Receiving Acupuncture as an Integrative Medicine Technique for Anxiety and Depression

Originally published by A Voice For Choice Advocacy on February 06, 2025.

EDITOR’S SUMMARY: Acupuncture, used worldwide, is an effective medicinal therapy for a variety of physical and mental health conditions. In the United States alone, the number of adults receiving this ancient treatment has doubled over the last twenty years. Experiment and take your time to find a practitioner that is right for you. Similar to getting a therapeutic massage, speak up to let your acupuncturist know what feels good, what is uncomfortable, and any areas on your body you don’t want needles.

By Tracy Reilly

If you’re struggling to keep your head above water, you’re not alone. It’s estimated that 40 million American adults will experience an anxiety disorder at some point in their lives, and recent figures show 22% of adults suffer from depression. While online therapy has broadened the ability to find a therapist, especially if you live in a rural area where there may be fewer practitioners, therapy can still be costly, and at best minimally covered by insurance. Additionally, psychotherapy may simply not be the right integrative modality for your particular needs or inner growth development. While acupuncture has become commonly known and used as a treatment for pain and inflammation-related issues, a lesser-known area where its efficacy has shown promise is for anxiety and depression.

Granted, if you’re someone who’s averse to needles, acupuncture might seem like something out of a horror movie. Even if you’re fine with them, if you’ve never experienced an acupuncture session, it could feel intimidating and mysterious. Rest assured … The needles used are actually as thin as human hair. In terms of discomfort, it depends in part on your personal sensitivity and the particular practitioner. Many patients feel the needles for a split-second, as they’re quickly inserted, then don’t feel any pain at all. On the other hand, some people feel an odd sensation with any slight motion, e.g., moving your hand while the needle is activated. Some practitioners will give the needle a bit of an extra tap or nudge to intentionally increase a reaction at that specific anatomical point.

With needles so tiny that you typically don’t bleed, inserted gently, and not penetrating your skin too deeply, you may wonder how this intervention can be effective. Acupuncture is based on traditional Chinese medicine (TCM), and the idea of qi (“chee”), the vital energy or life force believed to flow along 14 meridians that traverse your body. Hundreds of specific points along these meridians, known as acupoints, correspond with different parts of your anatomy. In TCM, it’s thought that mental disorders stem from dysregulation of the seven emotions: joy, anger, worry, contemplation (thinking), sorrow (grief), fear, and shock. Since each emotion is associated with an internal organ, the idea is that if one of those emotions is in excess, it may generate malfunction of that related organ. Conversely, physiological ailments can lead to emotional disruption. From “Emotions and Traditional Chinese Medicine”:

“Traditional Chinese medicine is unique in its belief that cause and effect are not linear, but circular. This means that the cause of an ailment may be an emotion, but also that an ailment can lead to an emotion. By striving to balance the organ related to the person’s emotional state, the emotion can be balanced as well, and visa versa.”

More on this interdynamic relationship that exists in a circular fashion can be found in Verywell Mind, “How Emotions and Organs Are Connected in Traditional Chinese Medicine: Mind-body connections affect mental and physical health”:

“In traditional Chinese medicine (TCM), emotions and physical health are intimately connected. This integrated mind-body approach to health and healing operates in a dynamic loop where emotions impact the health of the body and vice versa.

For example, according to TCM theory, excessive irritability and anger can affect the liver and result in multiple ailments, including menstrual pain, headache, redness of the face and eyes, dizziness, and dry mouth. Alternatively, imbalance in the liver can result in stormy moods.”

By inserting the narrow needles at precise points, energy blockages are thought to be cleared or released. This might sound “woo-woo,” but scientists have found that instigation by these needles can affect your body’s nervous system. They disrupt the attention of sensory neurons, increase endorphins, stimulate your parasympathetic nervous system, and improve heart-rate variability (HRV). Heart-rate variability comes from your heart’s interaction with your autonomic nervous system (ANS), which is comprised of your sympathetic nervous system and your parasympathetic nervous system. The former kicks on in times of stress, raising your heart rate; the latter slows it down. The ability to effectively go back and forth between increased heart rate and return to calm is essential to good health. From Deepak L. Bhatt, M.D., M.P.H.:

“A highly variable heartbeat means that the interval between beats fluctuates, although only by a fraction of a second. For example, if your heart rate is 60 beats per minute, instead of one second between beats, you’d have 0.8 seconds between some beats and 1.2 seconds between others. According to several studies, high HRV seems to signal a healthy heart, because it reflects the heart’s ability to respond quickly to rapid changes occurring throughout the body.”

