The use of lavender for anxiety and related symptoms

Maria Miyashiro
NFSC 345
April 15, 2016

Abstract

THE USE OF LAVENDER FOR ANXIETY AND RELATED SYMPTOMS

Lavender has historically been used for centuries across the globe for a variety of
properties, from embalming fluid in the times of the ancient Egyptians to wound dressing
in World War I. In the last few centuries, the calming perennial is most noted for its
relaxing and sleep-inducing properties. With the popularity of essential oils and
resurgence of aromatherapy, those looking for an alternative to Western medicine have
been looking into lavender to aid with anxiety and its accompanying symptoms.
Benzodiazepines, and other common prescriptions to alleviate anxiety-related symptoms,
can have harsh side effects such as sedation, drowsiness, and tiredness. In addition, they
have a high rate of abuse and addiction. An alternative is lavender in the form of
aromatherapy, topical use, or oral supplementation. Limited research has been conducted
on lavenders active ingredients, linalool and linalyl acetate, but the studies that have
been done suggest that silexan, an active substance derived from concentrated levels of
the active ingredients, may work as effectively as prescribed benzodiazepines at reducing
perceived levels of anxiety. It works by prohibiting voltage-dependent Calcium channels,
a similar mechanism of action to benzodiazepines. These studies utilize methods such as
the Hamilton Anxiety Rating Scale to assess anxiety levels in study participants. Anxiety
and depression are difficult to quantify and the method to assess these levels has not been
perfected. This along with the limited number of studies done leads to little information
of the efficacy of lavender as an alternative to traditional medication. Additionally, there
are safety concerns to consider before recommending to any patient. Patients with
lavender allergies should avoid using as well as those using other treatments of central
nervous system depression. There is the potential for skin irritation so topical use of
lavender essential oil should be diluted with carrier oil. Some report gastrointestinal
discomfort with internal ingestion and pregnant women should avoid it as it has
emmenagogue properties. For those that are looking for an alternative to their current
prescription, they should consult their doctor before stopping treatment and see if
lavender supplementation is right for them. Lavender supplementation is recommended
for those with anxiety, as long as they consult a doctor about possible side effects or
contraindications, and before stopping taking any current medication.
Introduction and Background
Ethnobotany

THE USE OF LAVENDER FOR ANXIETY AND RELATED SYMPTOMS

Lavender is an evergreen perennial indigenous to southern Europe and the

Mediterranean. There are 20 species of the genus Lavandula and a number of subspecies,
hybrids and cultivars. The blossoms are noted for their range of color including white,
their famous light purple, dark violet and vibrant pinks, as well as their distinct odor.
Though the species range in color and height, they have similar ethnobotanical properties
and are made up of the same active components: linalool, linalyl acetate, 1,8-cineole Bocimene, terpinen-4-ol, and camphor. Essential lavender oil is most commonly derived
from Lavandula angustifolia, or English Lavender. This lavender produces oil with 35%
linalool and 51% linalyl acetate when steam distilled. This essential oil can be used
topically, inhaled, or taken orally. It is, and has been, used for a variety of purposes in a
number of forms.
Historical Use
Historically, lavender was used as far back as in ancient Egypt as a component of
embalming fluid and as a perfume. It got its name from the Greek and Romans use in
their bathing rituals, with lavan meaning to wash. In later folklore it is used for its
soothing properties, aiding the restless with sleep when applied to their pillows. During
the middle ages, lavender was used as an insecticidal throughout sickrooms, and later
during World War I, it was used to dress and disinfect wounds. Today, it is noted for
similar properties. It is seen throughout the household in cleaning products, personal
hygiene, and as decoration and fragrance. This can be attributed to its antibacterial and
antiseptic properties. It is used in cooking and baking to add flavor and complexity.
Finally it is used for several medicinal purposes. It can relieve pain and muscle spasms
and reduce inflammation, thus used in treatment for headaches and allergies.
Additionally, it aids in healing skin ailments, such as burns or bites, and hair loss, like in
those affected by alopecia. Most notably, lavender is used for stress and insomnia relief.
Purpose
This paper will focus on the soothing benefits of lavender for those with anxiety.
This topic was chosen because it is important to aid those looking for an alternative to
traditional prescriptions in finding a more natural solution. Current medications for

