Review Article The Effectiveness of Aromatherapy for Depressive Symptoms: A Systematic Review

22 Pages·2017·1.41 MB·English

Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2017, Article ID 5869315, 21 pages
https://doi.org/10.1155/2017/5869315
Review Article
The Effectiveness of Aromatherapy for Depressive Symptoms:
A Systematic Review
DalindaIsabelSánchez-Vidaña,ShirleyPui-ChingNgai,WanjiaHe,JasonKa-WingChow,
BensonWui-ManLau,andHectorWing-HongTsang
DepartmentofRehabilitationSciences,TheHongKongPolytechnicUniversity,Kowloon,HongKong
CorrespondenceshouldbeaddressedtoBensonWui-ManLau;[email protected]
Received25August2016;Revised25October2016;Accepted14November2016;Published4January2017
AcademicEditor:ArndtBu¨ssing
Copyright©2017DalindaIsabelSa´nchez-Vidan˜aetal. This is an open access article distributed under the Creative Commons
AttributionLicense,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkis
properlycited.
Background.Depressionisoneofthegreatesthealthconcernsaffecting350millionpeopleglobally.Aromatherapyisapopular
CAMinterventionchosenbypeoplewithdepression.Duetothegrowingpopularityofaromatherapyforalleviatingdepressive
symptoms,in-depthevaluationoftheevidence-basedclinicalefficacyofaromatherapyisurgentlyneeded.Purpose.Thissystematic
reviewaimstoprovideananalysisoftheclinicalevidenceontheefficacyofaromatherapyfordepressivesymptomsonanytypeof
patients.Methods.Asystematicdatabasesearchwascarriedoutusingpredefinedsearchtermsin5databases:AMED,CINHAL,
CCRCT,MEDLINE,andPsycINFO.Outcomemeasuresincludedscalesmeasuringdepressivesymptomslevels.Results.Twelve
randomizedcontrolledtrialswereincludedandtwoadministrationmethodsforthearomatherapyinterventionincludinginhaled
aromatherapy(5studies)andmassagearomatherapy(7studies)wereidentified.Sevenstudiesshowedimprovementindepressive
symptoms.Limitations.Thequalityofhalfofthestudiesincludedislow,andtheadministrationprotocolsamongthestudiesvaried
considerably.Differentassessmenttoolswerealsoemployedamongthestudies.Conclusions.Aromatherapyshowedpotentialtobe
usedasaneffectivetherapeuticoptionforthereliefofdepressivesymptomsinawidevarietyofsubjects.Particularly,aromatherapy
massageshowedtohavemorebeneficialeffectsthaninhalationaromatherapy.
1.Introduction includefeelingsofguilt,sadness,worthlessnessanddesper-
ation, inability to experience pleasure, changes in appetite
Depression is a life-threatening mood disorder manifested and sleep patterns, lack of energy, poor concentration and
as a combination of cognitive and physical symptoms that memory, motor retardation, fatigue, and recurrent suicidal
leads to decreased interest in daily life activities [1] which and death ideation which are experienced for more than 2
imposessignificantnegativeimpactonpeople’squalityoflife weeks[1,9,12,13].
andworkperformanceduetodisability,suffering,andhigh Diagnosis of depressive symptoms is carried out using
riskofperpetratingself-harm[2,3]. validatedtools[14].Oneoftheoldestandmostwidelyused
Depression is reported as the largest health concern in diagnostic tools is the Hamilton Depression Rating Scale
the21stcentury[4].About350millionpeoplearecurrently [15] which comprises a clinical-rated and a self-reported
sufferingfromdepression[5].Majordepressivedisorderhas assessment. Another tool included the Beck Depression
been projected to be the highest cause of years of life lived Inventorythatusesapatientself-reportingtoolofdepressive
with disability by 2030 [6, 7]. The prevalence of depression symptoms[14].Thesetoolsdemonstratedhighsensitivityand
hasincreaseddramaticallyatagloballevelandonemillion specificity and therefore are the best validated scales used
people with depression commit suicide yearly [6, 8, 9]. In for assessing the degree of severity of depressive symptoms
USA, an annual economic loss around USD 210 billion is [14,16,17].
