Using Aromatherapy and Essential Oils to Treat Depression

203286_origFor 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 health care 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.

According to the University of Maryland Medical Center, researchers aren’t completely sure how aromatherapy works. Some experts believe our sense of smell plays a role. A Complementary and Alternative Medicine Guide explained:

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.

A 1995 study in the journal Neuroimmunomodulation 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.” In 2002, 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. I’m not joking, this stuff actually lifts my mood!”

“I’ve 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. I also use an oil for bladder infections and it works well.”

So I tried to open my mind a little—something I’ve been forced to do in the last year! For the last five 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 wild flowers, among them lavender, my mood lifts.

Coincidence?

Maybe the 6,000-year-old remedy is worth a try.

Join the “Essential Oils & Aromatherapy” group on ProjectBeyondBlue.com, the new depression community.

Photograph by Dawn Marie/DME Photography.

Originally published on Sanity Break.

 

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6 thoughts on “Using Aromatherapy and Essential Oils to Treat Depression

  1. Hi Therese,

    Do you know about this product?

    Thanks!
    Gillian

    L-Methylfolate: A Promising Therapy for Treatment-Resistant Depression?

    • inShare19

    Login to Download PDF version
    For most psychiatrists, treating depression tends to be a frustrating search for the right therapy to help a patient reach remission. Nearly 2 out of 3 patients with depression do not achieve remission with selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) monotherapy—in clinical practice, this means that a psychiatrist treating 20 patients for depression could see 14 come back with little to no initial improvement of symptoms.(1) “It’s demoralizing,” said Rakesh Jain, MD, MPH, Director of Psychiatric Drug Research at the R/D Clinical Research Center in Lake Jackson, Texas. “Treatment-resistant depression is really the rule and not the exception.”
    Treatment-resistant depression (TRD) is a term used to describe patients with major depressive disorder who do not reach remission after multiple antidepressant trials, including augmentation strategy, explained Jon W. Draud, MS, MD, Clinical Professor of Psychiatry at University of Tennessee College of Medicine in Memphis.
    Individuals with ongoing depression are more likely to incur high medical costs (2), have employment problems (3), and experience suicidal ideation (4). “The ruinous effects of depression are amplified for people with treatment-resistant depression, so therefore there’s great urgency to treat these patients,” said Michael Thase, MD, Professor of Psychiatry at the University of Pennsylvania in Philadelphia.
    Although the disease remains difficult to treat, researchers are continually seeking better solutions for patients with treatment-resistant depression. New studies, particularly a paper published by Papakostas et al in 2012 (5), have compelled psychiatrists to consider augmenting traditional antidepressants with the medical food L-methylfolate.
    Unique Neurobiology
    A medical food is a nutraceutical—essentially, a vitamin—rather than a pharmaceutical. However, unlike a vitamin, a prescription medical food such as L-methylfolate is regulated by the US Food and Drug Administration (FDA).
    L-methylfolate (Deplin), is indicated for the distinct nutritional requirements of individuals who have suboptimal L-methylfolate levels in the CSF, plasma, and/or red blood cells and have major depressive disorder, with particular emphasis as adjunctive support for patients taking antidepressant medications. The medical food has attracted attention due to its benign side-effect profile and unique neurobiology. “It has a mechanism of action that is very different from what we are used to,” said Dr. Jain.
    Traditional drugs such as SSRIs and SNRIs block reuptake of neurotransmitters, while L-methylfolate spurs the production of more neurotransmitters. “It primes the pump from within,” said Dr. Draud.
    Dr. Draud added that clinicians might hesitate to use the compound because the mechanism of action is unfamiliar and because of a misconception that a prescription for folic acid is just as effective as L-methylfolate.
    Literature suggests that depression is linked with folate deficiency (6) and that patients with insufficient folate are less likely to respond to treatment (7) and more likely to experience a relapse (8). Folate supplementation does help some patients, acknowledged Dr. Jain, but the full story is more complicated.
    Folic acid in and of itself does not alleviate depression. Our brain must convert folic acid into L-methylfolate before it can manufacture enough serotonin, norepinephrine, and dopamine to alleviate depression. However, certain individuals lack the ability to convert folic acid to l-methylfolate, rendering folic acid supplements ineffective for this group of patients.
    This processing deficiency is caused by the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, which is quite common among patients with depression. Up to 70% of patients with depression test positive for the polymorphism and therefore cannot convert folic acid into L-methylfolate. (9)
    “In a scenario like that,” said Dr. Jain, “it becomes important to not use folate but to use L-methylfolate directly. That way you don’t have to worry about the patient potentially having the genetic polymorphism.”
