Aromatherapy Massage and Inhalation Improve Symptoms of Depression in Older Adults
Depression among older adults is associated with problems including functional decline or disability, low quality of life, demands on caregivers, increased use of mental health services, and mortality due to chronic illnesses or suicide. Prescription antidepressants can have limited efficacy and may cause adverse effects. Aromatherapy, which is easy to use, inexpensive, and associated with few adverse effects, is among the complementary and alternative medicine therapies used to manage depression. These authors, from Chengdu Medical College in Chengdu, China, conducted a prospective, randomized, controlled trial to evaluate the psychological and physiologic effects of aromatherapy on depression in older adults.
The participants included adults aged 60 years and older from six communities in the Xindu District of Chengdu City, Sichuan Province, China, who completed a mental health survey from May to August 2015. The mean age of all 60 participants was 67.87 ± 7.51 years; 39 (65%) completed primary education only or were illiterate, and 42 (70%) had a chronic disease. Thirty of the participants were males. On average, they scored 6.83 ± 1.58 out of 15 on the Geriatric Depression Scale-Short Form (GDS-SF) and 10.55 ± 1.54 out of 27 on the Patient Health Questionnaire-9 (PHQ-9). Higher scores on the questionnaires indicate more severe symptoms of depression. Participants were able to understand, communicate, and follow instructions and had no apparent cognitive impairment. They had not used aromatherapy but agreed to its use for the study.
Twenty patients were randomly assigned to each of the following groups: aromatherapy massage, aromatherapy inhalation, or control. The groups were similar in age, sex distribution, educational level, chronic disease, GDS-SF and PHQ-9 scores, and 5-hydroxytryptamine (5-HT) concentrations. Low levels of 5-HT are associated with depression.
The aromatherapy massage group received 30 minutes of massage with 5 mL oil twice weekly for eight weeks. The oil contained 50 µL (1 drop) of compound essential oils, including lavender (Lavandula angustifolia, Lamiaceae), sweet orange (Citrus sinensis, Rutaceae), and bergamot orange (Citrus bergamia) in a 2:1:1 ratio, diluted in sweet almond (Prunus dulcis, Rosaceae) oil to a concentration of 1%. The aromatherapy inhalation group received 30 minutes of nasal inhalation of 50 µL of the essential oils blended in 10 mL of purified water, twice weekly for eight weeks. The control group received no intervention.
Fasting blood samples were collected at baseline and after the eight-week intervention to measure 5-HT concentrations. Data were recorded at baseline, after eight weeks of intervention, and at follow-up visits at six and 10 weeks. Because of difficulties obtaining blood, only the GDS-SF and PHQ-9 were measured at the follow-up visits.
In the aromatherapy massage group, symptoms of depression improved in 13 (65%) participants after the eight-week intervention, 12 (60%) participants at the six-week follow-up, and 11 (55%) participants at the 10-week follow-up. In the aromatherapy inhalation group, symptoms of depression decreased in 11 (55%) participants after eight weeks of treatment, in 11 (55%) participants at the six-week follow-up, and in eight (40%) participants at the 10-week follow-up. In the control group, one (5%) participant after eight weeks, one (5%) participant at the six-week follow-up, and two (10%) participants at the 10-week follow-up had fewer symptoms of depression compared with baseline.
The 5-HT concentrations were significantly increased after the eight-week intervention period compared with baseline in the aromatherapy massage and aromatherapy inhalation groups (P<0.05 for both groups).
Limitations of this study include the following: changes in 5-HT concentrations could not be monitored during the follow-up period because of difficulties in collecting blood samples; researchers and participants could not be blinded to the interventions; the placebo effect in the experimental groups could not be eliminated, as no massage or inhalation without aromatherapy was provided; and diagnosis of depression was not confirmed in the participants. The authors suggest future studies investigate the effects of aromatherapy alone or combined with psychotherapy or drug therapy on depression in the elderly.
“As an intervention approach,” write the authors, “aromatherapy has significant potential for older adults with depression, and may have important implications for mental health promotion in the community.”
Xiong M, Li Y, Tang P, et al. Effectiveness of aromatherapy massage and inhalation on symptoms of depression in Chinese community-dwelling older adults. J Altern Complement Med. July 2018;24(7):717-724. doi: 10.1089/acm.2017.0320.