The International Journal of Aromatherapy (2004) 14, 63–69

The International
Journal of
Aromatherapy

intl.elsevierhealth.com/journals/ijar

An assessment of treating depression and

anxiety with aromatherapy
Katie Lemon

22 Perceval Road, Inverness, IV3 5QE, Scotland, UK

KEYWORDS Summary This investigation studied the effects of aromatherapy in alleviating

Aromatherapy; depression and anxiety. It was an evaluation of the aromatherapy service offered as
Anxiety; part of the Surrey Oaklands NHS Trust’s Day Hospital treatment plan. The research
Depression; was designed to identify if there was a significant difference in perceived levels of
Psychiatry; anxiety and depression between a control group receiving massage with carrier oil
Massage; alone and a test group receiving holistically prescribed essential oils diluted in
Prescribing carrier oil during massage. Thirty two subjects suffering from depression and/or
anxiety were recruited from both inpatient and predominantly outpatient clients of
the hospital. Half were randomly assigned to a control group and the other half to
the aromatherapy test group. The test group received six, fortnightly massages
lasting for 40 min. The essential oils were selected according to physical and
psychological symptoms, e.g. anxiety, depression, headaches and sleep problems.
The control group received massage with grape seed carrier oil without the essential
oils in an identical environment to the test group. Both groups were monitored by
their key worker in one-to-one sessions using the Montgomery-Asberg Depression
Rating Scale (MADRS) or the Tyrer Brief Anxiety Scale (TBAS) on a monthly basis until
week 12. The clients also completed a Hospital Depression Anxiety Scale (HADS) at
the same time intervals. Statistical analysis of the results indicated a significant
difference between aromatherapy and control groups. The test group showed a
marked improvement in the results of the three questionnaires.

c 2004 Elsevier Ltd. All rights reserved.

Introduction from within the patient. This type of depression is

Lyttle (1988a) states that depression is a disorder
in which mood and vitality are lowered to the point
of distress. Depression occurring as an unusually
prolonged or intense reaction to loss is called re-
active or exogenous depression and is classified as
neurosis, thus being often called neurotic depres-
sion. Particularly severe depression may also arise
E-mail address: answersbynature@hotmail.com.
called endogenous depression and is classified as
psychosis, thus being referred to as a psychotic
depression. Genetic and biochemical factors play
an important part in its development.
About one in 10 of the population will suffer
from depression and women are twice as likely to
be affected as men. Reactive depression is twice as
common as endogenous depression and the over-
all incidence of depression in the UK appears to
be rising. Usual treatment may be physical
(electroplexy or anti-depressant drugs – tricyclics,

