Acupuncture and Depression
針灸與憂鬱症

Major depressive disorder (MDD) is a leading cause of global disability and is associated with significant functional impairment and increased mortality.

重度憂鬱症（Major Depressive Disorder, MDD）是全球主要的失能原因之一，並與顯著的功能受損及死亡風險上升相關。

Although pharmacological and psychotherapeutic interventions remain first-line treatments, a substantial proportion of patients experience partial response, adverse effects, or treatment resistance.

儘管藥物治療與心理治療仍為第一線治療方式，仍有相當比例的患者出現療效不足、副作用明顯或治療抗拒的情況。

Consequently, complementary and integrative approaches, including acupuncture, have attracted increasing research interest.

因此，包含針灸在內的輔助與整合性治療方式逐漸受到研究關注。

Randomized controlled trials (RCTs) investigating acupuncture for depression have demonstrated potential antidepressant effects.

隨機對照試驗（RCT）顯示，針灸在改善憂鬱症狀方面具有潛在療效。

Early Western trials reported significant symptom reduction in patients receiving individualized acupuncture compared with wait-list controls, although differences between true and control acupuncture were modest.

早期西方研究發現，接受個別化針灸的患者，其症狀改善幅度優於等待組，但真針與對照針灸之間的差異有限。

Subsequent RCTs, particularly those conducted in East Asia, have compared electroacupuncture with selective serotonin reuptake inhibitors and reported comparable reductions in Hamilton Depression Rating Scale scores with fewer adverse effects.

後續多項來自東亞地區的 RCT 比較電針與選擇性血清素再吸收抑制劑，結果顯示兩者在 HAMD 分數改善上相近，而針灸組的不良反應較少。

Systematic reviews and meta-analyses have further synthesized these findings.

系統性回顧與統合分析進一步整合了這些研究結果。

Moderate effect sizes have been observed for acupuncture compared with usual care and sham acupuncture, with larger effects reported when acupuncture is used as an adjunct to antidepressant medication.

相較於常規照護與假針灸，針灸呈現中等效果量；當針灸作為抗憂鬱藥物的輔助治療時，效果量更為顯著。

Network meta-analyses have ranked electroacupuncture combined with pharmacotherapy among the more effective interventions for symptom reduction in MDD.

網絡統合分析亦將電針合併藥物治療列為改善 MDD 症狀較有效的介入方式之一。

However, substantial heterogeneity, methodological limitations, and regional concentration of studies limit the certainty of these conclusions.

然而，研究間的高度異質性、方法學限制以及地區集中性，仍限制了結論的確定性。

Overall, current evidence suggests that acupuncture may offer clinically meaningful benefits for depressive symptoms, particularly as an adjunctive treatment.

整體而言，目前證據顯示針灸可能在憂鬱症治療中具有臨床意義，特別作為輔助治療方式。

Nevertheless, the quality of evidence remains low to moderate, highlighting the need for larger, well-designed trials and mechanistic studies.

然而，證據品質仍屬低至中等，未來仍需更大規模、設計嚴謹的臨床試驗與機制研究加以驗證。

TCM Perspectives in Depression

From the perspective of Traditional Chinese Medicine, depressive disorders are commonly conceptualized as disturbances in regulatory balance.

從中醫學的觀點來看，憂鬱相關疾患多被理解為整體調節失衡。

Common patterns include liver qi stagnation, spleen deficiency, phlegm obstruction, and heart–shen disharmony.

常見病機包括肝氣鬱結、脾虛、痰阻，以及心神失調。

These frameworks emphasize impaired systemic regulation rather than localized structural pathology.

此類理論著重於整體功能調控失序，而非局部器質性病變。

Contemporary neurobiological models similarly conceptualize depression as a network-level dysregulation involving multiple interacting systems.

現代神經生物學亦將憂鬱症理解為多重系統交互作用下的網絡層級失調。

Major depressive disorder has been associated with altered monoaminergic signaling, HPA axis hyperactivity, neuroinflammation, impaired neuroplasticity, and dysfunctional limbic–cortical connectivity.

重度憂鬱症與單胺類神經傳導異常、HPA 軸過度活化、神經發炎、神經可塑性受損，以及邊緣－皮質網路連結失調相關。

Experimental evidence suggests that acupuncture may modulate several of these neurobiological processes.

實驗研究顯示，針灸可能影響上述多項神經生物學機制。

Reported effects include modulation of serotonergic and dopaminergic signaling, normalization of HPA axis activity, reduction of inflammatory cytokines, and upregulation of brain-derived neurotrophic factor.

包括調節血清素與多巴胺訊號、改善 HPA 軸功能、降低促發炎細胞激素，以及提升腦源性神經滋養因子（BDNF）。

Rather than equating TCM diagnostic categories with specific neurotransmitters, acupuncture may be more appropriately conceptualized as a neuromodulatory intervention acting on distributed regulatory networks.

因此，與其將中醫辨證直接對應至單一神經傳導物質，針灸更適合被理解為一種作用於分散性調節網絡的神經調控介入方式。

References

1. Allen JJB, Schnyer R, Hitt SK. Acupuncture for depression: a randomized controlled trial. J Clin Psychiatry. 2006.
2. Armour M, et al. Acupuncture for depression: a systematic review and meta-analysis. J Clin Med. 2019.
3. Chen Z, et al. Comparative effectiveness of acupuncture for depression: a network meta-analysis. Front Psychiatry. 2022.
4. Tan Y, et al. Efficacy and safety of acupuncture for depression. Front Neurosci. 2024.