    Genetics and BMI
    Clinicians have differing opinions on whether it is necessary to test patients for the genetic abnormality before prescribing L-methylfolate, as the medical food is approved regardless of patient polymorphism status. “I do the test a lot,” said Dr. Draud. “It depends on the patient. Some don’t care about the test and others want to have it.” Dr. Thase noted that he has made clinical decisions without the test, and Dr. Jain said the test is “not critically necessary” and that the marker does not offer a 100%, definitive indication that the patient will or will not respond to L-methylfolate.
    Yet psychiatrists have other assessment tools besides genetics at their disposal— body mass index (BMI) offers a clue as to how patients may respond to L-methylfolate. Data show that L-methylfolate is particularly effective in patients with depression and a BMI of 30 or greater (10). This may be because of the relationship between obesity, inflammation, and depression and because excess fat increases the body’s methylation needs to the point that some people may require a methyl donor such as L-methylfolate, according to Dr. Draud and Dr. Jain.
    “I recommend to my colleagues that they put a BMI calculator on their smartphone and put the numbers in and calculate on the spot if they’re sitting across from a patient and have any question,” said Dr. Jain.
    Choosing an Adjunctive Therapy
    Dr. Jain also recommends that clinicians refer to the 2010 American Psychiatric Association Practice Guideline for the Treatment of Patients With Major Depressive Disorder (11) for guidance on adjunctive depression treatment in general, which often consists of augmentation with second-generation antipsychotics.
    “Antipsychotic medications really work,” added Dr. Thase. “There’s no doubt about that, and when they work they work quickly.” He cautioned, though, that a clinician must carefully consider the risk/benefit equation when making a prescribing decision.
    While often effective as an augmentation therapy, antipsychotic medications have a significant side-effect burden that includes weight gain and tardive dyskinesia. Patients may hesitate to agree to these drugs as a result of the side effects.
    In contrast, L-methylfolate has a relatively benign side-effect profile and has shown adverse events similar to those of placebo in clinical trials (5).
    Dr. Draud typically tries augmentation with L-methylfolate before antipsychotics because of the low risk to patients and because of clinical trial data on timing. L-methylfolate was studied in patients who were newly treatment resistant, not those who had failed five or six other therapies, so “the earlier you use something like this, the better the chance you have to make it work,” he said.
    A Game Changer?
    Anecdotally, Dr. Draud and Dr. Jain and have seen patients improve on the medical food, while Dr. Thase remains optimistic about L-methylfolate based on clinical trial data but has not yet treated enough patients to comment personally on its efficacy.
    Although L-methylfolate is a promising new treatment option, psychiatrists should remain realistic in their expectations. “It’s only had two clinical trials, so it’s passed FDA approval, but a lot of other drugs have been on the market for a long time. Is it going to continue to look good? It’s hard to say,” said Dr. Draud.
    Provided the positive findings hold up, “linking the genetic abnormality with the specific indication for use is very 21st century medicine and a truly revolutionary step,” said Dr. Thase.
    —Lauren LeBano
    References
    1. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917.
    2. Crown WH, Finkelstein S, Berndt ER, et al. The impact of treatment-resistant depression on health care utilization and costs. J Clin Psychiatry. 2002;63(11):963-71.
    3. Greenberg P, Corey-Lisle PK, Birnbaum H, et al. Economic implications of treatment-resistant depression among employees.Pharmacoeconomics. 2004;22(6):363-373.
    4. Papakostas GI, Petersen T, Pava J, et al. Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: prevalence and impact on treatment outcome. J Nerv Ment Dis. 2003;191(7):444-449.
    5. Papakostas GI, Shelton RC, Zajecka JM, et al. L-methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials. Am J Psychiatry. 2012;169:1267-1274.
    6. Tolmunen T, Voutilainen S, Hintikka J, et al. Dietary folate and depressive symptoms are associated in middle-aged Finnish men. J Nutr. 2003;133(10):3233-3236.
    7. Papakostas GI, Petersen T, Mischoulon D, et al. Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 1: predictors of clinical response in fluoxetine-resistant depression. J Clin Psychiatry. 2004;65(8):1090-1095.
    8. Papakostas GI, Petersen T, Mischoulon D, et al. Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 2: predictors of relapse during the continuation phase of pharmacotherapy. J Clin Psychiatry. 2004;65(8):1096-1098.
    9. Kelly CB, McDonnell AP, Johnston TG, et al. The MTHFR C677T polymorphism is associated with depressive episodes in patients from Northern Ireland. J Psychopharmacol. 2004;18(4):567-571.
    10. Papakostas GI, Zejecka J, Shelton R, Fava M. Effect of L-methylfolate on Maier Subscale Scores in a randomized clinical trial of patients with major depression. Poster presented at 25th Annual US Psychiatric and Mental Health Congress; November 8-11, 2012; San Diego, CA. Abstract 106.
    11. Gelenberg AJ, Freeman MP, Markowitz JC, et al. Practice guideline for the treatment of patients with major depressive disorder, third edition. American Psychiatric Association. 2010; 1-152.

