 Aromatherapy is the use of concentrated essential oils extracted from plants to treat disease, and is commonly used to treat anxiety symptoms. Anxiety disorders are the most prevalent class of psychiatric disorders in the general population. However, their treatment is still challenging, as the drugs used for the relief of anxiety symptoms can have important side effects. Thankfully, double-blind randomized placebo-controlled clinical trials performed to evaluate the effects of essential oils on anxiety symptoms are gradually starting to appear in the medical literature. However, in most of these studies, exposure to the essential oil odor was accompanied by massage. This makes it difficult to draw firm conclusions about the effect of the aroma itself. Here's a typical example. Patients in the intensive care unit the day after open heart surgery getting foot massages with orange-scented oil. Why not back massages? Because they just had their chests cracked open, so of this huge sternotomy wound. Maybe a preventive plant-based diet, rather than a post-op plant-based massage, might have been the better choice. But the massages felt great, restful, peaceful, calming. You know, it's a British study, because one described the effect as smashing. But how do we know the essential oil had anything to do with it? Maybe it was just a massage that was so bloody good. In which case, great! Let's give people massages. I'm all for more ICU foot routes. There's considerable evidence from randomized trials that massage alone reduces anxiety. So if massage is effective, then aromatherapy plus massage is also effective. So, you know, aromatherapy may work even if it doesn't. We have one study where cancer patients got massaged during chemo and radiation, even found that the massage, without the fragrance, may be better. They thought it might be like a negative Pavlovian response. You know, people smell the citrus and their body's like, oh no, another, you know, cancer treatment. More recently, the ambient odor of orange was tested in a dentist's office to see if it reduces anxiety and improves mood. Ambient odor of orange was diffused into the waiting room. It appeared to have a relaxing effect, less anxiety, better mood, and calmness compared to the control group where there was no odor in the air. No odor, that is, except the nasty dentist office smell. Maybe the orange scent was just masking the unpleasant odors. Maybe it had nothing to do with any kind of orange-specific molecules. More research was necessary. The effect of sweet orange aroma on experimental anxiety in humans. They exposed some grad students to an anxiety-producing situation and tested the scent of orange versus a non-orange aroma versus no scent at all. And the orange did appear to have an anxiety-reducing effect. Interestingly, the observed anxiety-reducing effects was not followed by physical or mental sedation. On the contrary, at the highest dose the orange oil made the volunteers feel more energetic, so potentially less anxiety without the downer effect of valium-type drugs. Which does that mean we can get the benefits without the side effects? Well, I've talked about the concerns about using scented consumer products, even ones based on natural fragrances. And there have been reports of adverse effects of aromatherapy, in fact some pretty serious reactions. Alternative medicine isn't necessarily risk-free. Like there's dozens of reported cases of people having their hearts ruptured by acupuncture. Ouch! But the adverse effects of aromatherapy were mostly from skin irritation, from essential oils being applied topically to the skin, or even worse, swallowed. Certain citrus oils can make our skin sensitive to sunlight, though less of a problem in France, evidently, where they're known to stick them where the sun doesn't shine.