THE USE OF LAVENDER FOR ANXIETY AND RELATED SYMPTOMS

anxiety have a wide range of side effects from drowsiness and tiredness to sedation and
chemical dependency. Studies on the effects of lavender as an anxiolytic have
demonstrated lesser side effects than the prescription counterparts. Lavender needs to be
further explored as an alternative to benzodiazepines and other anxiety medications. This
paper will analyze the research that has been done thus far to explore whether lavender is
an effective alternative to currently prescribed anxiety medications and give a
recommendation of whether professionals should utilize lavender or not for anxiety
related symptom of their patients.
Discussion
Evidence
Limited research has been conducted on the use of lavender as an anxiolytic. The
most effective results of reducing anxiety and related symptoms come from the use of
Silexan, a gel-capsuled active substance that is derived from the essential oil of
Lavandula angustifolia. This oral supplementation has high concentrations of the active
ingredients linalool and linalyl acetate. One such study, conducted by Kasper et al.
(2016), was a randomized, placebo-control trial that involved 318 adults (18-65 years
old) with an anxiety rating of 18 or higher on the Hamilton Anxiety Rating Scale
(HAMA). This rating scale is a psychological questionnaire designed to assess the
severity of anxiety related symptoms. The study was conducted over 10 weeks in which
half of the participants were administered 80 mg a day of Silexan while the other half
were given a placebo. The results indicated that Silexan was more effective than the
placebo in reducing anxiety related symptoms. The patients that received Silexan
perceived a higher increase in quality of life. Those that received Silexan experienced a
10.8+/-9.6 deduction in points for HAMA, whereas the placebo group stated a 8.4+/-8.9
reduction. These results revealed statistical significance with a p-value of less than 0.01.
Some limitations of this study are the short 10- week length of the trial and Dr. Willmar
Schwabe GmbH & Co, a manufacturer of Silexan, funded the research.
Another study was conducted by Woelk et al. (2010) and compared the use of
Silexan to the use of the benzodiazepine lorazepam. This double-blind, randomized,
reference-controlled multi-center trial involved 40 patients who were administered 80 mg

THE USE OF LAVENDER FOR ANXIETY AND RELATED SYMPTOMS

of Silexan a day while another 37 were given 0.5 mg of lorazepam for six weeks, a
comparable dosage for Generalized Anxiety Disorder. The HAMA was again used to
determine severity of anxiety related symptoms with a baseline rating of 25+/-4 points.
Results indicated comparable results between the Silexan and lorazepam groups: the
patients given Silexan saw a reduction of 11.3+/-6.7 (45%) compared to the lorazepam
group who experienced a 11.6+/-6.6 point reduction (46%). The silexan group did not
experience sedative effects and there was no potential for drug abuse. One limitation of
this study was the small sample size used to conduct the study.
Finally, an evidence-based review, also conducted by Kasper et al. (2013),
collected data from seven randomized double-blind trials that all used 80 mg a day of
Silexan. Given that so few trials have been conducted on Silexan, all trials were included.
Five of the studies focused on the efficacy of Silexan while the other two investigated the
safety of the supplement. Each involved a means of evaluating anxiety and related
symptoms severity. Three of the seven primarily used HAMA while a fourth used the
combination of State Check, State-Trait Anxiety Inventory (STAI), a sleep diary,
Symptom Checklist (SCL90R), and a SF-36 Health Survey Questionnaire. The collection
of the studies included a total of 221 adult patients studied between 6-10 weeks. The
results of the review displayed a statistical superiority of Silexan over the placebo and
comparable results between Silexan and benzodiazepines. Silexan proved to be more
effective than placebo in extending sleep duration, decreased morning tiredness,
decreased restlessness, and increased quality of life. When compared to the results of
benzodiazepines Silexan showed slightly less improvements in daily living than the
prescription counterpart. The collection of studies found that the only side effects of
Silexan that were more prevalent in patients than the placebo and benzodiazepine were
eructation and dyspepsia. In contrast, tiredness and lethargy were reported at a
significantly higher frequency in the benzodiazepine patients. This review had a
relatively small inclusion of studies given that very little research has been done on
Silexan. Other limitations are the small sample size of the collection of patients, the short
durations of the studies, and the funding again being donated by a manufacturer of
Silexan. Furthermore, a limitation of each of the studies is that given that anxiety is a
mental condition, it is individualized and hard to quantify. The efficacy outcome