associated with depression, which is one of the diseases Nowadays, the first-line treatment for major depressive
withhighesteconomicburden[10,11].Depressivesymptoms disorder is antidepressants including monoamine oxidase
2 Evidence-BasedComplementaryandAlternativeMedicine
inhibitors, tricyclic antidepressants, and serotonin-norepi- stimulate brain areas directly via the olfactory epithelium
nephrine and selective serotonin reuptake inhibitors (SN/ [44, 48]. Essential oils trigger mechanisms in the brain via
SSRIs)[13,30,31].Despitethewidevarietyofantidepressants the olfactory system. The mechanism of action of essential
available in the market, a significant proportion of patients oils administered by inhalation involves stimulation of the
cannot reach full remission or experience side effects [13, olfactory receptors cells in the nasal epithelium, about 25
32, 33]. For instance, it has been reported that nearly 30% million cells, connected to the olfactory bulb. After stim-
of the patients do not respond [8]. Side effects includ- ulation, the signal is transmitted to the limbic system and
ing nauseas, insomnia, agitation, weight gain, somnolence, hypothalamus in the brain through the olfactory bulb and
sexual dysfunction, and cardiovascular adverse events have olfactory tract. Once the signals reach the olfactory cortex,
been reported [9, 31, 34]. Another downside of the use release of neurotransmitters, for example, serotonin, takes
of antidepressants is the long treatment period needed to placewhichresultsintheexpectedeffectonemotionsrelated
experience the beneficial antidepressant effect. Due to the toessentialoiluse[49–51].
ineffectivenessofthetreatmentin somepatientsorintoler- Increasingpopularityofaromatherapyhasbeenreported
ability to the side effects, a large number of patients do not intheUKasoneofthemostcommonlyusedCAMtherapies
complywiththetreatmentandsearchforothertherapeutic [52]. Due to the increasingpopularityof aromatherapythis
options [13, 31, 35]. Hence, increasing number of people modalityofCAMwaschosentocarryoutasystematicreview
withdepressivesymptomsexploredothernonpharmacolog- onitseffectiveness[53].
ical interventions including psychotherapy and counseling, Therewasonepublishedsystematicreviewevaluatingthe
psychoeducation, exercise, problem solving therapy, guided effectsofaromatherapyforpeoplewithdepressivesymptoms
self-help and behavioral activation treatments [36], or even whichincludedstudiesfrom2000to2008[2].Since2009to
complementaryandalternativemedicine(CAM)[3,31]. date, 10 new RCT studies have been carried out to evaluate
CAMisdefinedasabroadsetofhealingresources,suchas the effectiveness of aromatherapy on depressive symptoms
medicalproductsandpractices,fortheprevention,diagnosis, therebyraisingtheneedtoupdatethediscussiononthenew
andtreatmentofdiseasesthatfunctionsasacomplementto findingstakingintoaccountalltheevidencereportedupto
themainstreammedicinesystem[37].InUSA,about53.6% date on the topic. Therefore, this systematic review aims to
ofthepatientssufferingfromdepressionhavereportedtouse provideanupdatedanalysisoftheevidenceoftheefficacyof
CAMasanadjuvanttherapyforthetreatmentofdepression aromatherapyfordepressivesymptoms.
[31,38].OneoftheCAMoptionsthatpatientswithdepressive
symptomschooseisaromatherapy.Aromatherapyisdefined 2.Methods
asthetherapeuticuseofplant-derivedconcentratedessences
whichareextractedbydistillation[39–41].Aromatherapyis 2.1. Search Strategy. An extensive literature search was car-
an inexpensive and noninvasive modality of CAM used to riedoutinthefollowingdatabases:AlliedandComplemen-
improvethepsychologicalhealthandwellbeing[40,42,43]. taryMedicineDatabase(AMED),CochraneCentralRegister
Essentialoilscontainvolatileorganiccompoundsthatexert ofControlledTrials(CCRCT),CumulativeIndextoNursing
a pharmacological effect by penetrating the body by oral, and Allied Health (CINAHL), MEDLINE, and PsycINFO.
dermal(aromatherapymassageortopicalapplicationofaro- The predefined search strategy used to obtain the reference
matherapy)[44,45],orolfactoryadministration(inhalation list of potential articles in the present study is shown in
aromatherapy)[46–48].Theclassificationofessentialoilsis Table1.OnlystudiesinEnglishwereincludedandthesearch
basedonthebotanicalclassificationoftheplantfromwhich was carried out by 2 independent authors having a third
theessentialoilsareextracted[44].Theuseofchemotypesis author to consult when discrepancy occurred. The present
anotherclassificationofessentialoilsbasedonthesubspecies study included randomized clinical trials involving adult
of a plant with the same morphological characteristics that subjectsofbothgenders.Therewasnoagerestriction.