Counterintuitively, high heart-rate variability indicates good health, showing that your heart’s response to rapid physiological changes in your body is quick and effective. Physicians look to it as a measure of fitness and general wellness—a type of mind-body coherence. Rollin McCraty, Ph.D., director of research at HeartMath? Institute Research Center says, “As a marker of physiological resilience and behavioral flexibility, it reflects our ability to adapt effectively to stress and environmental demands.” A study in early 2024 found that participants who completed twice-weekly acupuncture treatments for four weeks showed significant improvement in reduced anxiety, and an increase in heart-rate variability heart-rhythm coherence (HRC). The study’s authors speculate that the anxiety-reducing effects may come from the needles stimulating the vagus nerve. Running from the brain stem down the neck, chest, and abdomen, the vagus nerve connects your organs. It’s responsible for regulating bodily functions like heart rate, breathing, digestion, and controlling inflammation. There are many ways to stimulate your vagus nerve—from massage to tapping with your fingers—and even the simple act of looking in different directions can affect it. Your eyeballs are connected to suboccipital muscles at the base of your skull, so eye movement can actually stimulate blood flow to your vagus nerve.

Practitioners who are skilled in using acupuncture for anxiety and depression place the needles at points that stimulate this powerful nerve, and their method appears to be effective. A meta-analysis of 29 studies and over 2,200 patients showed a clinically significant reduction in depression when treated with acupuncture compared to three groups: usual care (typically antidepressant medication), sham acupuncture (mimics needles but without penetrating the skin, or penetrating the skin at points unrelated to depression), and acupuncture as an adjunct to antidepressant medication. If you’re already using an antidepressant drug, and are considering adding acupuncture, other studies have shown that using the method as an adjunct (combining both treatments) can be more effective than medication alone. Patients taking paroxetine (Paxil) were given acupuncture for six weeks, then followed up with four weeks later. Two groups received acupuncture—one manual (needles only), and one electrical (needles hooked up to a low-frequency electric current). The two acupuncture groups had a “markedly greater” clinical response compared to the control group who received paroxetine alone. At the four-week follow-up point, patients who had undergone electronic acupuncture continued showing improvement; manual acupuncture patients did not. Since the premise of acupuncture is to stimulate certain points to clear blockages, it would make sense that extra stimulation (via electrical current) could increase or expedite improvement.

While its focus was pain alleviation, a small six-week study compared electrical and manual auricular acupuncture (using ear points only; more on this method later). The results revealed not only significant pain reduction in the electrical acupuncture group, but also significant improvement in psychological well-being, activity, and sleep—a promising finding if you’re experiencing emotional distress. When it comes to anxiety, some practitioners have seen even more effective, prompt relief of symptoms than with depression. This has been the experience of Licensed Acupuncturist (L.Ac.), Veda Gastaldi. She says that while both issues are treatable with acupuncture, especially when combined with herbal formula, depression can be slower to resolve. “Depression is generally a more chronic and often more complex condition with overlapping issues and deficiencies that can take longer to change,” Gastaldi states. Additionally, a patient in a depressive state is likely coming in at a low-energy place, where lying on a table in stillness and resting for a while is not much of an energy change. On the other hand, when patients come in seeking relief from anxiety, they’re often in a high-energy state. Gastaldi says she can sometimes see the client release, and begin to calm as soon as the first needle goes in, since they’re having to lie still and rest, which is likely a state change for them.

One of the reassuring aspects of trying acupuncture is that whether or not you find it effective, side effects are generally mild. While adverse events are possible with any medical intervention, a study of 535 systematic reviews of acupuncture’s adverse reactions showed minor ones occurred at a rate of 6.7–8.6%. Most common was pain, bleeding, or bruising, and generally resolved quickly (i.e., if a point bleeds as the needle is removed, the acupuncturist typically wipes away the small amount of blood, or applies pressure if necessary). Serious adverse events rarely occur, appearing in approximately 0.001% of cases. Relatively minor risk of side effects aside, one of acupuncture’s draws is its prompt efficacy. Shifts in mood and emotional state are sometimes felt immediately following treatment, or else within a few sessions. Sometimes practitioners use a method called auricular acupuncture (AA), where they stimulate specific points on just your ear. Oftentimes, these needles are so tiny that they can be left in, taped down, and “worn” home for several days, to be removed at a later appointment. One benefit of this method is that the stimulation is extended, possibly increasing the effects, as well as saving time and money by having continuous “treatment” rather than multiple appointments.

