Silexan worked as an antidepressant, and not just by reducing anxiety
STUDY: Möller HJ et al, Int J Neuropsychopharmacol 2026
STUDY TYPE: Randomized controlled trial (secondary item-level analysis)
FUNDING: Dr. Willmar Schwabe GmbH & Co. KG (maker of Silexan)
Background
Silexan is a lavender oil extract approved in Europe for anxiety and available as CalmAid in the US. Earlier studies found it worked in anxious depression, and it recently equaled sertraline, but whether it treats depression directly or by reducing anxiety is not clear. This paper sorts through the rating scales to find an answer.
The Study
- 498 adults with mild-to-moderate major depression.
- Randomized to silexan 80 mg/day, sertraline 50 mg/day, or placebo for 8 weeks, double-blind.
- Each of the nine core MADRS symptoms was scored separately.
Results
Silexan beat placebo on five of nine symptoms: Sadness (both self-reported and observed), reduced appetite, poor concentration, and lassitude (ie, low energy and motivation). Two more symptoms, inner tension and loss of pleasure, came close (p<0.06).
The profiles of Silexan and sertraline nearly overlapped, improving mood, exhaustion, and concentration the most while sleep and pessimistic thoughts changed the least, pointing to a direct antidepressant effect rather than sedation.
While Silexan and sertraline had similar outcomes on the MADRS, Silexan was significantly better for overall functioning.
Limitations
No validated threshold exists for a clinically meaningful change on a single MADRS item. The analyses were exploratory, uncorrected for multiple comparisons, and funded by Schwabe, the maker of Silexan.
Practice Implications
- Silexan, which modulates serotonin, glutamate, and calcium channels, appears to have direct antidepressant effects.
- Still, this is only one study, and its large effect size in anxiety (where it beat paroxetine by a wide margin) makes it a good choice for anxious depression (there, the dose is higher, 160 mg).
- Find the Schwabe-licensed product here.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