produces essential oils with different chemical profile, for
example, type and quantity of chemical components [45]. 2.2. Inclusion and Exclusion Criteria for Study Selection and
Thechemotypedescribesthemaincompoundwithincertain Outcome Measures. The studies included in the present
essentialoil[45].Frequently,essentialoilsareusedatdifferent review comprise RCTs with any kind of study design (e.g.,
concentrations depending on the route of administration: double blind, single blind, and crossover study). No time
(1)foraromatherapymassage,1–5%essentialoilisused,(2) restriction on the publishing year was considered for the
fororaladministration,8–50%essentialoilisused,and(3) study selection and studies that fulfill the inclusion and
concentratedessentialoilisusedininhalationaromatherapy exclusioncriteriauptodatewereincluded.Studiesinwhich
[48].However,thedosageanddilutionofessentialoilchosen depressivesymptomswereevaluatedusinganystandardized
are not standardized in practice [48]. The most potent assessmenttoolfordepressivesymptomswereincludeddis-
and effective administration method is oral administration regardingthetypeofclinicalconditionstudied.Studiesthat
in which the components of the essential oil reach the assesseddepressivesymptomsbyanxietyscalesoranyother
bloodstream[44].Sinceessentialoilsarelipophilic,theycan assessmentsfordepressivesymptoms,forexample,Profileof
easilybecarriedtoallorgansinthebody[44].Ininhalation Mood States rating scale (POMS) or Hospital Anxiety and
aromatherapy, the inhaled air containing essential oils can Depression Scale (HADS), were included. Eligible studies
notonlyreachthecirculationsystemviathebloodcapillary had to include the use of essential oils administered by
network in the nose and the bronchi in the lungs but also inhalation or topical administration. Any study combining
Evidence-BasedComplementaryandAlternativeMedicine 3
Table1:Searchtermsanddatabasesearchstrategy. 2.5.QualityAssessment. Thequalityofthestudiesincluded
wasassessedusingtheJadadscalewhoseratingcriteriatake
ID Diseasesearchterms
into account randomization, double blinding, withdrawals,
1 Depress∗ anddropouts[54].ThescoringrangeintheJadadscalegoes
2 Majordepress∗ from0to5inwhichahigherscorerepresentshigherquality
3 Mooddisorder ofthestudy.
4 Depressivedisorder
5 1OR2OR3OR4 3.Results
ID RCTsearchterms
6 Controlledclinicaltrial∗ 3.1.DescriptionoftheStudySelectionScheme. Thecombined
7 Random∗controlledtrial∗ databasesearchwascarriedoutfrominceptiontoMay2016
and resulted in 875 studies identified using the predefined
8 6OR7 search terms (Figure 1). After removal of duplicates (𝑛 =
ID Aromatherapysearchterms 207), the title of 668 studies was screened. Most of the
9 Aroma studiesexcludedwerenotconcernedwithdepressionand/or
10 Aromatherapy aromatherapy (𝑛 = 552). In addition, 84 studies were
11 Aromatictherapy excluded because they were not RCTs, they were not in
12 Essentialoil∗ English, and/or no depressive symptoms were measured.
13 Fragrance Aftertitlescreening,32studiesremainedforfurtherfulltext
14 Fragrantoil∗ screening. A total number of 20 studies were excluded at
this stage, 7 studies did not assess depressive symptoms, 1
15 Scent
studywasacommentary,6werenotRCTs,1studyassessed
16 Massagetherapy
cologneswhicharenotessentialoils,and5studiescouldnot
17 Medicalmassage
beaccessed.Fromthe5studiesthatcouldnotbeaccessed,1
18 Massage studywasnotdetectedasduplicatebeforesinceitappeared
19 9OR10OR11OR12OR13OR14 with a short title in the database search; therefore, only 4
OR15OR16OR17OR18
studies could not be accessed. The abstract of 2 of those
20 5AND8AND19 studies was available while no abstract was available of the
∗Truncationsymbolfordatabasesearch. other2studies.Theauthorsofthose4studieswerecontacted
viaemailrequestingthemthefullstudies.Wecouldnotget
access to four studies whose title suggested that the studies
aromatherapy and massage was included regardless of the
could be included in the systematic review. However, the
applicationmethodofthemassage.Therewasnorestriction
studieswerenorprovidedbytheauthorduetothefollowing
inthedurationofthetreatmentandnumberofsessionsused.
reasons: the study was still unpublished, the authors did
Systematicreviewsandmeta-analysesonaromatherapyand
not reply, or the author could not be reached. Therefore,
depression, mood disorders, or depressive symptoms were
those studies were excluded. A total number of 12 RCTs
notincluded.