0962-4562/$ - see front matter c 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijat.2004.04.002
64
monoamine oxidase inhibitors, lithium salts) or
non-physical (psychotherapeutic approaches) and
the two are often combined. Depression has phys-
ical, psychological and social effects and the
overall picture is one of loss of drive, vitality, in-
terest and libido with the added problems of de-
lusional thinking and loss of insight in many
endogenous attacks (Lyttle, 1988a).
Anxiety consists of a blend of physical and psy-
chological responses to threat;be that threat real
or imagined. Objective anxiety is a realistic re-
sponse to perceived danger in the environment and
is adaptive in most situations. Neurotic anxiety
arises from inner threat generated by conflict in
the unconscious. Anxiety is the raw material from
which all neuroses are constructed, and neurosis
may be regarded as a maladaptive response to
anxiety. In some neuroses the individual attempts
to reduce anxiety by developing ritualistic tech-
niques (obsessive compulsive neurosis), in others
the individual becomes morbidly preoccupied with
self (neurotic depression), and in others the anxi-
ety itself predominates (anxiety state). Anxiety
states are probably the commonest mental disor-
ders and arise when stress exceeds capacity to
cope. Anxiety states may be phobic (related to
object or situation) or free-floating (unattached
and unexplained). Anxiety states are widespread in
their distribution but tend to be commonest in
young females. Physical and psychological effects
of anxiety vary and cause much psychosocial dis-
ruption. Phobias respond favourably to psycholog-
ical methods of treatment and prognosis is usually
good (Lyttle, 1988b).
Half of the clients attending the Surrey Oaklands
NHS Trust Day Hospital suffered from depression
and half suffered from anxiety, or a combination of
the two.
A previous study carried out by Garnett-Ore
(1996) found that aromatherapy could be beneficial
in alleviating psychological distress. The object of
this investigation was to measure that improve-
Table 1 Essential oils most frequently used in the Day Hospital environment
Top notes Bergamot
Lemon
Clary sage
Middle notes Lavender
Roman chamomile
Geranium
Base notes Rose otto
Sandalwood
Jasmine
K. Lemon
ment by use of questionnaires, quantify it and
statistically analyse whether the difference be-
tween the test and control groups was significant or
the result of chance.
Essential oils
Assessment was made by the aromatherapist as to
which essential oils would be most beneficial for
the client according to other presenting conditions
e.g. headaches, sleep problems. A pilot study prior
to the research indicated that a number of essen-
tial oils were used most frequently in the Day
Hospital setting and so client blends were chosen
from this range by the aromatherapist. These es-
sential oils are shown in Table 1.
All nine essential oils have been empirically re-
ported to potentially alleviate anxiety and de-
pression.Three top notes, three middle notes and
three base notes were selected for inclusion in the
study and their claimed effects described in the
literature are given below.
Bergamot was selected as its light, fresh, citrus
fragrance is uplifting to the mind, lifting one out of
depression. It can stimulate or sedate the nervous
system according to the individual needs, relieving
anxiety and calming fears (Lawless, 1994).
Clary sage is often described as euphoric it does
not always induce such heightened feelings, but it
certainly has a deeply relaxing effect, thus helpful
in dealing with muscular stress and tension (Davis,
1995). It was also included for treating hormone-
related mood disorders.
Another citrus oil, lemon, was included for its
tangy, bright fragrance is refreshing and uplifting
to the spirit. It also has been found to have a psy-
chologically strengthening effect on usually de-
pressed or fearful patients (Lawless, 1994). Lemon
has also been said to boost the immune system and
fight infection.
Citrus bergamia
Citrus limon
Salvia sclarea
Lavandula angustifolia
Chamaemelum nobile
Pelargonium graveolens
Rosa damascena
Santalum album
Jasminum officinalis
An assessment of treating depression and anxiety with aromatherapy 65

