients; and fluctuated in 1 patient. Somatic anxiety improved in 4 patients, had no change in 1 patient; fluctuated in 2 patients; and worsened in 1 patient. The patients taking the higher dose (160 mg/day) did not show a greater improvement than those taking 80 mg/day.

No adverse effects were reported. Three of the patients discontinued taking Lasea because agitation, anxiety, or insomnia had decreased, and no further improvement was needed. Two patients continued with Lasea after the evaluation period ended. Three patients discontinued Lasea because there was no subjective or objective improvement.

The authors conclude that Lasea has a positive effect on agitation, restlessness, and anxiety in patients with MDD, and they add that their findings could indicate a possible benefit for patients without MDD with symptoms of anxiety or agitation. Most patients showed improvement within the first week; there was global improvement when Lasea was given in conjunction with conventional therapy; and it was well tolerated. They suggest that Lasea is a promising treatment (a) as an adjunct to conventional MDD treatment, as it takes effect within the first week and there is usually a 2-week latency until pharmaceutical antidepressants produce a whole therapeutic effect and (b) for patients who decline or cannot tolerate chemical pharmaceutical treatments.

The authors acknowledge the limitations of the study (small sample size; not a prospective, randomized controlled trial) but suggest that the results may encourage researchers to conduct a more rigorously designed study. They recommend that a 3-arm randomized controlled trial be conducted to comparatively evaluate Lasea, a benzodiazepine, and placebo. In addition, the effectiveness of Lasea in combination with antidepressant medications should be examined.

—Heather S. Oliff, PhD

Editorial Comment: Given the data presented, the conclusion that Lasea produced positive effects seems overly optimistic.