[18–29] that met the inclusion and exclusion criteria were
selected.
2.3. Selection of Relevant Studies. After the article search
andremovalofduplicates,thetitlesofthearticlesretrieved
3.2.DescriptionoftheSubjects. Detailedinformationonthe
in the database search were screened. The abstracts of the
subjects is stated in Table 2. The total number of subjects
preselected articles were screened to make a selection for
from all the studies was 1226 from which 984 were female
further analysis. In case of doubt to include any study in
(80.3%) and 224 (18.3%) were male participants. The study
the second screening, the full article was reviewed. Two
conducted by Lemon [23] did not specify the number of
independentauthorscarriedoutthesearchandselectionof
female and male subjects in the control group; therefore
relevant studies for the present review. Disagreement was
thegenderof18subjects(1.4%)wasnottakenintoaccount
resolvedbydiscussion.
in the above mentioned percentages. The mean subject age
includedinthestudieswas47withmeanaverageagerange
2.4. Data Extraction. The data extracted included the ref-
of21–73.Theparticipantsincludedinthestudiesselectedare
erence, type of study, total number of subjects, number of peoplewithcancer(𝑛 = 682),pregnantwomen(𝑛 = 333),
subjects per treatment condition, brief description of the women in menopause phase (𝑛 = 90), patients diagnosed
subjects,andtheinclusioncriteria.Regardingtheinterven- withdepressionand/oranxiety(𝑛=32),postpartumwomen
tion,informationaboutthecomparisongroup,typeofaro- (𝑛 = 28), women whose children were diagnosed with
matherapy,durationofthestudy,frequencyofthetreatment, attention deficit/hyperactivity disorder (𝑛 = 25), healthy
outcomemeasures,andconclusionwereextractedfromthe female volunteers (𝑛 = 20), and patients diagnosed with
selectedstudies. idiopathicenvironmentalintolerance(𝑛=16).
4 Evidence-BasedComplementaryandAlternativeMedicine
n Initial search (n=875)
o
cati AMED (n=8) MEDLINE (n=153)
fi
nti CCTR (n=616) PsycINFO (n=44)
Ide CINAHL (n=54)
Duplicates
removed
(n=207)
Number of studies left
after elimination of
duplicates
(n=668)
g
n Studies excluded after title screening
eni (n=636)
e
cr Studies were excluded for the following reasons:
S
Remaining studies (i) Not RCT (n=71)
after title screening (ii) Not focused on depression (n=494)
(n=32)
(iii) Depressive symptoms not measured
(n=1)
(iv) Not focused on aromatherapy (n=58)
(v) Not in English (n=12)
Studies excluded after full text screening
(n=20)
Studies were excluded for the following reasons:
(i) Depressive symptoms not measured
bility Remaftaeinr ifnugll stteuxdties (ii) (Fnul=l s7t)udy not available from which 1
Eligi s(cnre=en1i2n)g was a duplicate study (n=5)
(iii) Commentary (n=1)
(iv) Not RCT (n=6)
(v) Other fragrances different than essential
oils used (n=1)
ed Studies included in the
ud systematic review
cl (n=12)
n
I
Figure1:Studyselectionflowchart.
3.3.Intervention 3.3.2. Intervention Group. Two administration methods for
aromatherapyidentifiedinthestudiesselected includearo-
3.3.1. Control Group. The comparison groups used in the matherapy via inhalation (inhalation aromatherapy, 𝑛 =
studies includednointerventiongroup(𝑛 = 6)[20,22,24, 5) [18–22] and aromatherapy with massage (aromatherapy
26, 28, 29], vehicle group (𝑛 = 4, received vehicle such as massage, 𝑛 = 7 plus 1 study from Conrad and Adams,
carrieroilorwater)[18,19,21,23],andactivecontrolgroup 2012,whichalsousedinhalationaromatherapy)[19,23–29].
(𝑛=2;usualsupportivecareandcognitivebehaviortherapy, NoRCTstudyincludedinvolvedaromatherapyadministered
well known treatments with positive effect on the outcome orally.Detailsoftheinterventionadoptedinthe12included
measures)[25,27]. studiesweresummarizedinTable3.