The ubiquitous lavender had to be included as it consent form before joining the study. The clients
covers a multitude of conditions, but primarily as it were randomly divided and assigned to either a
is invaluable to those who suffer from widely control group or an aromatherapy test group.
fluctuating mood states and feelings of emotional
instability, including hysteria and manic depres-
sion. It also helps to calm feelings of anxiety and Methods
assist in getting good nights sleep. Lack of sleep has
a profound effect on mood and perception of pain
Clients in the test group were seen once a fortnight
(Lawless, 1994).
over a 12-week period at approximately the same
Roman chamomile has a calming effect on an
time and day. They were welcomed into a warm
emotional level and is mildly sedating without be-
room and asked to sit down; 5–10 min were spent
ing depressive. It is for hyper-sensitive individuals
discussing ailments and changes so as the essential
who are deeply affected by emotional upsets, es-
oils could be chosen by the aromatherapist. The
pecially those prone to allergies (Lawless, 1994).
blended oil combination would vary from session to
Geranium is similar to clary sage in that it was
session according to presenting problems, but re-
selected for its affinity to women’s conditions. It
mained from the list of nine frequently used es-
has an excellent regulatory effect on the body in-
sential oils and at the same dilution rate (4 drops of
cluding the nervous system. It is soothing yet re-
essential oil in total to 15 ml of carrier oil). Any
vitalising (Lawless, 1994).
medication or therapy changes were also asked
Psychologically, the scent of rose has a powerful
about and recorded. A tape of gentle music was
effect on the emotions. It is also a mild sedative
playing softly throughout – Pantops (Hemi-Sync.
and anti-depressant, excellent for emotional
Nellysford, VA). The room was warm and dimly lit.
shock, bereavement and grief (Lawless, 1994).
Clients in the control group were also received
Sandalwood essential oil was also included as a
over the same time period and into an identical
masculine scent as opposed to some of the femi-
environment as those of the test group. One to one
nine, floral essential oils. It is beneficial for de-
time was spent by the aromatherapist and client
pression, anxiety and stress-related problems as it
prior to the massage.
has a grounding and opening effect on the psyche.
Both client groups were asked to remove jew-
Its heavy scent is gently sedating and antiseptic in
ellery and undress to expose back, arms and legs.
nature (Lawless, 1994).
The client then lay face down on an aromatherapy
Jasmine boosts a person’s sense of self-worth
couch and was covered with a bath sheet towel
and thus confidence. It is invaluable in treating the
from the buttocks down.
lethargy that is associated with depression (Davis,
Four drops in total of the chosen essential oils
1995).
were diluted in 15 ml grape seed carrier oil for each
client in the test group. The control group were
massaged using grape seed oil alone.
Subjects The full 15 ml of the blend or grape seed oil
alone was used for a full body massage using gentle
effleurage (large, gentle, and rhythmical stroke)
Thirty two clients suffering from depression and/or
and petrissage (circular movements over a limited
anxiety were selected from the psychiatric in-pa-
area using thumbs or finger tips).
tient wards and predominately those attending
Surrey Oakland’s NHS Trust’s Day Hospital. De-
pressed clients were initially assessed by their key Back
worker (either their psychiatric nurse or occupa-
tional therapist) using the Montgomery-Asberg De- Approximately 5 ml of the blend was warmed in the
pression Rating Scale (MADRS) for a level above 7 aromatherapist’s hands and then applied to the
indicating mild to severe depression. Similarly, back using gentle effleurage strokes. Petrissage
anxious clients were assessed using the Tyrer Brief action was used around the shoulders and sacral
Anxiety Scale (TBAS). The cohort was chosen from areas. The back was then covered with the towel
both sexes, in as wide an age range as possible and and the legs exposed.
included patients with varying degrees of impair-
ment. As the clients were potentially vulnerable, Back of legs
permission was gained from the Hospital’s Ethics
Committee and from the clients themselves, who The oil blend was applied to the back of both legs.
after reading an information sheet, completed a A second towel then covered the leg not receiving
66
massage at that time. Approximately 212 min mas-
sage was given to each leg. Gentle effleurage was
directed up the leg towards the heart. Particular
attention was made to the calf muscle. If varicose
veins or oedema were present, very light pressure
was used.
Front of legs
The client then turned over whilst remaining
covered with a towel from top of legs up. The
blend was then applied to the front of legs, and 5
min was spent massaging each leg as before. This
time attention was paid to the thigh muscles. The
feet were then massaged using a combination of
effleurage, then petrissage between tendons
leading to toes on the top of the feet, and down
the toes, which were then pulled gently. The
legs were then covered on completion of the
massage.
Arms
One arm was exposed at a time, and massaged
begun with gentle effleurage strokes used from
wrist to shoulder. Petrissage was used to the inner
forearm, wrist joint, between tendons leading to
fingers on the back of the hands, and down the
fingers, which were then pulled gently.
Both arms were covered on completion.
Top of shoulders and face
The towel was folded back down to just below the
clavicle. The remainder of the oil was utilised.
Effleurage was given around the shoulders to the
back of the neck, with petrissage used into the top
of the posterior shoulder muscles. Petrissage was
applied to the centre of the nape of neck working
gradually out towards the ears. Gentle traction was
applied to the neck. Effleurage to the neck, as at
the start, completed this section. The face was
gently massage using effleurage. The client was
then allowed to relax for a short time, before
getting dressed again.
The massage time was allocated as follows:
Back 10 min
Back of legs 5 min
Front of legs 10 min
Arms 10 min
Top of shoulders and face 5 min
K. Lemon
Measurements
To try to reduce bias from the client or the aro-
matherapist, assessments were made by the key
workers using the MADRS or the TBAS at weeks 0, 4,
8, and 12. The clients also completed a HADS at the
same time intervals.
The depression rating scale devised by Mont-
gomery and Asberg (1979) has been used for over
20 years. It was used as an assessment tool in this
study because it includes 10 commonly occurring
symptoms that show the largest change with
treatment, and the greatest correlation with
overall change, which is an important factor in
clinical trials. The questions take into account
levels of apparent and reported sadness, feelings
or inner tension, affects on sleep and appetite,
ability to concentrate and feel, lassitude and
thoughts whether pessimistic or suicidal. Each
question ranges from 0 to 6.
TBAS is described by the authors as a sub-divi-
sion of the Comprehensive Psychopathological
Rating Scale, which allows evaluation of patients
other than those with anxiety neurosis (Tyrer
et al., 1984). Its pattern is similar to that of the
MADRS, which simplified usage. These questions
evaluated feelings of inner tension and hostility,
hypochondriasis, worrying over trifle issues, pho-
bias, reduced sleep, autonomic disturbances such
as palpitations or sweating more, aches and pains
(other than an organic cause), separate from
muscular tension, which is rated separately.
HADS was a questionnaire completed by the
client, as it was also important to record how the
client felt about the benefits of the treatment. It
was designed to measure the perceived severity of
emotional disorder. It consisted of 7 anxiety items
and 7 depression items and rated each 1–4 (Zig-
mond and Snaith, 1983). Anxiety questions ad-
dressed symptoms such as being frightened, fearing
something bad will happen, worry, relaxation,
feeling butterflies in stomach, restlessness and
panic. Depression questions rated feelings of en-
joyment in the present, future and tasks one used
to enjoy, feelings of cheerfulness, feeling slowed
down, still being able to laugh and see things as
funny and interest in one’s own appearance.
Medication and therapy changes during the as-
sessment period were also recorded so that bene-
fits could not be attributed to these.
Results
Six subjects in the control group dropped out after
the first session and their details have been omit-
An assessment of treating depression and anxiety with aromatherapy 67

