Comparison of the Effect of Lavender and Bitter Orange on Depression in Menopausal Women: A Triple-Blind Randomized Controlled Trial

Menopause is an inevitable milestone and an important stage in every woman’s life (1) and a physiological event that occurs due to lack of ovarian activity and permanent cessation of menstruation and it is when 12 months have passed from the last menstrual period (2). Since one third of women’s life is spent after menopause, there should be conditions for postmenopausal women to experience a life with high quality without pain, illness, and disability. Menopause is a natural and important stage of women’s life that occurs between the ages of 45 and 55 and the average age for menopause is 50 (3,4). In developed countries, the average age at menopause is about 51 years, whereas in countries like India (5), Philippines, Pakistan and Thailand, it is reported to be 45-50 years (6). The average age of menopause in Iran was reported as 48.2 in 2011 (7). The population of postmenopausal women is estimated to increase from 742 150 000 in 2010 to 1.2 billion until 2030, and the most of this enhancement will occur in developing countries (8). Decreased estrogen levels are associated with a wide range of menopausal symptoms, the most common vasomotor symptoms include hot flashes and night sweats (9). Symptoms such as irritability, anger and depression also aggravate at menopause (10). In a study in 2013 in Pakistan, prevalence of depression in postmenopausal women was reported as 39.4% (1) and it was reported as 34.7% in postmenopausal women in Dezful, Iran (11). Reduced estrogen levels in menopause indicates that the cause of depression is related to female hormones (12). Depression can negatively affect social functioning and may cause loss of interest in enjoyable activities, sleep problems, loss of appetite or increased appetite, feeling of sadness, tiredness, low energy and even lead to suicide attempts (13). Although medical treatment including hormone therapy and relaxation therapy are considered the first-line of treatment for depression, many women are not eligible to use them (14). Several potential side effects have been associated with hormone therapy including thromboembolism, gallstones, cerebral stroke, breast and endometrial Abstract Objectives: Menopause is an inevitable milestone and an important stage in every woman’s life. This study aimed to compare the effects of lavender and bitter orange on depression in menopausal women. Materials and Methods: This triple-blind randomized controlled clinical trial was conducted on 156 menopausal women in Urmia, Iran in 2015. Eligible women were allocated into 2 intervention groups and one control group with a ratio of 1:1:1 through the randomized block design. Intervention groups received 500 mg capsules containing only bitter orange or lavender flower’s powder and control group received 500 mg starch capsules, all groups used capsules twice daily after breakfast and dinner for 8 weeks. Capsules were in the same appearance. Beck Depression Inventory was completed by the participants before and 8-week after the commencement intervention. The analysis was performed based on intention to treat approach. Results: The one-way analysis of variance (ANOVA) analysis showed no significant difference in mean depression score in the three groups before the intervention (P = 0.262); however, the general linear model test adjusted for base line and confounding factors such as menopausal age and women age showed significant differences between the groups in the mean depression score after 8 weeks of treatment (P < 0.001). Bitter orange significantly reduced the mean depression score compared with the control group (adjusted mean difference [AMD], -2.88; 95% CI, -4.26 to -1.51). Lavender significantly reduced the mean depression scores compared with the control group as well (AMD, -3.01; 95% CI, -4.40 to -1.63). There was no significant between lavender and bitter orange groups after intervention (P = 0.850). Conclusion: Considering the positive effect of bitter orange and lavender in reducing depression in menopausal women, they can be used as a complementary medicine in depressed patients.