Lavender (Silexan)
CAM (blocks glutamate through calcium channels (similar to gabapentin). Modulates serotonin receptor binding at 5HT1A (similar to SSRIs but does not block reuptake. Neuroprotective)
- Generalized Anxiety1
- Anxious Depression1
- Major Depression2 (and moodiness in women on oral contraceptives)
- Insomnia with anxiety2
- Non-specific anxiety1
- Safe in bipolar
Features
Dosing
Anxiety: 80 mg qhs x7 days then 80 mg bid (can take all at night). 80 mg is barely effective.
Depression and insomnia: 80 mg qhs (can raise to 160 but most studies used 80 mg).
INTERACTIONS: None.
Management
Large effect in generalized anxiety (twice that of SSRIs), also improves sleep a little. Has benzo-like effects but not addictive, also serotonergic and glutamatergic effects. Unlike most CAM products lavender is produced by a German pharmaceutical firm and has regulatory approval for anxiety in many countries (as Silexan; US product is CalmAid by same company).
Benefits may be within a few days but generally 1-2 months for full effect.
Aromatherapy also improves sleep and anxiety independent of its scent (it is intranasal drug delivery)
TOLERABILITY: Lavender burping, reflux. Not sedating but improves restless, anxious sleep.
RISKS: Estrogen-like effects so may not be safe in child/adolescent boys, but this has since been refuted. It is also safe in history of breast cancer, and does not disrupt oral contraceptives (see EMR text).
EMR Text
Generalized Anxiety Disorder
Lavender (Silexan) use based on large randomized controlled trials in generalized anxiety disorder, where it surpassed paroxetine and equaled lorazepam (Silexan has regulatory approval in Europe) (Kasper S, Eckert A, Eur Arch Psychiatry Clin Neurosci 2024).
Lavender side effects reviewed with patient.
Depression
Lavender (Silexan) use based on large randomized controlled trials in major depressive disorder, including lareg trials in anxious depression, pure depression, and mood problems related to oral contraceptives (Kasper S, Eckert A, Eur Arch Psychiatry Clin Neurosci 2024).
Lavender side effects reviewed with patient.
Anxious insomnia
Lavender (Silexan) use based on a large randomized controlled trials where it improved restless sleep related to anxiety (Kasper S et al, Eur Neuropsychopharmacol. 2015;25(11):1960-7).
Lavender side effects reviewed with patient.
Use in adolescent boys
Lavender (Silexan) use based on large randomized controlled trials in generalized anxiety disorder, where it surpassed paroxetine and equaled lorazepam (Silexan has regulatory approval in Europe) (Kasper S, Eckert A, Eur Arch Psychiatry Clin Neurosci 2024).
Lavender side effects reviewed, including risk of gynecomastia. This was observed with topical lavender oil in early case reports, but has not been reported with oral lavender, and laboratory and clinical studies have found no endocrine-disrupting effects (Hareng L et al, Arch Toxicol 2024;98(1):347-361; Hawkins J et al, Int J Pediatr Adolesc Med. 2022;9(2):117-124).
Use in women with breast cancer history
Lavender (Silexan) use based on large randomized controlled trials in generalized anxiety disorder, where it surpassed paroxetine and equaled lorazepam (Silexan has regulatory approval in Europe) (Kasper S, Eckert A, Eur Arch Psychiatry Clin Neurosci 2024).
Lavender side effects reviewed, including risk of estrogen-like effects. Although reported in early papers, this has since been refuted (Hareng L et al, Arch Toxicol 2024;98(1):347-361). Lavender does not interact with oral contraception and is often used as a symptomatic treatment at breast cancer centers. Preclinical studies suggest it has anti-tumor effects against breast cancer (Mehdipour A et al, Sci Rep. 2024;28;14(1):29543; Maitisha G et al, Heliyon. 2023;8;9(11):e21759).