Table 2 The sex, age and oil selection of the test group
Sex Age Oil selection
1 F 25 Bergamot, chamomile, geranium, lavender, lemon
2 F 35 Clary sage, geranium, lavender, rose
3 M 37 Chamomile, lavender, lemon, rose
4 M 43 Chamomile, geranium, lavender, sandalwood
6 M 24 Chamomile, geranium, lemon, sandalwood
7 M 50 Jasmine, lavender, lemon, rose, sandalwood
8 F 42 Bergamot, chamomile, clary sage, jasmine, lavender,
lemon, sandalwood
9 F 23 Clary sage, geranium, lavender, lemon, sandalwood,
11 F 37 Bergamot, chamomile, lavender, geranium, rose
12 F 41 Chamomile, lavender, lemon, rose
13 F 53 Chamomile, geranium, jasmine, lemon
14 F 39 Clary sage, lavender, geranium, jasmine, lemon
15 F 48 Chamomile, clary sage, lemon, rose
16 F 30 Bergamot, chamomile, lavender, jasmine, rose

ted from the results. The essential oils chosen

by each member of the test group are given in
Table 2.
After the raw data were collated from the
questionnaires taken over the 12-week period, the
averages of the results were determined (Tables 2
and 3) and plotted as graphs (Graphs 1 and 2).
The two groups (test and control) were then
grouped together to rank the differences. Then the
totals of the ranks of the test groups gave T.
To carry out the calculations, the number of
clients in the test group was designated n1 , and the
number of clients in the control group was desig-
nated n2 .
The Mann–Whitney equation
T  n1 ðn1 þ n2 þ 1Þ=2
z ¼ pffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
fn1  n2 ðn1 þ n2 þ 1Þ=12g
was applied to give z (Campbell and Machin, 1999).
This value was then compared to a table of
probability to give U. If U is less than 0.05, the
confidence limit of probability, then this indicates

Table 3 Average of control results (see Graph 1)

Questionnaire Time (weeks)
0 4 8 12
MADRS 19.8 19.4 18 21.1
TBAS 17.1 17.6 16.8 21.3
HA(D) 14.6 13.3 13.1 13.7
H(A)D 13.3 11.3 10.3 10.8
Number 10 10 10 10
Graph 1 Average of control results.
68 K. Lemon

that there is a significant difference between the

test and control group, which cannot be attributed
to chance.

HA(D): U ¼ 0.0455
H(A)D: U ¼ 0.4295
MADRS: U ¼ 0.0105
TBAS: U ¼ 0.0031

The overall results are shown in Table 4.

