Acupuncture significantly reduces anxiety and depression symptoms in patients with chronic insomnia. Biochemical data from a randomized, single-blind, placebo-controlled clinical trial reveals reduced serum cortisol and increased serotonin levels, suggesting neuroendocrine modulation as a primary mechanism of action [1].
Sixty adult patients with chronic insomnia and elevated baseline scores on the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were enrolled and randomly assigned to two groups. The treatment group received acupuncture, while the control group received sham acupuncture at non-acupoint locations [1].
Patients in the real acupuncture group were treated at Baihui (GV20), Yintang (extra), Shenmen (HT7), and Sanyinjiao (SP6), with bilateral needling at HT7 and SP6 [1]. Sterile, single-use filiform needles approximately 0.25 mm in diameter were used. Needles were inserted to a depth sufficient to elicit the deqi sensation using gentle lifting, thrusting, and bidirectional rotation for 15 seconds every 10 minutes during the 30-minute retention period. No electroacupuncture stimulation was applied [1].
Treatments were administered three times weekly over a four-week period, totaling 12 sessions. The control group received superficial needling (2–3 mm depth) at non-meridian, non-acupuncture points, without deqi or manual stimulation, but with the same frequency and retention time [1].
The acupuncture group showed significantly greater reductions in anxiety and depression scores compared to the sham group. HAMA, HAMD, and Pittsburgh Sleep Quality Index (PSQI) scores all improved markedly after the four-week treatment period and remained stable at the three-month follow-up [1].
Objective serum biomarkers were also significantly altered. Serum cortisol (CORT), which is commonly elevated in chronic insomnia and anxiety, decreased significantly in the acupuncture group compared to the control. Concurrently, serum serotonin (5-HT) concentrations increased, supporting the hypothesis that acupuncture exerts an anxiolytic effect through regulation of the hypothalamic-pituitary-adrenal (HPA) axis and serotonergic neurotransmission [1].
The modulation of the HPA axis was evidenced by reduced cortisol levels, suggesting reduced hyperactivity of this stress-response system. Simultaneously, the increase in serum serotonin, a key neurotransmitter in mood and sleep regulation, suggests central effects mediated through peripheral endocrine markers [1].
No serious adverse events were reported. Minor side effects included transient bruising and mild discomfort at the needle insertion sites. The study confirmed that standardized acupuncture is safe and well-tolerated when performed by trained practitioners using proper technique and hygiene [1].
The authors concluded that acupuncture at GV20, Yintang, HT7, and SP6 yields clinically meaningful reductions in anxiety symptoms associated with chronic insomnia, with both subjective and objective evidence supporting its efficacy. The treatment protocol is clearly replicable and includes a defined needle gauge, insertion method, manual stimulation technique, and session frequency [1].
While this study focused on patients with chronic insomnia, the consistent reduction in anxiety and associated endocrine markers suggests broader clinical relevance. Future research should examine its applicability to general anxiety disorders using DSM-based diagnostic criteria, and could incorporate neuroimaging or additional biomarkers to further elucidate central mechanisms [1].
Source:
Liu C, Zhao Y, Qin S, Wang X, Jiang Y, Wu W. Randomized controlled trial of acupuncture for anxiety and depression in patients with chronic insomnia. Ann Transl Med. 2021 Sep;9(18):1426. PMID: 34733978; PMCID: PMC8506741.