THE USE OF LAVENDER FOR ANXIETY AND RELATED SYMPTOMS

measures utilize HAMA and other anxiety scales or ratings, but consistency amongst
ratings is hard to prove. Despite these limitations, the study review provides enough
uniformity throughout the studies to indicate some efficacy of Silexan for the use of
anxiety and related symptoms.
Mechanism of Action
Further research needs to be conducted with larger sample sizes and longer
durations to ensure that efficacy is fully understood in a wide range of individuals.
Additionally, a longer duration of study could reveal long-term side effects that do not
present themselves with more use. In addition to better understanding the side effects and
efficacy, more research should be conducted on the mechanism of action of linalool and
linalyl acetate. This is not well understood and there are several theories as to how these
active ingredients function as anxiolytics in conjunction with each other. A generally
accepted mechanism of action is that the active ingredients are potent inhibitors of
voltage-gated Calcium channels (VOCCs) in synaptosomes in the hippocampus
(Koulivand et al. 2013). This is thought to be the same mechanism as benziodiazepines to
reduce the stress response of the Central Nervous System (CNS).
Professional Recommendation
Medical professionals should recommend Silexan to patients with Generalized
Anxiety Disorder (GAD) or with mild to severe anxiety symptoms. Professionals should
especially recommend the lavender supplement to patients who are looking for an
alternative to benzodiazepines. Patients with a history of chemical dependency or
experiencing side effects such as drowsiness, and sedation should consider 80 mg a day
of Silexan. This dosage has been proven affective in treating symptoms of anxiety
disorder. This could replace a 0.5 mg dosage a day of lorazepam or other benzodiazepine,
but a higher dosage of Silexan should be monitored by a medical professional. Those
with GAD or experiencing anxiety related symptoms should consult a medical
professional before starting Silexan and before discontinuing any medications they are
currently taking. Silexan should not be taken with the use of benzodiazepines or other
Central Nervous System Depression treatments.

