Cheek acupuncture can improve the depressive and anxious symptoms of patients with moderate depression disorders

Through a randomized controlled clinical trial, the clinical efficacy of cheek acupuncture therapy in treating patients with moderate depressive disorder and explored its neuroimaging mechanisms was evaluated.

This clinical study recruited participants with moderate depressive disorder who met the inclusion criteria and did not meet the exclusion criteria, admitted to the outpatient clinics of Zhejiang Provincial Hospital of Traditional Chinese Medicine's Acupuncture and Mental Health Departments (September 2022 - May 2025). Participants were systematically randomized into three groups: cheek acupuncture (AC), sham-cheek acupuncture (SAC), and medication control. The AC group received acupuncture at five standardized points: Head Point (CA-1, 1 cun superior to the midpoint of the zygomatic arch), Neck Point (CA-5 at the zygomatic arch base), Upper Jiao Point (CA-2 posterior to the mandible coronoid process where it intersects the inferior border of the zygomatic arch), Middle Jiao Point (CA-3 midpoint of the line connecting Upper Jiao and Lower Jiao points), and Lower Jiao Point (CA-4 at anterior margin of the mandibular angle). The needle insertion depth was approximately 5-7.5 mm without tonification or dispersion techniques, totaling 10 needles. The SAC group selected points 10 mm lateral to the AC group points along the anterior midline of the body, using blunt-tipped needles without skin penetration. Needles were retained for 30 min. Treatment frequency: three sessions per week. Treatment duration: 12 weeks. Total treatment sessions: 36. The drug group received oral sertraline. Researchers collected HAMD-17 and HAMA scores from patients at baseline, and at 1, 2, 3, 4, 8, and 12-weeks post-treatment. and at the 2-month follow-up after completion of treatment. fMRI scans were performed on the AC group before and after treatment. Statistical analysis and efficacy assessment were conducted using SPSS (Version 25.0) and R (Version 4.3.3) statistical analysis software.

HAMD-17 scores in the AC group, SAC group, and drug group all decreased significantly compared to pre-treatment levels (P < 0.001), indicating that all three interventions effectively improved HAMD-17 scores in patients with moderate depression. The treatment efficacy of the AC group was superior to that of the SAC group and the drug group. A comparison of the scores two months post-treatment with those immediately following treatment revealed that both the AC group and the drug group exhibited a decline in scores during the follow-up period. Notably, the degree of improvement in HAMD-17 scores in the AC group was significantly greater than that in the SAC group and the drug group, indicating that AC can alleviate depressive symptoms in patients with moderate depression. Regarding the time to onset of effect, significant changes were observed in the AC, SAC, and drug groups starting from the second week of treatment. In the AC group, scores continued to decline significantly from the third to the fourth week and from the fourth to the eighth week, entering a plateau phase after the eighth week, with the therapeutic effect maintained through the follow-up period; in the SAC and drug groups, improvements were primarily observed in the early stages of treatment and remained stable in the later stages.fMRI results showed that after cheek acupuncture treatment, ReHo values at the cluster level in the left middle frontal gyrus (L-MFG) showed significant reduction, while ReHo values at the cluster level in the left superior frontal gyrus (L-SFG) were significantly increased. The HAMA scores in the AC group, SAC group, and drug group all showed significant differences compared to pre-treatment levels (P < 0.001), indicating that all three interventions were effective in alleviating anxiety symptoms in patients with moderate depression. The AC group demonstrated superior treatment outcomes compared to the SAC group and the drug group. Regarding the time to onset of effect, both the AC group and the SAC group showed significant improvement by the second week, while the drug group began to show significant improvement by the third week.

Cheek acupuncture, sham cheek acupuncture, and drug can all improve the severity of depression and anxiety symptoms in patients with moderate depression, with cheek acupuncture demonstrating the greatest efficacy. The onset of action for all three treatments is similar, but cheek acupuncture shows sustained improvement.fMRI findings revealed that cheek acupuncture modulates neural activity synchrony in distinct prefrontal subregions (middle frontal gyrus and superior frontal gyrus) through differential regulation, thereby reshaping the functional connectivity in cognitive and emotional control circuits. This neural mechanism may represent a key biological basis for its therapeutic efficacy in alleviating depressive symptoms.