Acupuncture demonstrates consistent clinical benefit for reducing depressive symptom severity across diverse patient groups, according to a comprehensive systematic review conducted at Heilongjiang University of Chinese Medicine. The review synthesizes thirty-seven randomized controlled trials and extensive mechanistic studies, concluding that acupuncture—through both manual acupuncture and electroacupuncture—produces measurable improvements in depression severity, sleep quality, cognitive function in certain populations, and neurobiological markers relevant to mood regulation. [1]
Across trials using acupuncture as monotherapy, core acupoints included Baihui (GV20), Yintang, Sishencong, Neiguan (PC6), Shenmen (HT7), Sanyinjiao (SP6), Taichong (LV3), Zusanli (ST36), and Hegu (LI4). A large open parallel-arm randomized controlled trial of seven hundred fifty-five patients receiving manual acupuncture with an average of thirteen needles per session—most commonly including SP6, LV3, ST36, and LI4—demonstrated a mean PHQ-9 score of 9.4 at three months, compared with 10.9 for counseling and 12.7 for usual care alone. [1] The PHQ-9 score is the total score on the Patient Health Questionnaire-9, a clinical tool that rates nine depression symptoms from 0–3 each to assess severity. Higher scores indicate more severe depression, with 0–4 considered minimal and 20–27 considered severe.
Manual acupuncture led to significant reductions in depressive symptoms among patients with malignant tumor–related depression. A protocol using GV20, Yintang, Sishencong, ST40, SP9, SP10, SP6, PC6, and HT7 over thirty days yielded a HAMD-24 decrease of −11.04, outperforming the −7.00 reduction produced by fluoxetine. The HAMD-24 is the 24-item Hamilton Depression Rating Scale, a clinician-scored measure used to evaluate the severity of depression. Higher scores indicate more severe depression, while lower scores indicate improvement and reduced symptom severity.
Sleep quality also improved as shown by PSQI reductions. [1] The PSQI is the Pittsburgh Sleep Quality Index, a questionnaire that measures overall sleep quality across multiple domains such as sleep duration, disturbances, and daytime dysfunction. Higher scores indicate worse sleep quality, while lower scores reflect better, more restorative sleep.
One study documents that of three hundred post-stroke depression patients treated six times weekly for two months using GV20, Sishencong, GV24, and syndrome-differentiated points, HAMD scores decreased by −19.2, greater than the −13.8 reduction in the fluoxetine group. [1]
Electroacupuncture produced similar or greater antidepressant effects. Electroacupuncture at GV20 and Yintang five sessions weekly for six weeks reduced HAMD-24 scores by −13.3, with a more rapid clinical onset compared to fluoxetine. [1] In another trial comparing electroacupuncture at LV3, SP6, PC6, and HT7 with manual acupuncture at GV20 and ST36, electroacupuncture resulted in a −14.35 reduction in HAMD-24, surpassing the manual acupuncture reduction of −12.87 and the fluoxetine reduction of −11.2. [1]
Adjunctive acupuncture enhanced antidepressant effectiveness and reduced medication side effects. In one multicenter trial involving four hundred seventy-seven patients, both manual acupuncture plus SSRIs and electroacupuncture plus SSRIs—administered three times weekly for six weeks—produced greater HAMD-17 reductions than SSRIs alone. Another randomized controlled trial found that fluoxetine combined with acupuncture reduced antidepressant-related side effects more effectively than fluoxetine with sham acupuncture. [1]
Auricular acupuncture also demonstrated efficacy. In moderately to moderately severe depression, auricular acupuncture at Shenmen, subcortex, heart, lung, liver, and kidney points twice weekly for six weeks produced a fifty-eight percent recovery rate at three months, compared with forty-three percent for nonspecific auricular acupuncture. [1]
Neurobiological findings revealed that acupuncture modulates multiple large-scale brain networks. Functional MRI demonstrated changes in the default mode network, cognitive control network, limbic system, sensorimotor network, and visual network. Electroacupuncture increased low-frequency oscillation amplitude in regions such as the middle temporal gyrus and cerebellum, and regulated connectivity among the anterior cingulate cortex, hippocampus, amygdala, parahippocampus, and prefrontal cortex. [1]
The review also documented restoration of neuroplasticity. Acupuncture reversed stress-induced synaptic loss, increased expression of synaptic proteins, enhanced dendritic spine density, improved long-term potentiation in hippocampal CA1, and restored neural progenitor cell proliferation in the dentate gyrus. Electroacupuncture reversed perineuronal net degradation in the medial prefrontal cortex, normalizing extracellular matrix structure associated with mood regulation. [1]
Neuroendocrine changes included increases in central serotonin and dopamine concentrations, modulation of serotonin receptor and transporter expression, normalization of glutamate and GABA levels in limbic and cortical regions, and suppression of excessive hypothalamic-pituitary-adrenal axis activity. [1]
Inflammation pathways showed consistent improvement. Acupuncture lowered pro-inflammatory cytokines IL-1β, IL-6, and TNF-α in the hippocampus, serum, and prefrontal cortex; suppressed microglial overactivation; and inhibited the HMGB1/TLR4 pathway and NLRP3 inflammasome activation. [1] Additional evidence demonstrated downregulation of JNK-related apoptosis signaling and modulation of the IDO-mediated tryptophan metabolism pathway. [1]
Gut microbiota studies showed that acupuncture reduced the bacteroidetes-to-firmicutes ratio, increased beneficial genera including Lactobacillus, Bifidobacterium, Allobaculum, and Dubosiella, and elevated fecal short-chain fatty acids. [1]
Across all studies reviewed, acupuncture was well tolerated. The authors conclude that acupuncture demonstrates clinically significant reductions in depression severity and modulates multiple biological systems involved in mood regulation. [1]
Reference:
1. Xu, N., Xu, S., & Wang, L. Bridging tradition and innovation: Acupuncture for depression through clinical efficacy and neurobiological insights. Heilongjiang University of Chinese Medicine. Complementary Therapies in Medicine, 2026.