  2. L-Methylfolate: A Promising Therapy for Treatment-Resistant Depression?

    • inShare19

    Login to Download PDF version
    For most psychiatrists, treating depression tends to be a frustrating search for the right therapy to help a patient reach remission. Nearly 2 out of 3 patients with depression do not achieve remission with selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) monotherapy—in clinical practice, this means that a psychiatrist treating 20 patients for depression could see 14 come back with little to no initial improvement of symptoms.(1) “It’s demoralizing,” said Rakesh Jain, MD, MPH, Director of Psychiatric Drug Research at the R/D Clinical Research Center in Lake Jackson, Texas. “Treatment-resistant depression is really the rule and not the exception.”
    Treatment-resistant depression (TRD) is a term used to describe patients with major depressive disorder who do not reach remission after multiple antidepressant trials, including augmentation strategy, explained Jon W. Draud, MS, MD, Clinical Professor of Psychiatry at University of Tennessee College of Medicine in Memphis.
    Individuals with ongoing depression are more likely to incur high medical costs (2), have employment problems (3), and experience suicidal ideation (4). “The ruinous effects of depression are amplified for people with treatment-resistant depression, so therefore there’s great urgency to treat these patients,” said Michael Thase, MD, Professor of Psychiatry at the University of Pennsylvania in Philadelphia.
    Although the disease remains difficult to treat, researchers are continually seeking better solutions for patients with treatment-resistant depression. New studies, particularly a paper published by Papakostas et al in 2012 (5), have compelled psychiatrists to consider augmenting traditional antidepressants with the medical food L-methylfolate.
    Unique Neurobiology
    A medical food is a nutraceutical—essentially, a vitamin—rather than a pharmaceutical. However, unlike a vitamin, a prescription medical food such as L-methylfolate is regulated by the US Food and Drug Administration (FDA).
    L-methylfolate (Deplin), is indicated for the distinct nutritional requirements of individuals who have suboptimal L-methylfolate levels in the CSF, plasma, and/or red blood cells and have major depressive disorder, with particular emphasis as adjunctive support for patients taking antidepressant medications. The medical food has attracted attention due to its benign side-effect profile and unique neurobiology. “It has a mechanism of action that is very different from what we are used to,” said Dr. Jain.
    Traditional drugs such as SSRIs and SNRIs block reuptake of neurotransmitters, while L-methylfolate spurs the production of more neurotransmitters. “It primes the pump from within,” said Dr. Draud.
    Dr. Draud added that clinicians might hesitate to use the compound because the mechanism of action is unfamiliar and because of a misconception that a prescription for folic acid is just as effective as L-methylfolate.
    Literature suggests that depression is linked with folate deficiency (6) and that patients with insufficient folate are less likely to respond to treatment (7) and more likely to experience a relapse (8). Folate supplementation does help some patients, acknowledged Dr. Jain, but the full story is more complicated.
    Folic acid in and of itself does not alleviate depression. Our brain must convert folic acid into L-methylfolate before it can manufacture enough serotonin, norepinephrine, and dopamine to alleviate depression. However, certain individuals lack the ability to convert folic acid to l-methylfolate, rendering folic acid supplements ineffective for this group of patients.
    This processing deficiency is caused by the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, which is quite common among patients with depression. Up to 70% of patients with depression test positive for the polymorphism and therefore cannot convert folic acid into L-methylfolate. (9)
    “In a scenario like that,” said Dr. Jain, “it becomes important to not use folate but to use L-methylfolate directly. That way you don’t have to worry about the patient potentially having the genetic polymorphism.”
    Genetics and BMI
    Clinicians have differing opinions on whether it is necessary to test patients for the genetic abnormality before prescribing L-methylfolate, as the medical food is approved regardless of patient polymorphism status. “I do the test a lot,” said Dr. Draud. “It depends on the patient. Some don’t care about the test and others want to have it.” Dr. Thase noted that he has made clinical decisions without the test, and Dr. Jain said the test is “not critically necessary” and that the marker does not offer a 100%, definitive indication that the patient will or will not respond to L-methylfolate.
