Researchers at Beijing University of Chinese Medicine published findings on acupuncture and depression that challenge a foundational assumption in psychiatric medicine: that treating depression with needles and treating it with pills produce essentially the same effect on the brain. The brain scans revealed they do not.
The brain regions that activated under acupuncture were measurably different from those activated by antidepressant medication.
The study, published in the journal Medicine, set out to examine the effects of acupuncture on brain function in patients with depression. Researchers pooled neuroimaging data from seven previous clinical trials to conduct a coordinate-based meta-analysis – a method that compares brain activation coordinates across multiple independent imaging studies to identify consistent patterns. The 357 participants had all been formally diagnosed with major depressive disorder, and brain activity was assessed using resting-state functional magnetic resonance imaging, a technique that measures spontaneous neural activity rather than activity triggered by a specific task.
The Global Weight of Depression and the Limits of Medication
According to the World Health Organization, approximately 332 million people worldwide live with depression, affecting an estimated 5.7% of adults globally.
The downstream effects extend well beyond mood. Late-life depression has been associated with a roughly twofold increased risk of developing dementia, according to a 2021 review. Depression is now recognized in the research literature as a risk factor for dementia, with current studies actively exploring the biological pathway connecting the two conditions.
Antidepressants remain the frontline clinical response, but their effectiveness is far from universal. As many as 50% of patients who begin treatment with an antidepressant do not respond to it. Even after two separate antidepressant trials, 30% to 40% of patients report no significant symptom improvement. Treatment-resistant depression in major depressive disorder is formally defined as the failure to respond to two or more antidepressant treatments of adequate dose and duration.
What the Brain Scans Actually Showed
The Beijing-led research team analyzed fMRI data from the seven included trials, comparing three groups: participants who received acupuncture (most of whom were also on antidepressants), those on antidepressants alone, and those given sham acupuncture (a placebo version using non-penetrating needles or needling at non-acupuncture points). The comparisons between groups revealed a pattern that was consistent and anatomically specific.
Acupuncture induced significant increases in neural activity within the right cingulum and right caudate nucleus. In contrast, conventional antidepressant treatments primarily increased activity in the left hippocampus and right middle occipital gyrus.
The cingulum is a bundle of nerve fibers running through the cingulate gyrus, a region involved in emotional processing and the regulation of mood responses. The caudate nucleus is part of the brain’s reward circuitry – the network responsible for motivation, anticipation of pleasure, and the ability to feel positive emotions. Depression is associated with dysfunction in both of these systems: the emotional dysregulation that characterizes depressive episodes and the anhedonia (inability to feel pleasure) that many patients describe as its most disabling feature.
A related analysis found that more acupuncture sessions were linked to greater change in the left amygdala, the brain’s emotional alarm center, with researchers suggesting that acupuncture may act as a kind of emotional brake.
The hippocampal and occipital effects seen with antidepressants, while clinically meaningful, appear to represent a different neurobiological mechanism. The hippocampus is central to memory consolidation and the regulation of the stress-response system. Its involvement in antidepressant action is well-established and partly explains why SSRIs take weeks to show full effect – the hippocampus undergoes structural and functional changes over time with treatment.
A meta-regression analysis within the study also linked clinical improvement to plasticity changes in the left cerebellum and revealed a dose-dependent relationship between the number of acupuncture sessions and modulation of the left amygdala – meaning more sessions corresponded to greater amygdala changes, suggesting a structured neurobiological response rather than a random one.
A Broader Pattern Confirmed Across Dozens of Studies
The Beijing study is not the first to observe acupuncture’s effects on brain activity in depressed patients, but it is among the most precisely focused. A broader body of neuroimaging research provides important context.
A 2025 systematic review in Frontiers in Psychiatry, covering 26 neuroimaging studies and a combined 1,138 participants, found that acupuncture affects neural activity across multiple brain regions implicated in depression – including the cingulate gyrus, precuneus, insula, and prefrontal lobe. The review concluded that acupuncture treatment may regulate abnormal functioning of neural regions and networks, including the default mode network, limbic system, emotion regulation and cognitive network, and reward network.
Acupuncture and the Treatment-Resistant Depression Question
Why the Neural Differences Are Clinically Significant
Patients whose brains do not respond to hippocampal-targeted pharmacotherapy may respond to acupuncture, which operates through the reward system and emotional regulation circuitry rather than the hippocampal pathways targeted by medication.
The researchers described this explicitly in their published paper, noting that acupuncture may offer complementary mechanisms for patients who exhibit hippocampal nonresponsiveness or reward-circuit dysfunction – a profile they described as a common pattern in treatment-resistant depression. The correlation between neuroplastic changes in the brain’s affective circuits and clinical improvement supports a potential mechanism for acupuncture’s role in alleviating core depressive symptoms such as anhedonia and emotional dysregulation.
The Anxiety Dimension
Depression rarely travels alone. Comorbid anxiety – anxiety occurring alongside depression – is common, and achieving treatment responses for both conditions simultaneously is a persistent clinical challenge. Research in Frontiers in Neuroscience has found that acupuncture alleviates anxiety-like behaviors. Clinical trial evidence supports acupuncture’s ability to reduce anxiety symptoms. The amygdala and prefrontal cortex, both directly targeted by acupuncture’s neural effects, are core nodes in anxiety processing.
Real-World Potential and Study Limitations
The Beijing study’s findings are encouraging, but they come with acknowledged constraints. Limitations include the small number of included trials, heterogeneity in acupuncture protocols and resting-state fMRI metrics, absence of long-term follow-up data, and methodological caveats inherent to coordinate-based meta-analysis. The seven trials analyzed used different acupuncture techniques, different needle placements, different session frequencies, and different imaging parameters – a degree of variation that makes it harder to isolate which elements of the treatment drive the neural effects observed.
A total of 357 participants across seven trials is also a modest sample for the weight of the conclusions being drawn. The findings are best understood as hypothesis-generating: they establish a biologically plausible and imaging-confirmed mechanism, and they set a clear agenda for larger, more standardized research.
Future research needs larger, standardized trials with follow-up assessments and integration of neuroimaging with molecular biomarkers to advance personalized approaches to neuromodulation in depression. Measuring neurotransmitter levels, inflammatory markers, and gene expression before and after treatment would give researchers the tools to predict which patients are most likely to benefit from acupuncture – and to optimize the treatment protocol accordingly.
What This Means
Acupuncture may affect parts of the brain involved in mood, emotions, and feelings of reward. Research suggests that these effects may become stronger with repeated treatment and may be linked to improvements in depression symptoms. Antidepressants, on the other hand, appear to affect somewhat different areas of the brain.
Three practical points stand out. First, acupuncture seems to work best when it is given over multiple sessions rather than as a one-time treatment. Second, the evidence so far suggests acupuncture may be most useful alongside antidepressants, rather than instead of them. Many of the strongest studies included people who were already taking medication. Finally, people whose depression has not improved after trying two or more antidepressants may be an especially important group for future research, since acupuncture could potentially offer an additional treatment option.
Brain scans can show researchers where acupuncture changes brain activity, but they cannot yet tell us exactly how or why those changes happen. Future research will need to combine brain scans with other tests to better understand how acupuncture works and which people are most likely to benefit from it.
Disclaimer: The information provided here is for educational and informational purposes only and is not a substitute for professional psychological, psychiatric, or mental health advice, diagnosis, or treatment. Always seek the guidance of a licensed mental health professional, therapist, psychologist, or psychiatrist with any questions or concerns about your emotional well-being or mental health conditions. Never ignore professional advice or delay seeking support because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.
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