Is treatment of ear points alone as effective as standard acupuncture? The data are mixed. In one smaller study, “Efficacy and Safety of Auricular Acupuncture for Depression: A Randomized Clinical Trial,” 74 people received auricular acupuncture, and patients showed no statistically significant difference in depression recovery between the ear acupuncture group and the control group after three months of treatment. However, if you look more closely, a couple of this study’s details are worth noting. First off, its design addressed one of the more challenging aspects of acupuncture efficacy research: the blinding. “Blinding” is when participants don’t know whether or not they’re receiving the treatment or the placebo. With acupuncture, this presents an obvious dilemma: You’d likely know whether needles have poked you or not. Double-blinding, where neither the patient nor the practitioner knows if the patient is receiving treatment, is even more difficult since acupuncturists presumably know if they are inserting a needle into a patient. Scientists try to address this patient-blinding limitation in different ways. Some use a non-penetrating needle that presses on but doesn’t penetrate the skin, or a no-touch needle that’s essentially a holder for a needle that touches your skin with no actual needle inside.

However, even “sham acupuncture” such as this can be problematic as a placebo because there can still be some effect by applying whatever they use, be it pressure, smaller needles, or a lighter insertion, as nerves can be stimulated. As its control group mechanism, the above-mentioned/aforementioned study of 74 patients did use acupuncture needles, but thinner, shorter ones inserted only half as deep as the test group. The needle placement was also different. The researchers located and used points on the ear that were not associated with mental health. This study defined depression recovery as a decrease of at least 50% compared to a participant’s initial questionnaire score, and depression remission as scoring a 5 or less on their questionnaire (with moderate depression quantified as 10–15, and severe as 20+). While there was no statistical significance between the mental health acupoint treatment and the control in terms of depression recovery, the acupoint treatment group showed statistically significant improvement in depression remission compared to the control group.

If there’s a downside to acupuncture, it may be the cost. Fees vary widely, but generally run from $50 to $200 per session, depending on the region and provider. Some practices offer multi-session packages at a discounted rate. Medi-Cal coverage of acupuncture varies by state, and is generally limited to a specific number of treatments (in California, two per month). Medicare part B covers it, but only for the treatment of chronic back pain. While it may take an extensive private insurance plan to include acupuncture as a covered expense, if you have a Flexible Spending Account (FSA) or Health Spending Account (HSA), it is considered an eligible expense, but you may need a letter of medical necessity from your doctor. Using one of these pre-tax accounts can essentially save you around 20%, depending on your tax bracket. FSAs are only available through an employer, but you may be able to utilize an HSA on your own if you qualify by having a high-deductible health plan.

A more cost-effective way to access treatment is to find an acupuncture school. Students practice under supervision, while offering more affordable rates than a standard office. Keep in mind that while they are supervised, they are students nonetheless, and may not be as skilled as long-time acupuncturists. Even so, it’s definitely possible to discover a good fit for you with a student practitioner. One resource to find a reputable program is to search for a so-called “California accredited school.” Contrary to the name, these schools are offered in many states, but meet California’s strict standards, such as completing 3,000 hours of training in order to graduate. Another resource for programs nationwide is the Accreditation Commission for Acupuncture and Herbal Medicine (ACAHM), the directory to which Medicare refers patients.

Whether you find a licensed acupuncturist by word-of-mouth, online reviews, or simply locating a clinic your insurance will cover, it’s worth inquiring with the staff to see if a particular practitioner specializes in treating depression or anxiety. Some offices have multiple acupuncturists where one may be more experienced with, say, back pain or an acute injury, while another is skilled with addressing emotional issues. Between acupuncture’s proven health benefits, and its mild risks, it may be worth committing to a handful of sessions to see if this time-honored, science-based method will work some vagus nerve magic, and restore your energy, getting you back to feeling yourself again.

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