    Yet psychiatrists have other assessment tools besides genetics at their disposal— body mass index (BMI) offers a clue as to how patients may respond to L-methylfolate. Data show that L-methylfolate is particularly effective in patients with depression and a BMI of 30 or greater (10). This may be because of the relationship between obesity, inflammation, and depression and because excess fat increases the body’s methylation needs to the point that some people may require a methyl donor such as L-methylfolate, according to Dr. Draud and Dr. Jain.
    “I recommend to my colleagues that they put a BMI calculator on their smartphone and put the numbers in and calculate on the spot if they’re sitting across from a patient and have any question,” said Dr. Jain.
    Choosing an Adjunctive Therapy
    Dr. Jain also recommends that clinicians refer to the 2010 American Psychiatric Association Practice Guideline for the Treatment of Patients With Major Depressive Disorder (11) for guidance on adjunctive depression treatment in general, which often consists of augmentation with second-generation antipsychotics.
    “Antipsychotic medications really work,” added Dr. Thase. “There’s no doubt about that, and when they work they work quickly.” He cautioned, though, that a clinician must carefully consider the risk/benefit equation when making a prescribing decision.
    While often effective as an augmentation therapy, antipsychotic medications have a significant side-effect burden that includes weight gain and tardive dyskinesia. Patients may hesitate to agree to these drugs as a result of the side effects.
    In contrast, L-methylfolate has a relatively benign side-effect profile and has shown adverse events similar to those of placebo in clinical trials (5).
    Dr. Draud typically tries augmentation with L-methylfolate before antipsychotics because of the low risk to patients and because of clinical trial data on timing. L-methylfolate was studied in patients who were newly treatment resistant, not those who had failed five or six other therapies, so “the earlier you use something like this, the better the chance you have to make it work,” he said.
    A Game Changer?
    Anecdotally, Dr. Draud and Dr. Jain and have seen patients improve on the medical food, while Dr. Thase remains optimistic about L-methylfolate based on clinical trial data but has not yet treated enough patients to comment personally on its efficacy.
    Although L-methylfolate is a promising new treatment option, psychiatrists should remain realistic in their expectations. “It’s only had two clinical trials, so it’s passed FDA approval, but a lot of other drugs have been on the market for a long time. Is it going to continue to look good? It’s hard to say,” said Dr. Draud.
    Provided the positive findings hold up, “linking the genetic abnormality with the specific indication for use is very 21st century medicine and a truly revolutionary step,” said Dr. Thase.
    —Lauren LeBano
    References
    1. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917.
    2. Crown WH, Finkelstein S, Berndt ER, et al. The impact of treatment-resistant depression on health care utilization and costs. J Clin Psychiatry. 2002;63(11):963-71.
    3. Greenberg P, Corey-Lisle PK, Birnbaum H, et al. Economic implications of treatment-resistant depression among employees.Pharmacoeconomics. 2004;22(6):363-373.
    4. Papakostas GI, Petersen T, Pava J, et al. Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: prevalence and impact on treatment outcome. J Nerv Ment Dis. 2003;191(7):444-449.
    5. Papakostas GI, Shelton RC, Zajecka JM, et al. L-methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials. Am J Psychiatry. 2012;169:1267-1274.
    6. Tolmunen T, Voutilainen S, Hintikka J, et al. Dietary folate and depressive symptoms are associated in middle-aged Finnish men. J Nutr. 2003;133(10):3233-3236.
    7. Papakostas GI, Petersen T, Mischoulon D, et al. Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 1: predictors of clinical response in fluoxetine-resistant depression. J Clin Psychiatry. 2004;65(8):1090-1095.
    8. Papakostas GI, Petersen T, Mischoulon D, et al. Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 2: predictors of relapse during the continuation phase of pharmacotherapy. J Clin Psychiatry. 2004;65(8):1096-1098.
    9. Kelly CB, McDonnell AP, Johnston TG, et al. The MTHFR C677T polymorphism is associated with depressive episodes in patients from Northern Ireland. J Psychopharmacol. 2004;18(4):567-571.
    10. Papakostas GI, Zejecka J, Shelton R, Fava M. Effect of L-methylfolate on Maier Subscale Scores in a randomized clinical trial of patients with major depression. Poster presented at 25th Annual US Psychiatric and Mental Health Congress; November 8-11, 2012; San Diego, CA. Abstract 106.
    11. Gelenberg AJ, Freeman MP, Markowitz JC, et al. Practice guideline for the treatment of patients with major depressive disorder, third edition. American Psychiatric Association. 2010; 1-152.

