An estimated 17.5 million Americans suffer from depression. Among those, many are seeking alternatives to anti-depressant medication. Of course, as an acupuncturist, I am interested in staying on top of recent studies and ensuring I can provide my patients with the most up-to-date information regarding non-prescription treatment options. 

There are some promising recent studies showing how acupuncture can treat depression, anxiety, and stress, as well as providing clear, biological explanations for the clinical evidence I have seen. The Anxiety and Depression Association of America (ADAA) states that “evidence for the use of acupuncture… to treat anxiety disorders is becoming stronger.” 

In one example, Reuters Health reported on a study from the University of York, in the U.K. The study recruited 755 people with moderate to severe depression. Seventy percent of the patients were already on anti-depressants and continued on them throughout the study. The study concluded that both acupuncture and counselling (or both) had a strongly positive effect on depression, lowering the depression scale from an average of 16 (out of 27) at the start of the study, to 9 for acupuncture and 11 for counselling at its conclusion. 

The benefits lasted three months after treatment had concluded. So how does acupuncture work? The acupuncturist inserts fine needles into certain identified acupuncture points on “meridians” which run throughout the body and correspond to certain organs. Meridians can be thought of as a highway of energy, or “qi” in traditional Chinese medicine. 

Acupuncture is theorized to work by getting rid of the roadblocks on this energy superhighway. When there is congestion on the highway, energy gets backed up. When the meridians are clear (no roadblocks), the qi flows freely. Each meridian “homes” to an organ and each organ has certain associations, such as emotions or body parts. 

For example, in Chinese medicine, the emotion of the liver is anger. When the qi is blocked, it can cause liver qi stagnation, which can result in anger. It goes both ways, though—when you’re angry a lot, you can block the flow of liver qi. 

Western medicine has shown that acupuncture releases endorphins and activates natural pain killers. Now we see that it affects other biological functions as well. Chinese medicine sees acupuncture as improving functioning by correcting blockages or imbalances in the organs. 

A 2013 article in the Journal of Endocrinology presented the results of a series of animal studies done at Georgetown University Medical Center which showed that rats who endured stress conditions and then received acupuncture had lowered blood hormone levels secreted by the hypothalamus pituitary adrenal (HPA) axis, which controls reactions to stress and regulates processes like the immune system, digestion, emotions and moods, and sexuality . 

They also measured the levels of NPY, a peptide secreted during a “fight or flight” response. The study’s author, Eshkevari, said, “We found that electronic acupuncture blocks the chronic, stress-induced elevations of the HPA axis hormones and the sympathetic NPY pathway… Our growing body of evidence points to acupuncture’s protective effect against the stress response. “I have seen patients whose anxiety-induced rashes almost disappear in two treatments. I have also seen acupuncture significantly reduce anxiety and stress as well as improve depression. It’s important to note that most of these conditions require an initial treatment protocol of eight or more sessions. Once a significant improvement is reached, you can then move to a maintenance schedule. Obviously, acupuncture can’t always treat moderate or severe depression alone and you should consult your doctor before going off or reducing any medication. 

The realities of treating anxiety are that different people require different treatments, even when suffering from the same type of anxiety. That’s because different people have different personalities, different needs, and of course, different symptoms. Research is mixed on the benefits of acupuncture. Born from centuries of Chinese history, acupuncture is based on the principle of Qi (also spelled Chi), Yin and Yang, Elemental Theory and more. In acupuncture symptoms are corrected by placing sterilized needles at very specific points in the body. While the components are much more complex, acupuncturists believe that by balancing qi correctly throughout the body (including circulating the blood, warming, etc.), and responding to diagnoses using these acupuncture points, it is possible to effectively treat anxiety.

Ancient Chinese medicine describes an energy force called Qi that regulates the body’s overall health, according to University of Chicago Medicine. Like blood in the circulatory system, Qi moves throughout the body via pathways called meridians. When factors like injury, stress, poor nutrition, or a change in environment disrupt the flow of Qi, health issues follow, according to the University of Miami Health System. 

By inserting needles at specific points in the body, acupuncturists restore the balance of Qi and the body’s overall health, University of Chicago Medicine reports. This concept might seem outdated to some, but Daniel Hsu, DAOM (Doctor of Acupuncture and Oriental Medicine), LAc, a practitioner at New York AcuHealth Acupuncture in New York City, says Qi is just a metaphor for metabolic function, or the chemical reactions constantly taking place in the body. 

Acupuncturists insert each needle half a millimetre away from a nerve, Dr. Hsu explains. Depending on where the needles go, acupuncture can cause the nervous system to produce painkilling chemicals, jump-start the body’s natural ability to heal itself, or stimulate the part of the brain that controls emotions, including anxiety. All of these results, Hsu adds, can help people feel more balanced and treat a variety of illnesses. 

If you go for an acupuncture treatment, you’ll give a thorough medical history to your practitioner. Then, you’ll relax on a comfortable table, face up or down, while very fine needles—about the width of a hair—are carefully inserted under the surface of your skin. When done right, they shouldn’t hurt. But the needles don’t just go in random places along your anatomy. 

They need to be inserted into very specific locations based on your physical or mental symptoms. Points for anxiety may include your breastbone, between your eyebrows, or the insides of your wrists. The reason for these placements? According to Chinese medicine, energy, or “qi,” flows up and down pathways in the body. “Sometimes the energy is blocked, deficient, excessive, or unbalanced. 

This puts the body out of balance and in turn causes illness,” Elizabeth Trattner, a board-certified doctor of Chinese and integrative medicine who practices in Miami Beach, Florida, tells Health. “Acupuncture restores homeostasis and encourages healing. “As a part of traditional Chinese medicine, acupuncture uses a “whole system” approach to health. “We don’t separate the physical and mental aspects [of a patient], as they’re both intimately tied together,” Trattner explains. 

Here’s an example: Tell your acupuncturist you’re feeling anxious and also waking up sweaty in the middle of the night, and she won’t think you’re complaining about two totally different issues. You just described symptoms of one of the most common explanations for anxiety in Chinese medicine: “yin deficiency. “If that sounds too far-out there for you, there is a more Western answer for how acupuncture can work its magic. “Acupuncture eases anxiety by regulating the nervous system, specifically by bringing the branches of the autonomic nervous system back into balance,” Ashley Flores, a licensed acupuncturist in Chicago who sees many women for anxiety, especially anxiety that has to do with fertility and pregnancy, tells Health.

When you’re anxious, your sympathetic nervous system—the one that controls your “fight or flight” system—takes over, Flores explains, whereas your parasympathetic (“rest and digest” system) is stifled. This explains why your heart hammers in your chest and you can feel short of breath as anxiety takes hold in you. “Acupuncture treatment helps shift the body back into a relaxed state where the sympathetic system is more balanced and no longer dominating,” says Flores.The evidence is clear: acupuncture may be able to improve depression, anxiety, and stress