Basic and clinical research on acupuncture for post-stroke depression: A narrative review

Post-stroke depression (PSD) is a common neuropsychiatric complication affecting 20%-65% of stroke survivors, with limited therapeutic options due to the side effects of antidepressants. This narrative review synthesizes recent advances in acupuncture for PSD, highlighting its multi-target mechanisms and clinical applications. Acupuncture regulates neurotransmitters (e.g., 5-hydroxytryptamine, norepinephrine, glutamate), neurotrophic factors (e.g., brain-derived neurotrophic factor), the hypothalamic-pituitary-adrenal axis, inflammatory cytokines (e.g., interleukin-6, tumor necrosis factor-alpha), and oxidative stress, while modulating the brain-gut axis and homocysteine levels. Clinically, pure acupuncture, electroacupuncture, scalp/auricular acupuncture, and comprehensive therapies (combined with herbs, moxibustion, music, or rehabilitation) demonstrate efficacy in improving depressive symptoms and daily function. However, research gaps include standardized treatment protocols, mechanistic exploration, and large-scale controlled trials. This review underscores acupuncture's potential as a safe, multi-modal therapy for PSD and highlights areas for future research.