THE USE OF LAVENDER FOR ANXIETY AND RELATED SYMPTOMS

Another option for those with situation-based anxiety might consider

aromatherapy or topical use of lavender essential oil. These methods of lavender
supplementation have proven less effective than oral supplementation for GAD, but help
for individual situations when anxiety related symptoms might present themselves, such
as anxiety induced sleeplessness. A proper dosage for aromatherapy is to inhale the steam
of 1-2 drops per 2-3 cups of boiling water. Those using lavender essential oil topically
should use 1-2 drops for every tablespoon of carrier oil such as olive oil, almond oil, or
coconut oil.
The benefits of lavender supplementation prove effective for those experiencing
anxiety or related symptoms. Silexan was statistically superior to a placebo, and
demonstrated comparable effects to benzodiazepines. The mild side effects of Silexan,
eructation and dyspepsia, or other forms of lavender may outweigh the side effects for
benzodiazepines in individuals, especially since there is no risk for drug abuse of the
supplement.
Other Safety Concerns
Alongside the contraindication with other nervous system depressants are other
safety concerns with lavender essential oil. These include skin irritation in topical use
when carrier oil is not used appropriately or if the user is allergic to properties of the
perennial. Some patients that used oral supplementation of lavender oil experienced
gastrointestinal discomfort such as eructation and dyspepsia. Pregnant women should
avoid taking lavender oral supplementation, as it is an emmenagogue, which promotes
blood flow to the uterus. Those with allergies to lavender should not inhale lavender
essential oil or use it topically or orally. Further research should be conducted to evaluate
if there are any other undiscovered contraindications and/or side effects.
Other Benefits
If using lavender essential oil topically or with aromatherapy, the oil can be used
for other ailments not related to anxiety. Mild rashes, burns and bites can be treated using
carrier oil and the lavender due to its anti-inflammatory properties, as well as
antibacterial and antiseptic properties. Another added benefit is for those experiencing

THE USE OF LAVENDER FOR ANXIETY AND RELATED SYMPTOMS

hair loss as it is proven to increase hair growth. Topical use of lavender can be applied
directly to headaches to relieve pain and tension or in other areas of discomfort to relieve
pain. With use of lemon and peppermint essential oils, some report decreased seasonal
allergy symptoms when taken with lavender oil. Sleeplessness, not related to anxiety, can
also be treated using lavender without the drowsy side effects in the morning related to
sleep aid medications. Finally, older adults experiencing issues with balance have
experienced decreased incidence of falling when taking oral supplementation of lavender.
Not enough research has been conducted to pinpoint the exact mechanism of action of
this but some suggest it might also be related to the CNS, just as the anxiolytic function
is.
Further research of all purported benefits of lavender, including as an anxiolytic,
need to be conducted. The efficacy and safety concerns are limited to seven studies on
oral supplementation as an anxiolytic so results are limited. In addition, all studies used
the same dosage so increased dosage should be tested for efficacy in more severe cases of
anxiety. The increased dosage may reveal increased side effects so that too should be
investigated.
Conclusion
This paper has demonstrated that lavender oral supplementation is an effective
alternative to benzodiazepines in treating anxiety and related symptoms. The limited
studies on the efficacy of lavender oral supplementation have demonstrated statistically
significant improvements in patients experiencing anxiety or related symptoms. Most
studies exploring efficacy utilized the Hamilton Anxiety Rating Scale to assess the
severity of anxiety in the baseline of patients. The studies found that severity decreased
by as compared to placebo-controlled groups. When assessing the efficacy versus
prescribed anxiety medication benzodiazepines, the studies indicated similar results in
reducing the severity of anxiety. In all studies, the dosage 80 mg a day was used, thus this
should be the recommended until further research is conducted. This is an effective
alternative to the side effect laden and historically drug abused medications currently
prescribed to patients with anxiety. Those with very mild anxiety or situation-based
anxiety might consider aromatherapy or topical use if they wish to avoid oral

THE USE OF LAVENDER FOR ANXIETY AND RELATED SYMPTOMS

supplementation or are prone to gastrointestinal discomfort. More research needs to be

conducted to better understand Silexan and other forms of lavender essential oil use. Side
effects and efficacy should be further explored as well as increased dosage to ensure
safety. Medical professionals should suggest Silexan to patients with anxiety looking for
an alternative to traditional prescriptions. They should be monitored as they make the
transition to this more holistic alternative.

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. Silexan, an orally administered Lavandula oil preparation, is effective in the treatment
of subsyndromal anxiety

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Kasper, S., Volz, H., Dienel, A., & Schlfke, S. (2016). Efficacy of Silexan in mixed
anxietydepression A randomized, placebo-controlled trial. European
Neuropsychopharmacology, 26331-340. doi:10.1016/j.euroneuro.2015.12.002

Kasper, S. (2013). An orally administered lavandula oil preparation (Silexan) for anxiety
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