Evidence-BasedComplementaryandAlternativeMedicine 5
Baselinescorefordepressivesymptoms Baselinedepressionstatus:oddsratioof29usingHADS. ThebaselinescoreusingtheEdinburghPostnatalDepressionScaleforthecontrolgroupwas15.9and16.1fortheinterventiongroup. Depression-dejectionscalebaselinescoreusingPOMSwas2.7inthecontrolgroupand1.6inthetreatmentgroup. Thedepression-dejectionscalebaselinescoreusingPOMSwasnotprovided,butthechangedifferencebetweenpre-andposttreatmentwasreported.Thechangeindepression-dejectionscorewas−lowerthan1inthetreatmentgroupandstatisticallysignificantwhencomparedtothechangeinthecontrolgroup.DepressiongradebaselineintheEdinburghtestwas6.3inthecontrolgroupand6.1intheinterventiongroup.
rn a
theselectedstudies. Diagnosticsystems/inclusioncriteria Patientsprescribedwith8ormorefractionsofradiotherapy 0–18-monthpostpartumwomenwithscoresof10orhigheroneithetheEdinburghPostnatalDepressioScaleortheGeneralizedAnxietyDisorderScale 28-week-pregnantwomen,singletonpregnancy Healthyvolunteers Womenbetween18–35years,withpregnancyagebetween38and42weeks,ascoreof12orlessintheEdinburghtest
n
i
ded cts y en
participantsinclu Subje Typeofsubject ationaromatherapIndividualswithcancerreceivingradiotherapytreatment Postpartumwom Pregnantwomen Collegestudents Pregnantwomen
aracteristicsofthe 𝑛Gender() Inhal Female(150)Male(163) Female(28) Female(13) Female(20) Female(320)
h
C p
e2: ct up rou age
Tabl Meansubjeage(range) 65(33–90) 32(25–43) 27.3forthecontrolgro(NA)29.3forthetreatmentg(NA) 20.5 20–30,averageNA
of
r
e
b
m
us
nct
Totalsubje 313 28 13 20 320
Typeofstudy Placebo-controlledrandomizeddoubleblindRCT Randomizedobservationalpilotstudywithrepeatedmeasures ProspectiveRCT Randomizedcontrolledcrossoverstudy Controlleddouble-blindedRCT
Ref. [18] ∗[19] [20] [21] [22]
6 Evidence-BasedComplementaryandAlternativeMedicine
Baselinescorefordepressivesymptoms ThebaselineusingtheMontgomery-AsbergDepressionRatingScalewas19.8inthecontrolgroupand30inthetreatmentgroup.ThebaselineusingtheHADSwas14.6and15.3inthecontrolandtreatmentgroup,respectively. BaselinescoreusingHADSwasnotstated.OnlythemedianchangeinHADSwasprovidedbeing0forthe−aromatherapygroup,1.5forthe−massagegroup,0.5forthearomatherapymassagegroup,and0.5forthecontrol. ThebaselinescoreusingtheCenterforEpidemiologicalStudiesDepressionScalewas26.1forthearomatherapygroupand26forthegroupreceivingusualcare(control). DepressionsubscalebaselinescoreusingPOMSwasaround2.8inthecontrolperiod. ThebaselinescoreusingtheEdinburghPostnatalDepressionScaleforthecontrolgroupwas15.9and16.1fortheinterventiongroup.
Diagnosticsystems/inclusioncriteria Patientsscoringmorethan7intheMontgomery-AsbergDepressionRatingScaleand/ortheTyrerBriefAnxietyScale Individualswithcancerwithawidevarietyoflevelsofphysicalandpsychologicalsymptoms Patientsdiagnosedwithcancer,aprognosisofmorethan3months,withclinicalanxietyordepression Clinicalexaminationbyaphysicianandscoringabove26formenand30forwomenintheChemicalOdorSensitivityScale0–18-monthpostpartumwomenwithscoresof10orhigheroneithertheEdinburghPostnatalDepressionScaleortheGeneralizedAnxietyDisorderScale
ble2:Continued. Subjects Typeofsubject matherapymassage Patientswithdepressionand/oranxiety Individualswithcancer Individualswithcancer Patientsdiagnosedwithidiopathicenvironmentalintolerance Postpartumwomen
Ta 𝑛Gender() AroFemale(10inthetreatmentgroup)Male(4inthetreatmentgroup)Noinformationprovidedonthenumberoffemaleandmalesubjectsinthecontrolgroup Female(32),male(10) Female(250),male(38) Female(15),male(1) Female(28)
