Dear Mr. Tisserand,
I was treating a young woman with back pain recently. This young woman is on selective serotonin re-uptake inhibitor (SSRI) type of anti-depressant medication. Because her pain was acute I used a 10% blend on the specific site of pain that included German chamomile, black pepper, ginger and everlasting. About 30 minutes after the application she vomited and told me she suspected the essential oils may have caused her to be sick. She mentioned serotonin syndrome which is caused by an overload of serotonin in her system.
I referred to quite a few texts (including your book) and could not find any contraindications listed. I did find some notes that my aromatherapy lecturer gave me that states chamomile, lavender, marjoram, and neroli have the action of releasing seratonin in the system when used.
Are there any active chemicals (eg linalool or some other) that might have this effect that you are aware of? I would appreciate any help you could provide.
Kind regards
-Liliana
Dear Liliana,
Tough question. I wonder how much total oil you applied to her body? And what proportions you used of each oil? Only about 10% of that would be absorbed by the skin, so 10% EO applied becomes 1% EO absorbed. It’s then a matter of whether enough oil got into her bloodstream to provoke such a strong non-local reaction. It’s not impossible.
Some oils do affect serotonin directly, but not massively. It’s more likely that an oil/constituent increased the SSRI effect (so indirectly causing a further increase in serotonin), if indeed the essential oils were responsible for her vomiting. The only ones known to interact badly with SSRI drugs are eugenol-rich oils (such as clove) and myristicin-rich oils (such as nutmeg), and you used none of those. These two constituents are monoamine oxidase (MAO) inhibitors, which can cause this interaction with SSRI drugs.
If it was something you used, I would guess that it’s not the black pepper or ginger, which are rich in terpenes.
-Robert
Hi Robert
Thank you so much for your quick reply!
What you have said makes a lot of sense. In answer to your question: I did not give her a full body massage. I massaged the oils directly on the area, about 25 x 30 cm of her back to treat muscular inflammation. In 15 ml of carrier oil I mixed 12 drops German chamomile, 6 drops ginger, 6 drops black pepper and 6 drops everlasting (and not all of the oil was used up).
Thank you so much for your assistance.
Kind regards
-Liliana
In conclusion – very little essential oil, equivalent to 1 or 2 drops maximum, would enter the bloodstream from this treatment. If one of the oils did interact with the SSRI medication, it must be quite a potent MAO inhibitor.
Any thoughts on the possibility that the aroma of the oils were a contributing
factor?
I have run into a similar situation with a client who was newly prescribed a triptan med for chronic migraines. Triptans are known to cause heavy serotonin release in some individuals, which can manifest as cardiac palpitations. My client frequently diffuses lavender in both home and office, and his first week on the drug, he took his medication after having diffused lavender for several hours, then suffered dizziness, shortness of breath and heart palpitations very shortly thereafter (all signs of serotonin syndrome). He does have uncontrollable HBP and a family history of severe cardiac problems, and I am surprised that his physician prescribed triptans since that is a known caution with those meds. I’ve always wondered if in this instance, the lavender was a contributing factor to his episode. In any event, I asked him to temporarily avoid use of lavender and Roman chamo, and he went off the meds after just 2 weeks, so there’s no telling…
Dear Robert,
Having read the above, I would be very interested in knowin whether lavender can indeed intereact with some anti-depressants as quite a number of pregnant women have used / are using antdepressants.
Thank you.
PS The discovery of this weblink is very interesting!
Ingrid – it’s not impossible, but has not been tested.
Robert…I had the most unfortunate situation happen: Last week a good friend had her husband massage 2 drops of peppermint and 1 of lavender, in carrier oil, to her back as she was suffering severe indigestion. He is being treated with Dilatin and Lyrica, by a physician here in the States. She told me he had such a severe seizure that evening and then, again in the morning…that she believes was directly related to the Essential Oils I had given her. Can you comment? I have found nothing documented about either of these oils contraindicated with those drugs.
Anne, this could have been caused by the peppermint oil, which is a moderately potent inhibitor of CYP3A4, an enzyme that is also affected by Dilantin. Dilantin is metabolized by CYP2C9 and CYP2C19, and it’s feasible that the menthol in peppermint speeds up the body’s production of one of these enzymes, which would clear the drug from the system too quickly. The inhalation of essential oils by practitioners can be a problem for them.
Hi Robert,
I just recently had to start taking the SSRI Celexa as a last resort to treating panic attacks that were started by the Cipro antibiotic I was on this summer. I would like to continue oil usage but can’t find much information out there on how oils interact with Celexa. I use all do Terra oils and one of my favorites is their On Guard which I apply 2 drops on each foot in the morning (more if I am fighting a cold or virus. I also use their throat drops if I feel something coming on). Their On Guard has Clove as one of it’s main ingredients. What would that do in regards to the SSRI? Is that enough drops to impact the Celexa? I would love to know if there are other oils I should avoid. The main oils I diffuse are Breathe Blend, Balance Blend, Frankincense, Wild Orange, Elevation Blend, Citrus Bliss Blend. The main oils I use topically are On Guard, Balance Blend, Frankincense, Deep Blue, Melaleuca, Eucalyptus, Cypress. The oils I put in my water from time to time are Lemon, Cilantro and Lime. Do I need to avoid peppermint or lavender? Thank you so much for your input as this seems to be a very elusive area of expertise!
Hi Kristen,
To the best of my knowledge none of the oils or uses you refer to are likely to interact with Celexa. There is still much that is not know about essential oil / drug interactions, and peppermint might possibly be a slight risk. But – if you don’t experience any adverse effects, then there is no problem.
Hello Robert, I hope you can help me because yours is the only website I’ve found that addresses possible drug/oil adverse interactions. I am taking Lexapro and Ativan for depression and anxiety. I was introduced to essential oils in December and have used the following oils: lavendar, lemon, frankincense, cypress, basil, rosemary, digestzen, Clary calm, elevation and vetiver. Recently I have been experiencing worsening depression and anxiety and the only thing I can contribute it to is the essential oil usage, since I’ve changed nothing else. Could any of these oils be interacting badly with my SSRI or benzo? I love the idea of a more natural approach but not if it will cause me further issues. Thanks for your input.
Hi Barbara. Of the oils you list, the only one I know of that might lead to an interaction is peppermint (in Digestzen). Peppermint oil inhibits CYP3A4, an enzyme that also metabolizes both the medications you mention. This could feasibly lead to the medications being less effective. The more peppermint oil you have been using, the greater the chances of an interaction.
Robert Tisserand’s experience in the industry is extraordinary, and this blog is an exceptional resource. Kudos Robert, our paths crossed many years ago with other gurus in the field through NORA in the early 90’s. With respect to this post – in my opinion it is difficult to determine if the EO’s in this treatment were to blame for the client vomiting solely from transdermal or inhalation absorption. Other factors must be considered. We don’t know if the client had taken another medication on the day of the treatment, perhaps for pain. Or the extent of this client’s physiological condition. Pain can induce all sorts of effects including nausea. Simply lying face down on a massage table and rising too quickly can interfere with blood pressure causing a equilibrium imbalance and nausea. A 10% solution seems a little strong in my mind – especially with German chamomile. German chamomile has quite an offensive aroma and can elicit a nauseating response. Due to the fact that the olfactory system is so sensitive and very very subjective – it is imperative that our EO concoctions be created taking in mind the ‘smell’ qualities not only the chemical constituents.