Effect of Citrus × aurantium L. Aromatherapy on Anxiety:  A Systematic Review and Meta-Analysis

Alieh  Farabi; Hamid  Ahanchian; Vahid  Ghavami; Vahid Reza  Askari; Ali Reza  Derakhshan; Maryam  Soleimanpour-Moghaddam

doi:10.18502/tim.v10i4.20731

Alieh Farabi Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Hamid Ahanchian Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
Vahid Ghavami Department of Biostatistics, School of Heath, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Vahid Reza Askari Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
Ali Reza Derakhshan School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Maryam Soleimanpour-Moghaddam Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran

DOI: https://doi.org/10.18502/tim.v10i4.20731

Keywords: Anxiety; Aromatherapy; Citrus × aurantium; Persian medicine; Meta-analysis; Systematic review; Herbal medicine

Abstract

Anxiety is a common condition often treated with pharmacological agents that have side effects. Aromatherapy, a non-pharmacological method using plant-derived essential oils, offers a safer alternative. Citrus × aurantium L. (bitter orange), traditionally used in Persian medicine to treat anxiety, is of particular interest. This systematic review and meta-analysis evaluate the efficacy of C. aurantium aroma in reducing anxiety. A systematic review and meta-analysis were conducted following PRISMA guidelines to evaluate the effect of C. aurantium aroma on anxiety. Databases including PubMed, Cochrane Library, Scopus, ProQuest, Science Direct, and Web of Science were searched for relevant clinical trials. Studies were included if they were randomized controlled trials involving human participants, used inhalation aromatherapy with C. aurantium, and measured anxiety with the State-Trait Anxiety Inventory (STAI). Data extraction and bias assessment were performed by two independent reviewers. Statistical analyses were conducted using Meta in R software version 4.2.2. An initial search identified 445 potential studies. After removing duplicates (n=46), 399 unique studies were screened. We excluded 35 review articles and 348 unrelated articles, resulting in 16 articles for detailed examination. Seven studies met the inclusion criteria and were analyzed, involving 666 participants (333 in intervention groups and 333 in control groups). The analysis revealed a significant reduction in anxiety in treatment groups using C. aurantium essential oil or neroli oil compared to control groups, with a mean difference of -12.45 (95% CI: -20.90 to -3.99, p = 0.004). Subgroup analysis indicated that both oils significantly reduced anxiety compared to control groups, with no significant difference between them (Q=0.64, p=0.42). Inhalation aromatherapy using C. aurantium essential oil and neroli oil effectively reduces anxiety. Further research is needed to explore underlying mechanisms and long-term benefits.