Meansubjectage(range) 32.9(23–53)inthetreatmentgroup 73,(44–85) 52.1;52.8fortheusualcaregroup;and51.5fortheusualcareplusaromatherapygroup 46.1(37.9–54.3) NA
of
r
e
b
m
us
nct
Totalsubje 32 42 288 16 28
r
e
Typeofstudy RCT DoubleblindRCT RCT Nonblindedrandomizedcrossovtrial Randomizedobservationalpilotstudywithrepeatedmeasures
Ref. [23] [24] [25] [26] ∗[19]
Evidence-BasedComplementaryandAlternativeMedicine 7
Baselinescorefordepressivesymptoms Thebaselinescoreinthedepression-dejectionsubscaleofPOMSwas11.2forthearomatherapymassagegroupand13.4forthecontrolgroup. Atbaseline,accordingtotheMenopauseRatingScale,thefrequencyoftheseverityofthedepressivemoodwasreportedasmild(14.9%),moderate(36.8%),severe(20.7%),andverysevere(2.3%).Nodifferencewasfoundamongthegroupsatbaseline.BaselineusingtheBeckDepressionInventorywas8.6inthecontrolgroupand10.8inthetreatmentgroup. etable.NA,notavailable;HADS,Hospital
h
Diagnosticsystems/inclusioncriteria Patientsdiagnosedforatleastonemonth,whoalsohadatleastapredictedsurvivalof6monthsandscore11ormoreintheHADSforanxietyordepression Woman,agebetween45and60years,withamenorrheaforatleast1year Womenwhosechildrenwerediagnosedwithattentiondeficithyperactivitydisorder studywasincludedinbothcategoriesint
e
h
able2:Continued. Subjects Typeofsubject Individualswithcancer Womenwhoenteredtheirmenopausalperiodnaturally Womenwithchildren erapymassage.Therefore,t
T h
at
m
𝑛Gender() Female(31),male(8) Female(90) Female(25) erapyandaro
h
Meansubjectage(range)52.5;51.1forthearomatherapygroup;and54forthecognitivebehaviortherapygroup53.70forthecontrolgroup(49.42–57.98),52(47.12–56.88)forthemassagetherapygroup,and53.35(49.01–57.69) 34–48,averageageNA d,inhalationaromatStates.
berof weretesteofMood
Totalnumsubjects 39 90 25 modalitiesMS,Profile
yO
apP
herale;
ofstudy eblindRCT y,botharomatDepressionSc
TypeRef. Singl[27] RCT[28] RCT[29] ∗InthisstudAnxietyand
8 Evidence-BasedComplementaryandAlternativeMedicine
InthestudycarriedoutbySehhatieetal.[22],acombi- from 1 to 56 sessions [18–21] (Table 3). In one study, the
nationofnonpharmacologicalinterventionsforpainreliefin totaldurationoftheexposuretothearomawasnotspecified
labor,includingaromatherapy,wasusedintheintervention sincetheinterventionwascarriedoutduringtheactivephase
group. The contribution of aromatherapy in the combined of the labor process that pregnant women underwent [22].
interventioncannotbediscriminatedinthisstudy.Therefore, Furthermore,thefrequencyofthetreatmentinthe5studies
caution should be taken when discussing the results of this differs greatly. For example, the frequency of treatment in
study. the studies varies from once [20, 22], twice [21], and twice
a week [19] to daily [18]. The duration of the treatment in
3.4.SelectionofEssentialOils. Essentialoilsweremainlyused theinhalationaromatherapystudiesallowedtheevaluationof
pure, diluted, or in a mixture of 2 or more essential oils acuteandlongtermeffectduetothedurationofthetreatment
at a particular ratio. The selection of the essential oils used from1-2daysto4–8weeks,respectively.
wasdeterminedbythearomatherapist,theeffectonphysical
andphysiologicalstates,subject’spreference,orsafetyforuse 3.5.2. Aromatherapy Massage. The types of massage are
duringpregnancywhileotherstudiesdidnotmentioninthe performed with standardized protocols [24–27] in which 3
methodology section the rationale behind the essential oils ofthestudies[25–27]didnotdescribetheareasofthebody
chosennorspecifythetypeofessentialoilsused.Themost forthedeliveryofthemassagewhileanotherstudyspecified
commonlyusedessentialoilswerelavenderin8studies[18– the target body areas to deliver the massage such as back
