Journal of Complementary and Alternative Medical Research

Aromatherapy is widely offered to people experiencing psychological distress, yet the term encompasses chemically diverse essential oils, several routes of administration, and interventions that frequently combine odour exposure with massage, rest or supportive interaction. These distinctions complicate claims that aromatherapy specifically modifies stress, anxiety or depression. This critical narrative review evaluates clinical effectiveness, potential mechanisms, measurement quality, contextual moderators and safety, distinguishing inhaled essential oils from topical aromatic massage and orally administered standardised lavender-oil preparations. Peer-reviewed clinical studies, evidence syntheses, experimental investigations and relevant clinical guidance published from 2000 to 4 September 2026 were selected through targeted scholarly searching and citation examination. Findings are most consistent for short-term, self-reported situational anxiety in selected perioperative, dental and other healthcare settings, although small studies, imperfect blinding and heterogeneous comparators substantially restrict certainty. Evidence for reduced perceived stress is promising but inconsistent, and physiological indices of stress do not reliably corroborate questionnaire changes. Depression-related results are more variable and depend on population, severity, outcome measure and intervention type; improvements in mixed symptom samples cannot establish efficacy for major depressive disorder. Experimental olfactory pathways and investigations of individual volatile constituents provide biological plausibility without demonstrating that clinically inhaled concentrations reproduce laboratory pharmacology. Trials of a standardised oral lavender preparation offer a stronger, but route-specific, evidence base and should not be pooled conceptually with fragrance inhalation. Reporting of botanical identity, chemical composition, concentration, exposure, sensory expectations and adverse events remains inadequate. The synthesis proposes an intervention-specific interpretation framework and priorities for scent-matched, adequately powered trials incorporating clinical relevance, objective measures, safety and longer follow-up. Aromatherapy may be considered a preference-sensitive adjunct for short-term symptom comfort, but current evidence does not justify presenting generic aromatherapy as an established treatment for anxiety disorders or depression.