Discussion

As the clients were randomly assigned to the

groups there was a disproportionate amount of
‘severely’depressed or anxious clients assigned to
the test group, so their initial results averaged
higher than the control group. Even so, the final
averages show an improvement compared to the
control group.
The control averages made a slight improvement
according to the gradient of the graph. This was to
be expected, as massage itself is relaxing and the
expectation of the client is to improve and please
the aromatherapist. The test group shows a much
more dramatic change in the gradient. The final
questionnaire was carried out two weeks after
the completion of the course of treatment. At this
point we noticed an increase in the results as the
clients began to ‘act out’ or exhibit to their key
workers a possible reluctance in finishing their
Graph 2 Average of test results. treatment and a desire to be re-referred to the

Table 4 Average of test results (see Graph 2)

Questionnaire Time (weeks)

0 4 8 12
MADRS 30 23.4 15.8 18.1
TBAS 24.6 16.8 13.5 14.6
HA(D) 15.3 12.8 10.5 9.7
H(A)D 12.3 11.1 9.3 8.7
Number 16 16 16 16

Results used in the Mann–Whitney equation

HA(D) H(A)D MADRS TBAS
n1 ¼ 16 n1 ¼ 16 n1 ¼ 14 n1 ¼ 14
n2 ¼ 10 n2 ¼ 10 n2 ¼ 10 n2 ¼ 9
T ¼ 254 T ¼ 231 T ¼ 220:5 T ¼ 215
z ¼ 2:00 z ¼ 0:79 z ¼ 2:66 z ¼ 2:96
p ¼ 0:0455 p ¼ 0:4295 p ¼ 0:0105 p ¼ 0:0031
An assessment of treating depression and anxiety with aromatherapy
service. However, the questionnaires that the
clients completed themselves indicate a contin-
uing of improvement in the test group, the reasons
for which are unclear. In the control group, the
benefits gained are demonstrated by a slight re-
duction in the patients’perception of anxiety or
depression.
The test group showed a marked improvement in
the results of the three questionnaires in compar-
ison to the control group. The Mann–Whitney U
test was used for the analysis as a non-parametric
test as the numbers of the groups was less than 20.
According to the Mann–Whitney U test all except
the H(A)D probability results (or U) were less than
0.05, indicating that there was a significant dif-
ference between the control and test groups,
which was a result that can be attributed to the
treatment and not by chance.
The feedback from the clients involved in the
test group was also very positive as they found the
treatments both beneficial and pleasurable, with a
tangible improvement in their quality of life. The
overall effects of the aromatherapy treatments
were wider ranging than the original investigation
parameters were intended to assess. The re-
searcher found the use of essential oils, prescribed
for the relief of depression and anxiety, but also
blended specifically for the client, addressed other
issues such as sleep disturbance and headaches,
which the clients also reported had improved. This
in turn, had an effect on their perception of their
psychological condition.
Clients benefited from the physical contact
provided in a professional setting. The massage
eased muscular aches, pains, tension, soothed,
reassured and relaxed.
Although this study is a scientific evaluation of a
service, the writer believes that such additional
information reinforces the health professionals’
holistic role when dealing with people who have
needs and problems and who are not ‘just
numbers’.
It was interesting to note that there was a drop
out rate of 33% (6 people) after the first session
amongst the control group; perhaps they realised
that they were in the control group due to the lack
of odour from the massage oil. A follow-up study
69
could use a synthetic fragrance product in the
control group (assuming no inherent beneficial ef-
fect) and compare against massage with essential
oils to ascertain the therapeutic effect of essential
oils over a pleasant odour.
Clients tended to drop out just before the end of
the course of treatment in the test group (18%). An
exit interview would have been useful to identify
why this happened, so that it could be reduced in
the therapy and in any future research.
It was concluded that this study has statistically
proven that the holistic use of aromatherapy had a
beneficial therapeutic effect on clients who were
more than mildly depressed or anxious. Further
studies would be beneficial using larger numbers of
clients for statistical reasons.
Acknowledgements
Sincere gratitude to Shirley Price Aromatherapy for
the donation of all the essential oils and carrier oil
used in this evaluation. Ian Smith, Ewa Wikiel, Dr.
Ken Chezinski, and Dr. William Hood for their
clinical and statistical advice. Chris Lemon, Fran-
ces Fee, Tessa Flora, Jean Palmer, Druid Fleming,
Linda Davies, Carol Farrell and George Hogan for
completing the endless questionnaires, and most
importantly the clients for participating.
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