20,22–24,28,29]. massage[24].Othermassagetargetareaswerealsodescribed
in three studies [19, 28, 29]. Taavoni et al. [28] focused the
3.4.1. Inhalation Aromatherapy. The essential oils that were massage on the abdomen, thighs, and arms while Wu et al.
morecommonlyusedintheinhalationaromatherapystudies [29]focusedontheneck,shoulders,arms,back,andlegswith
werelavenderandbergamoteitherasasingleessentialoilor effleurage, friction, petrissage, and vibration at a moderate
inamixturewithotheressentialoils[18–20,22–24,28,29]. pressure.InthestudyofConradandAdams[19],theessential
Onemixtureoffractionatedessentialoilswasused,butthe oilmixturewasappliedonbothhands(handaromatherapy
typeofessentialoilscontainedinthemixturewasnotspeci- massage) using the well m’technique which involves gently
fied[18].Inaddition,thepurityofthefractionatedmixture strokingmovementsappliedinasetsequencewithstructured
was unknown. Other essential oils utilized were petitgrain strokes, sequence, number, and pressure [45]. The duration
[20] and Yuzu [21] essential oil alonewhile cedarwood [18] ofthestudieswas4,8,10,and12weeksand2years.Weekly
androseotto[19]wereusedincombinationwithamixture sessionswerecarriedoutinmostofthestudies[19,24,25,27–
oflavenderandbergamot,andlavender,respectively. 29];onlyinonestudythefrequencywasonceevery2weeks
[26].Thenumberofsessionsperweekalsovariedfromonce
3.4.2.AromatherapyMassage. Asetof20differentessential or twice weekly to once every 2 weeks. The duration of the
oil options were used in two of the studies from which the treatments was 15, 30min, and 40min to 1h and the total
therapistschosethemostsuitableessentialoilforeachoneof numberofsessionsvariedfrom4and6to8sessions.
thesubjects[25,27].However,thetypeofessentialoilsused
providedtotheparticipantswasnotspecifiedinthosestudies.
3.6. Outcome Measures. A summary of the outcome mea-
On the other hand, in the study conducted by Lemon [23],
suresisshowninTable4.Themostfrequentlyusedinstru-
theessentialoilsusedwereselectedfromalistof9options
mentswereHADSandPOMS[18,20,21,24,26,27]followed
andtheauthorspecifiedthetypeofessentialoilusedineach
by EPDS which was used in 2 studies [19, 22]. Other
subject of the intervention group. The essential oils used in
assessment tools include the MADRS [23], MRD [28], BDI
theotherstudiescompriselavender,amixtureof2–4different
[29],andCES-D[25].
essentialoils,androseottocombinedwithlavender.
3.7.EfficacyofAromatherapy
3.5.AdministrationProtocol
3.7.1.InhalationAromatherapy. Twooutof5studiesevaluat-
3.5.1. Inhalation Aromatherapy. The method of administra- ingtheeffectofinhalationaromatherapyreportedbeneficial
tion of inhalation aromatherapy also differed among the effects to improve depressive symptoms in the subjects [19,
studies [18–22]. The main differences in the administration 21].ThesubjectsinthestudyofConradandAdams[19]were
methodsrelyonthedistancebetweenthearomasourceand postpartum women exposed to two different aromatherapy
the subject’s nose. In one study, cotton impregnated with interventions, inhalation aromatherapy and topic applica-
essential oil placed in a diffuser was set in the nostrils of tion of aromatherapy, for 8 sessions. At baseline, control
the subjects [21]. In the other two studies the source of and treatment groups showed similar levels of depressive
aromawasplacedapproximately30cmawayfromthenose symptoms (EPDS: 𝑝 = 0.8). At the end of the study, the
of the subjects [18, 20]. In other two studies, the essential treatment group with aromatherapy showed a significant
oil was applied to a bib or to a cloth that were worn by reductionofdepressivesymptoms(EPDS:𝑝 = 0.01),butthe
the participants [18, 22]. The volume of essential oil used improvement was lesser than using m’technique. The study
intheinhalationaromatherapystudiesvariesfrom10𝜇Lto conducted by Matsumoto et al. [21] showed improvements
1mL or 3, 5, or 8 drops. The exposure time to the aroma in negative emotional stress after 2 sessions of 10min on