  3. I hope I’m on the right comment thread for the article on aromatherapy. I recently started using Lavender oil so I was excited to read your article. It seems like essential oils are a great add on therapy to support a good mental health program. I can definitely see a difference now that my depression isn’t in the suicidal realm. Thanks a lot for the article.
    I have to say I’m reading your book, Beyind Blue, what an amazing story! I also can’t tell you the number of times my jaw dropped open because of the similarities in our lives/stories/personalities. I have recommended your site and book to a friend who is struggling very hard right now with suicidal depression. She has been struggling for years. Started with meds, now she is trying every holistic/natural cute anyone throws out to her (like both of us have done) I’m very scared she won’t be able to hang on long if she doesn’t get proper help. And until she can, I hope your story can help her to have hope. Depression is so lonely and painful and like you said in your book most people lump all depressed souls into one category. Excercise more! Eat better! Do yoga! Don’t be so negative! Life isn’t that bad, you’re just being negative. UGH! I really want to help spread the word about major depression/bipolar disorder/ treatment resistant depression. Because they (we) suffer enough already and with all the science out there now they shouldn’t be made to feel like it’s their fault and they just aren’t trying hard enough. I think even mental health professionals need to be REQUIRED to read all the new info regarding mental health. No neuro surgeon would be allowed to not keep up with the latest science and technology but it seems like psychologists can take a course in “how to lift your mood with diet and excercise” OR the other extreme “this new medication our billion dollar company just spent millions of dollars on so you need to prescribe it now!” And they get their continued education unit credits for the year. It’s ridiculous! I was treated by a Pharma King like yours. He later got jail time I hear. All the warning signs were there but he was one of the few “Drs” in the area who took my insurance…..insurance coverage is a whole other topic and I’ve already gone all diarrhea of the mind on this post reply so I’ll sum up by saying thank you SO much for sharing your story! It’s helping others.

  4. I also use lavender oil nightly and love that the smell lingers into the morning when I wake up. I also have eucalyptus oil that I use but have enjoyed a basket full of dried eucalyptus I placed by the door the most. I get a fragrant scent every time I pass and it has lasted for many years. There are lots of free ebooks about essential oil as therapies, which I am enjoying. Thanks for the article.

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