Case Study on Depression and Lethargy

Introduction and History:  

The client is a 29 year old, single mother of three children who found herself in a precarious situation of trying to provide for her children during COVID 19.  Feeling stressed financially, emotionally, and physically, she agreed to try aromatherapy when encouraged to do so by her friend.  She had no prior knowledge or involvement with complimentary or alternative modalities. She experienced depression prior to the birth of her third child, but was reluctant to take medication while pregnant. Once she was done nursing the baby, she and her doctor worked together to address her depression. She has been taking Sertraline (Zoloft) since the cessation of nursing her last child, which was working fine until confined to her home and out of work. She described herself as having a stress level of 1 prior to the COVID 19 crisis and now a level 10 (scale of 1-10 with 1 being nominal and 10 severe).  She is feeling depressed and lethargic, finding it difficult to do simple tasks such as feeding her children, engaging with them, or cleaning her home. Joy is elusive. 

 Essential Oils Selected:  

Pink Grapefruit (Citrus paradise Macfad.) 

Rose Bulgarian (Rose damascene Miller)

Details of Blend: 

Combined in an inhaler. 

Choosing the Blend:  

The client was wary about applying anything to her body or following a protocol that would require follow through and energy on her part.  She was however, willing to try an inhaler.  She was decisive with smells with definite likes and dislikes.  Pink Grapefruit was her essential oil of choice.  I encouraged her to try the Rose and after a couple of quick sniffs she decided that there was something about it she found appealing.  

Client Response:  

The client remarked that she really liked the aroma and wanted to keep sniffing it. The combination of the two oils reminded her of sweet treats and frosting, taking her back to happy times. Over the course of the next two days, she found herself engaging with her children, reading them books and cooking them meals rather than just plopping a bowl of cereal in front of them. She felt strengthened and regenerated, choosing to organize closets and look to the future, rather than focus on the negativity of the current issues regarding the global pandemic. The simplicity is what has made this modality so wonderful for the client.

Rationale:

Grapefruit essential oil has the fragrance of a freshly peeled grapefruit that sparkles with citrus evoking confidence and clarity, while rose essential oil brings out strength and courage to overcome (Hargis, 2015). The combination of the two complimented one another in both fragrance and potential benefits.  

In experiments on animals, it was found that the smell of citrus seemed to restore homeostatic balance and with that success in mind, human subjects were exposed to citrus and antidepressant dosages were able to be significantly reduced (Komori, et al. 1995).  One of the most prevalent constituents in grapefruit essential oil is limonene (Tisserand, 2014).  One of limonene’s many benefits is its ability to lift one’s mood, invigorate and allow one to focus. It also has the ability to help a person fight depression and anxiety, which is prevalent with my client, especially with the COVID 19 situation (Lodi, 2018;).  Since my client was confined to her home due to the “Shelter in Place,” order, she not only experienced anxiety, but also lost the invigoration, which her employment provided.  

Rose is one of the most balancing essential oils for the emotions, with the ability to relieve sadness and depression (Hargis, 2015). Two constituents in rose are citronellol and geraniol, both of which have been identified as having anti-depressant properties and believed to bring happiness and self-confidence (Mahboubi, 2016).  Additionally, a study done with pregnant and postpartum women found that rose can influence the central nervous system producing an anti-anxiety state, credited to the citronellol and phyenethyl alcohol content (Kianpour, M, et al. 2018). I was unsure if postpartum depression was a possible piece to this puzzle as the client was a bit reluctant to share.  However, given the circumstances, I felt the Rose would be an ideal complement to the fragrance of the blend with the potential for additional emotional support.  Fortunately, the client, did indeed, find the fragrance very satisfying. 

The simplicity of breathing and inhalation is interesting and much is being written about it.  Rats that had been deprived of sleep, exhibited a decrease in physical endurance as well as negative emotions and cognitive dysfunction compared to a control group.  The group that was exposed to essential oils via inhalation behaved significantly better (Han, et al. 2018). Studies continue with exploring slow, deep breathing on stress pathways and global changes in brain activity which change the emotional response to stressors with calm alertness (Noble and Hochman, 2019).  The simple act of inhalation of essential oils certainly made a difference for this young mother and she is finding joy again. She is taking the time to prepare meals, eat with the children, and engage in activities with them, rather than let the television be the sole babysitter.  She still requires her Zoloft medication and notices definite changes in her demeanor and mood when she forgets to take it. At this point, the inhaler acts as a support mechanism.  

Follow Up and Conclusion: If the client were so inclined, I would have preferred to continue to meet with her to ascertain the long-term benefit of this blend.  However, this client is not currently interested in continuing with protocols unless suggested by her doctor and covered by her insurance. She has also admitted to having an addiction to fast food, which she feels interferes with her moods, but she is not ready to begin addressing it.  At this point, the most important gift I can give her is a relationship of trust, allowing her to decide when she is ready for the next step.   

References:

1.) Han, C. et al. (2018) Beneficial effect of compound essential oil inhalation on central fatigue. BMC Complementary Medicine and Therapies. 18:309

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260882/

[Accessed April 24, 2020]

2.) Hargis, L. (2015).  Common Scent, A Practical Guide to Aromatherapy. French Kitchen Table Publishing. 

3.) Kianpour, M, et al. (2018)  The effects of inhalation aromatherapy with rose and lavender at week 38 and postpartum period on postpartum depression in high-risk women referred to selected health centers of Yarzd, Iran in 2015.  Iranian Journal of Nursing and Midwifery Research. Volume 23 (5) Page : 395-401

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111664/

[Accessed April 23, 2020]

4.) Komori, T. et al. (1995) Effects of citrus fragrant on immune function and depressive states. Neuroimmunomodulation. 1995 May-June; 2 (3): 174-80

https://www.ncbi.nlm.nih.gov/pubmed/8646568/

[Accessed April 24, 2020]

5.) Mahboubi, M (2016) Rosa damascena as holy ancient herb with novel applications. Journal of Traditional and Complentary Medicine.  2016 Jan; 6 (1): 10–16.

[Accessed April 23, 2020]

6.) Lodi, M. (2018) Terpenes 411:  What is Limonene?  EMBER A Journal of Cannabis and Culture December 04

https://www.medmen.com/blog/guides/terpenes-411-what-is-limonene

[Accessed April 25, 2020]

7.) Noble, D. and Hochman S. (2019) Hypothesis:  Pulmonary Afferent Activity Patterns During Slow, Deep Breathing Contribute to the Neural Induction of Physiologocial Rexlaxation.  Frontiers in Physiology. 2019; 10: 1176

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753868/

[Accessed April 24, 2020)

8.) Tisserand, R. and Young, R. (2014) Essential Oil Safety.  Churchill Livingstone.