ranged from 5 to 20 minutes, with the number of sessions healthy volunteers. The TMD score (𝑝 < 0.001) and the
Evidence-BasedComplementaryandAlternativeMedicine 9
r
bens
mo
nuessi 56 8 1 2 1
als
otof
T
Durationpersession 15–20min 15min 5min 10min(sessionsseparatedinintervalsaround2.6days) Durationoftheactivephaseoflabor
Treatmentfrequency Daily Twiceaweek Once Twice Once
dintheselectedstudies. Administrationmethod 3dropsofoilappliedtoabibwornduringtheadministrationofthetreatment 8dropsofoilappliedtoacottonpad.Subjectswereinstructedtosmellthecottonpadfor15min 5dropsofoilappliedonafilterplacedinadiffuser 𝜇10Loilinacottonpadusedinadiffusersetinthesubject’snostrils ×1010cmclothimpregnatedwith1mL20%lavenderessentialoilwhichwasattachedtothemother’sbreastatthebeginningoftheactivephase.Thearomatherapyinterventionwascombinedwithothernonpharmacologicalinterventions
e
s
andprotocolsu protocolDurationofthestudyromatherapy 8weeks 4weeks 1day 2days Duringlabor
escriptionoftheinterventions Interventionand Typeofessentialoilused Inhalationa(i)Fractionatedoilsofunknownpuritydiluted1:3incarrieroil(ii)Mixtureoflavender,bergamot,andcedarwood(2:1:1)(i)0.25roseottoessentialoiland0.75lavender,2%dilutionoftheessentialoilmixture(i)Lavender(ii)Petitgrain(iii)Bergamot (i)Yuzu (i)20%lavenderessentialoil
D
Table3: Treatmentgroup(s)𝑛() (i)Carrieroilwithfractionatedlow(NA)gradeessentialoil(ii)Pureessentialoil(NA) (i)2%dilutionofamixtureofessentialoils(6) (i)Pureessentialoil(7) (i)Pureessentialoil(20) (i)Nonpharmacologicalmethodsforpainreliefoflaborincludingshowering,beinginuprightposition,aromatherapy,andsoftmusicwithoutwords(160)
Comparisongroup𝑛() Controlwithsweetalmondcold-pressedpurevegetableoilwithnofragrance(NA) Control,jojobaoil(14) Control,nointervention(6) Control,water(20) Controlgroupwhichdidnotreceiveanynonpharmacologicalmethodforpainreliefoflabor(160)
e
c
n
e
Refer [18] ∗[19] [20] [21] [22]
10 Evidence-BasedComplementaryandAlternativeMedicine
Totalnumberofsessions 6 4 4 4 8 Upto8sessionsin10weeks 8
n
ationessio min min h h min h min
Durers 40 30 1 1 15 1 30
p
Treatmentfrequency Onceafortnight Weekly Weekly Everytwoweeks Twiceaweek Weekly Twiceaweek
Administrationmethod 15mLgrapeseedcarrieroilwith(4drops)orwithoutessentialoilsappliedinafullbodymassageusinggentleeffleurageandpetrissage Backmassage Standardizedmassageagreedbythetherapists Standardizedmassageontheback,shoulders,arms,hands,lowerlegs,andfeetusing20–30mLmassageoil TopicapplicationoftheoilorlotiononbothhandswithgentlestrokesofhomogeneouspressureandspeedStandardizedmassagecombinedwithtreatmentasusual(routinesupport)Massageintheabdomen,tights,andarmsusingmassageoilcontainingessentialoilsorodorlessliquidpetrolatum.Massagewasappliedwithclockwisecircularmovementsandlightpressure
ontinued. rotocolDurationofthestudypymassage 12weeks 2years 10weeks 8weeks 4weeks 2years 4weeks
C p a
Table3: Interventionand Typeofessentialoilused Aromather(i)9essentialoils(bergamot,lemonclarysage,lavender,romanchamomile,geranium,roseotto,sandalwood,andjasmine).Acombinationofessentialoilschosenbythearomatherapistoneachtreatmentsession(16) (i)1%lavenderessentialoildilutedinsweetalmondoil (i)20essentialoils (i)1%massageoilcontainingmelissa,juniper,androsemaryessentialoilsmixedintojojobaoil(1:2:2ratio) (i)0.25roseottoessentialoiland0.75lavender,2%dilutionoftheessentialoilmixture (i)20essentialoils (i)3%oilmixturecontaininglavender,geranium,rose,androsemary(4:2:1:1ratio)inalmondandeveningprimroseoil
Treatmentgroup(s)𝑛() (i)Dilutedessentialoil(16) (i)Aromatherapymassage(16)(ii)Massagewithinertcarrieroil(13)(i)Usualsupportivecareandaromatherapymassage (i)Aromatherapymassage (i)2%dilutionofamixtureofessentialoils(8) (i)Aromatherapymassage(20) (i)Aromatherapymassage(30)(ii)Massage(30)
e
Comparisongroup𝑛() Control,grapeseedoil(16) Control,nointervention(13) Usualsupportivecar Control,nointervention Control,essentialoilblendunscentedwhitelotion(14) Cognitivebehaviortherapy(19) Control,nointervention(30)
e
c
n
e
Refer [23] [24] [25] [26] ∗[19] [27] [28]